From this article you will learn: what is varicose veins of the esophagus, what causes can lead to the appearance of this pathology. Also described is the clinical picture, diagnosis and treatment of varicose veins of the esophagus.
Contents of the article:
- The causes of esophageal varices
- Symptoms
- Complications
- Diagnosis
- Treatment methods
- Forecast
Varicose veins of the esophagus( abbreviated as HSV) is a pathological increase in the diameter of venous vessels located in the lower part of the esophagus. Most often, this pathology is caused by portal hypertension( abbreviated PG) - increased pressure in the portal vein( v. Portae), which flows into the liver and collects blood from the entire intestine.
Compared to other types of varicose veins, VRVP has completely different causes, symptoms and treatment. Unites these different pathological conditions only the presence of enlarged veins.
The presence of HSVP is only one of the symptoms of severe diseases leading to portal hypertension. Its appearance is caused more often by cirrhosis of the liver - a dangerous and almost irreversible disease. Usually conducted treatment allows only a little to ease the patient's condition, but can not completely cure it.
Hepatologists, gastroenterologists, and surgeons are involved in the problem of HSV.
The causes of esophageal varices
The veins of the lower part of the esophagus flow into the system v.portae. In the case of GHG, which is practically the only immediate cause of HSVP, the pressure in them increases.
System of upper and inferior vena cava The veins of the lower part of the esophagus connect with the vessels of the middle third of the esophagus, which drain into the upper hollow vein. Since the pressure in v.portae is much higher than in the venous vessels of the middle part of the esophagus, there is a discharge of blood from it into the system of the superior vena cava through these junctions( anastomoses).Varicose veins of the esophagus and is these enlarged anastomoses.
SRVP is not an independent disease. The development of this pathology is caused by diseases that lead to the appearance of PG.Some of them are listed in the table:
| Cause Group | Immediate Cause |
|---|---|
| Prehepatic Causes | Portal Grombolysis Congenital portal vein narrowing Intensified blood flow in the portal vein due to the presence of a fistula Intensified blood flow in the splenic vein |
| Intrahepatic causes | Cirrhosis developingdue to various diseases, including alcoholic hepatitis and chronic hepatitis( eg, autoimmune or viral) Idiopathic PG Acute hepatitis(especially alcoholic) Congenital fibrosis Schistosomiasis |
| Superhepatic causes | Compression of the veins of the liver( eg, swelling) Badd-Chiari syndrome Constant pericarditis Right-sided heart failure |
Only occasionally esophageal varices can develop without PG - for example, with thrombosis of the splenic vein.
Symptoms of
In and of itself, HSVR before the development of bleeding does not cause any symptoms.
Since this pathology is primarily one of the complications of portal hypertension, one can suspect their presence in patients with liver cirrhosis symptoms, which include:
- Impairment of appetite.
- Nausea and vomiting.
- Yellowing of sclera, mucous membranes and skin.
- Weight reduction.
- Pain or discomfort in the right upper quadrant.
- Itching itch.
- Ascites( accumulation of fluid in the abdomen).
- Increased bleeding.
- Sexual dysfunction.
- Symptoms of encephalopathy, which include sleep disorders, decreased intelligence, memory impairment, abnormal behavior. These symptoms can be so pronounced that the patient can not even serve himself and lead a socially acceptable lifestyle.
Because of hypertension in the system of the inferior vena cava in severe cases, ascites and a "jellyfish head" symptom( anterior veins of the anterior abdominal wall) occur. Indicated by arrows Possible complications
Virtually the only complication is bleeding esophageal varices, which carries an immediate danger to the patient's life and disrupts its functional ability. Symptoms of its onset include:
- Black stool( melena) or the presence of blood in stool.
- Vomiting of blood.
- Rapid and noisy breathing.
- Dizziness.
- Accelerated heart rate( tachycardia).
- Drop in blood pressure.
- Pale skin.
- General weakness.
- Impairment of consciousness, agitation.
- Reduces the amount of urine.
Although varicose veins of the esophagus develop in many people with severe liver damage, bleeding is not observed in all. Factors that increase its risk:
- High pressure in v.portae. The risk of bleeding increases with increasing GHG.
- Large sizes of varicose veins. The more nodes, the higher the risk of complications.
- Red spots on varicose veins. When carrying out endoscopy, some nodes have red spots. Their presence indicates a high risk of bleeding.
- Severe liver damage. The heavier the liver disease, the more likely it is to bleed from the VRF.
- Continued abuse of alcoholic beverages. The risk of complications increases if the patient continues to drink alcohol, especially if the illness is caused by him.
Varicose veins of the esophagus with high risk of bleeding Diagnosis If a person has cirrhosis of the liver, the doctor should regularly conduct his examination of the presence of esophageal varices. Key survey help identify this pathology:
- Esophagogastroduodenoscopy( EFGDS) - the most common way of diagnosing esophageal varicose veins. During the endoscopic examination of the upper digestive tract doctor gets to the patient through the mouth a thin, flexible tube with a light( endoscope), and studies the structure of the esophagus, stomach and duodenum. If the doctor does not detect esophageal varices in the patient with cirrhosis of the liver, he usually recommends a repeat ECGDS in three years. If varicose nodules are found, endoscopy should be done once in 1 or 2 years. The timing of the re-examination depends on the appearance of varicose veins, the cause of PG and the overall health of the patient. Endoscopic treatment of bleeding from the ESA can also be carried out during the EGFDS.
