Oesophageal Varicose Veins

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

50

Pages:

5
Author:

Mariam A. A.

Oesophageal Varicose Veins Definition Dilated collateral veins that occur as a complication of portal hypertension Key Info It is a medical emergency Variceal size is the most important predictor of a haemorrhage Risk factors Decompensated cirrhosis Alcohol IV drug use Portal hypertension Most common cause Red wale marks Ascites Clinical features Can be asymptomatic in patients without bleeding Presence of risk factors Haematemesis Most common Melena Very common Haematochezia Ascites Spider angioma Caput medusa Jaundice Encephalopathy Splenomegaly Investigations Bloods FBC Microcytic anaemia Electrolytes Hyponatremia Serum LFTs Sr Cr and urea Blood typing and cross matching Hepatitis antigens Gastroscopy For all bleeding patients If unstable -> do after resus Intubate before if there is haematemesis Most accurate method of diagnosis Findings: Swollen veins Classified by size Red wale sign Overlying clots Capsule endoscopy Alternative when patients are not suitable for gastroscopy Shows dilated veins in lower oesophagus Liver U/S Screen for portal vein thrombosis and HCCC PVT -> filing defect portal vein HCC -> poorly defined coarse margins and irregular internal echoes CT Features of cirrhosis and portal hypertension MRI Features of cirrhosis Management Acute Variceal Bleeding Resuscitation + supportive care ABCDE IV fluids Largest possible cannula diameter If indicated give high flow oxygen Transfusion if needed Do not give purely to normalise lab values As indicated should include: RBC Platelets Fresh frozen plasma Terlipressin or somatostatin analogue All bleeding patients in presentation contraindicated in patients with arterial disease, hyponatraemia, myocardial ischemia, severe cardiac failure, or prolonged QTc interval vasoconstrictor -> decrease cardiac output and decrease portal pressure Prophylactic antibiotics All patients presenting with bleed IV ceftriaxone Endoscopy + endoscopic variceal band ligation All patients presenting with bleed -> endoscopy Haemorrhage confirmed -> band ligation Balloon tamponade or Danis stent Balloon -> temporary measure for uncontrolled bleeding until endoscopy, trans-jugular intrahepatic porto-systemic shunt (TIPS), or shunt surgery is available. Provides control of bleeding in 90% of patients Trans jugular intrahepatic portosystemic shunt If bleeding is not controlled by band ligation Contraindications: Severe portal hypertension Severe TR Congestive heart failure Severe liver disease Polycystic liver disease Active sepsis of systemic infection No acute bleeding and medium to large varices Non-selective beta blocker First line for bleeding prevention Propranolol or carvedilol Endoscopic variceal band ligation For patients who cannot tolerate beta blockers No acute bleeding and small varices Diagnostic endoscopy and annual endoscopy Previous variceal bleed First line Non-selective beta blocker and or endoscopic variceal band ligation TIPS For patients who re-bleeding despite beta blocker or band ligation therapy Shunt surgery Complications Life threatening haemorrhage Most common and most serious Haemorrhage shock Encephalopathy Infection Recurrent bleeding Oesophageal stricture