Varices

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Basics

Description

  • Increased portal venous pressure results in portal–systemic shunts
  • Shunts at gastroesophageal junction result in fragile submucosal esophageal varices

Etiology

  • 10–30% of all cases of upper GI bleeding
  • 90% of upper GI bleeding in patients with cirrhosis
  • Variceal hemorrhage occurs in 30% of patients with cirrhosis:
    • 50% will stop bleeding spontaneously
    • 30% mortality per episode
    • 70% have recurrent bleeding
  • In adults:
    • Cirrhosis due to alcoholism or chronic hepatitis
    • Storage disease: Wilson or hemochromatosis
    • Middle East: Schistosomiasis
    • Portal HTN
  • In children:
    • Intrahepatic obstruction from biliary cirrhosis
    • Biliary atresia
    • Cystic fibrosis
    • Hepatitis
    • Portal HTN
    • Congenital hepatic fibrosis
    • History of liver transplant
    • Umbilical vein cannulation

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Basics

Description

  • Increased portal venous pressure results in portal–systemic shunts
  • Shunts at gastroesophageal junction result in fragile submucosal esophageal varices

Etiology

  • 10–30% of all cases of upper GI bleeding
  • 90% of upper GI bleeding in patients with cirrhosis
  • Variceal hemorrhage occurs in 30% of patients with cirrhosis:
    • 50% will stop bleeding spontaneously
    • 30% mortality per episode
    • 70% have recurrent bleeding
  • In adults:
    • Cirrhosis due to alcoholism or chronic hepatitis
    • Storage disease: Wilson or hemochromatosis
    • Middle East: Schistosomiasis
    • Portal HTN
  • In children:
    • Intrahepatic obstruction from biliary cirrhosis
    • Biliary atresia
    • Cystic fibrosis
    • Hepatitis
    • Portal HTN
    • Congenital hepatic fibrosis
    • History of liver transplant
    • Umbilical vein cannulation

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