Skip to main content

Esophageal Varices-Causes-Clinical Signs-Treatment-Management.


esophageal-varices-image-reload

Esophageal (or Oesophageal) Varices:
Definition:
Oesophagal varices refer to dilated, tortuous mucosa or sub-mucosal esophageal veins.

Causes:
Portal hypertension is the main cause of dilatation of oesophagal veins. Portal hypertension is due to hepatic cirrhosis of any origin.

Pathogenesis:
Increased pressure in the portal vein results in the opening of collaterals veins between the portal and systemic venous system.

Clinical features and signs:
Dilated oesophagal veins may rupture and show clinical signs and symptoms. In un-ruptured condition, there will be no clinical symptoms.
when rupture the patient present with hematemesis, oesophagal laceration, peptic ulcer, 40 % of patients die during the first episode of hematemesis.

Treatment:
Treatment of Esophageal varices in patients who have no history of oesophagal bleeding.
1. Betablockers: betablockers such as propranolol, timolol and nadolol are used provided that these agents are not contra-indicated (eg, because of insulin-dependent diabetes mellitus, severe chronic obstructive lung disease, congestive heart failure) betablockers decreased the incidence of bleeding by 45%

2: Nitrates: if beta blockers are contra indicated nitrates can be used ( e.g isosorbide mononitrate.)

3. Endoscopic sclerotherapy and variceal ligation is an effective treatment to prevent bleeding.
4. Combined therapy: that is with endoscopic sclerotherapy and betablockers.


Treatment of Esophageal varices in patients who have no history of oesophagal bleeding.

1. Asses the rate and volume of bleeding, check blood pressure, pulse. take a blood sample of the patient and send it for cross match and hematocrit measurement, liver function test, platelet count, PT and APTT. 

2. Start emergency treatment.

Emergency Treatment:
1. Monitor blood pressure, pulse respiration and heart rate.
2. Establish and maintain an intravenous line for blood transfusion. If blood is not available or it is being cross-matched start 5% dextrose and colloid infusion until the blood pressure and adequate urine output is restored.
3. Establish airway protection in a patient with massive upper GI bleeding, especially if the patient is unconscious. 
4. If indicated, correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K-1.

5. Insert a nasogastric tube to asses the volume of bleeding and perform a gastric lavage before sending the patient for endoscopy.
6. support with pharmacological therapies.(octreotide or somatostatin, vitamin K, tranexamic acid)
7.  Endoscopic therapy probably has replaced balloon tamponade as the initial therapy for variceal bleeding. Balloon tamponade is now rarely necessary, and, when it is used, it must be performed by experienced personnel because the procedure is potentially dangerous.
8. and finally endoscopic sclerotherapy and variceal ligation.

Popular posts from this blog

Human Parasites, Types of Parasites, and Classification

Parasite: A parasite is a living organism which gets nutrition and protection from another organism where it lives. Parasites enter into the human body through mouth, skin and genitalia. In this article, we will generally discuss the types and classification of parasites. It is important from an academic point of view. Those parasites are harmful, which derives their nutrition and other benefits from the host and host get nothing in return but suffers from some injury. Types of Parasites Ecto-parasite: An ectoparasite lives outside on the surface of the body of the host. Endo-parasite: An endo-parasite lives inside the body of the host, it lives in the blood, tissues, body cavities, digestive tract or other organs. Temporary parasite: A temporary parasite visits its host for a short period of time. Permanent parasite: Permanent parasite lives its whole life in the host. Facultative parasite: A facultative parasite can live both independently and dependently. It lives in the

How to taper off, wean off beta blocker, atenolol, Propranolol, Metoprolol

Beta blockers include, atenolol (Tenormin), propranolol (Inderal ) and metoprolol (Lopressor) and are used to treat high blood pressure, certain cardiac problems, migraine and few other conditions. People usually take atenolol, propranolol or metoprolol for many years as a treatment of high blood pressure or after having an episode of heart attack . Sometimes, it becomes necessary to withdraw these beta blockers due to their potential side effects that trouble the patients or sometimes doctor wants to change the drug and shift the patient to some other anti-hypertensive medicine. No matter whatever the cause is, whenever, a patient who has been using a beta blocker for a long period of time, and he needs to be stopped from further usage of that beta blocker, must not stop taking it. One should taper off the dose of a beta blocker. Now a question arises how to wean off or taper off a beta blocker? The method of tapering off beta blocker varies from individual to individual. Allow you