- Capsule endoscopy - during this examination, the patient swallows a small capsule containing a tiny video camera that captures images of the esophagus and other parts of the gastrointestinal tract. Then these images are viewed by the doctor, revealing the presence of pathology. This method can be an alternative for those people who can not pass the EFGDS, but it is used very rarely due to high cost and inaccessibility.
- Visualization surveys. Computed tomography of the abdominal cavity and dopplerography of the portal and splenic veins can confirm the presence of HSVP.
Almost every patient with VRT is given the following laboratory examination:
- Determination of the level of hemoglobin, erythrocytes, platelets and leukocytes.
- Coagulogram( blood coagulation analysis).
- Biochemical analysis, including renal( urea, creatinine) and liver( aminotransferase) tests.
- Blood type.
- Radiography of the chest cavity.
- Analysis of ascites fluid.
Depending on the presumed cause of GHG, other methods of examination may be needed.
Methods of treatment
The main goal in the treatment of ART is to prevent bleeding, which can be life-threatening. When bleeding occurs, all efforts are directed at stopping it.
Prevention of bleeding
Treatment aimed at reducing blood pressure in v.portae, can reduce the risk of bleeding from the HSVP.It can include the following methods:
- Refusal to drink alcohol. This is one of the most important methods of preventing bleeding from VRF.Alcohol can worsen cirrhosis of the liver, increase the chance of bleeding and significantly increase the risk of death.
- Weight reduction. Many people with cirrhosis have fatty liver dystrophy due to obesity. Obesity can be both an independent cause of liver damage, and a contributing factor in its development. Weight loss can help remove fat from the liver and reduce further damage.
- Use of drugs to reduce pressure in v.portae. Reduce the pressure in v.portae and beta-blockers( propranolol, nadolol) can reduce the chance of bleeding.
- VARP dressing with elastic rings. If the doctor sees at the EFGDS that there is a high risk of bleeding from the HSVP, he may recommend that they be endoscopically ligated( bandaged).With the help of an endoscope, the doctor applies an elastic ring on the varicose node in the esophagus, which compresses the vein and prevents it from bleeding. This minimally invasive operation has a small risk of developing complications, such as scarring of the esophagus.
Preparation Anaprilin with active substance propranolol Stop bleeding from HSVP
Bleeding from varicose veins of the esophagus is a life-threatening condition in which urgent medical attention is needed. Methods used to stop bleeding and eliminate blood loss effects:
- Dressing of bleeding varicose veins with elastic rings.
- Tamponade using the Blackmore probe. This method is used as a temporary rescue measure for uncontrolled hemorrhage from the HSVP.The Blackmore probe has two cylinders. It is injected into the stomach through the mouth, after which the doctor inflates the first( gastric) balloon. Then the probe is carefully pulled up until the inflated balloon rests against the gastroesophageal junction. Doctors inflate the second balloon( esophageal).The inflated balloons of the Blackmore probe press the esophagus varicose, thereby stopping the bleeding.
- Drugs that slow blood flow in the portal vein. To reduce the flow of blood from the internal organs to the portal vein system, doctors often prescribe the drug Octreotide. Drug therapy complements the endoscopic ligation of blood vessels, its duration is approximately 5 days.
- Redirection of blood flow from the system v.portae. Doctors can recommend a patient with HSVP to carry out a transjugular intrahepatic portosystemic shunting, the essence of which is to place a small tube( shunt) connecting v.portae and hepatic vein. This shunt reduces the pressure in v.portae and helps stop bleeding. However, such an operation can cause serious complications, including hepatic insufficiency and brain disruption, which can occur because toxins that are normally cleared by the liver through a shunt directly enter the systemic circulation. This method is most often used when other methods of reducing pressure in v are ineffective.portae, and also as a temporary measure in people waiting for liver transplantation.
- Recovery of circulating blood volume. To replace lost blood and to eliminate clotting factors, patients often undergo transfusion( transfusion) of blood components.
- Prevention of infections. With the development of bleeding, the risk of infectious complications increases, so patients are often prescribed antibiotics.
- Liver transplantation is one of the treatment options for patients with severe liver damage who develop recurring episodes of bleeding.
Blackmore probe Prognosis
Varicose veins of the esophagus is a dangerous complication of PG, most often caused by cirrhosis of the liver. The main danger to the life of patients is bleeding, the first episode of which leads to the death of 30-50% of patients. In 60-80% of patients after the first case of bleeding within a year, repeated episodes occur, of which about 30% of patients die.
The risk of developing an early recurrence of bleeding( within 5 days of the first episode) is also affected by the severity of the liver damage:
- With an mild degree, the risk is 21%.
- With moderate severity - 40%.
- In case of severe injury - 63%.
