esophageal varices pathophysiology ppt
This rare condition causes blood clots that can block the veins that carry blood out of your liver. As blood flows more slowly, it causes a buildup of pressure in the portal vein, the connection between the gut and the liver. One of the main diagnostic procedures that are done with clients who have esophageal varices is esophagogastroduodenoscopy (EGD). Buy PDFs here: http://armandoh.org/shop Where do I get my information from: http://armandoh.org/resource"Achalasia is a rare disorder that results from progr. . Varices are caused by liver disease and can lead to serious complications, including death. J. It is the most common form of upper gastrointestinal (GI) bleeding in patients presenting with cirrhosis. Variceal bleeding has a high incidence . Triple-lumen tube used to compress the upper stomach and . A comprehensive review of the clinical manifestations of portal hypertension is presented by S. A. Al-Busafi et al. Esophageal varices are swollen veins in the lining of the lower esophagus near the stomach. Less common than uphill varices. 1-4 Esophageal varices are defined as normal veins of the esophagus that are abnormally dilated because of increased vascular resistance in the portal venous . Esophageal varices occur mainly in the palisade zone, which extends from the gastroesophageal junction for 4-5 cm towards the mid-esophagus (Fig. The frequency of esophageal varices varies from 30% to 70% in patients with cirrhosis (Table 1), and 9-36% of patients have what are known as "hi gh-risk" varices. 2, 17 In cirrhosis, increased sinusoidal resistance . Cirrhosis is the 12th leading cause of death in the United States. Instead of flowing through the portal vein, the blood flows through the smaller blood vessels, which eventually causes venous enlargement, leakage, or even rupture. The esophagus is the tube that connects your throat to your stomach. This phenomenon is. Portal hypertension is a common clinical syndrome defined as the elevation of hepatic venous pressure gradient (HVPG) above 5 mmHg. . The most common causes of upper GI bleeding include duodenal ulcers (28%), stomach ulcers (26%) and gastroesophageal varices (10—30%). Variceal rupture is the most common fatal complication of cirrhosis. 2), although the exact site of the bleeding may be difficult to identify. . . The second main symptom of gastrointestinal pathology is bleeding ().The character of the blood can help identify the source: hematemesis (i.e., vomiting of bright red blood), if the source is gastrointestinal, is most likely due to a source proximal to the ligament of Treitz.Melena (i.e., black, tarry stool) is most often due to upper gastrointestinal bleeding. intestine and bladder. Came to E.R. intestine and bladder. One of the main diagnostic procedures that are done with clients who have esophageal varices is esophagogastroduodenoscopy (EGD). This condition occurs most often in people with serious liver diseases. Diagnosis suspected on endoscopy but requires confirmation by pathology examination of biopsies. Rapid heart rate. Approximately 50% of patients with cirrhosis have esophageal varices. It is generally recommended that patients with cirrhosis undergo elective endoscopic screening for varices at the time of diagnosis and periodically thereafter if no or small varices are detected ().If screening EGD reveals appreciable esophageal varices, a size classification should be assigned. Single-lumen tube designed for gastric lavage. The nurse is aware that the tube is a: 1. In the lower 2 to 3 cm of the esophagus, the varices in the submucosa are very superficial and thus have thinner wall. In order to understand the mechanism leading to the development of esophageal varices, it is important to understand the normal vascular architecture and venous drainage of the esophagus. 1. • Temporary solution to stop bleeding - should only stay in for about 24 hours. Shock (in severe cases) Bleeding from varices is a medical emergency. Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). At the same time, variceal bleeding is the most dangerous complication of portal hypertension. 1—3 Considering all causes of GI bleeding, variceal . 1 INTRODUCTION. Sign of liver disease. Esophageal Varies (downhill & uphill) . not bleeding" What is the differential diagnosis? With EGD, a tube with a camera is inserted to visualize the inside of the esophagus. Diagnosis. In people, esophageal varices and ascites are the 2 most commonly reported complications of uncompensated liver cirrhosis. Liver function tests are also done to check the status of the liver through abnormalities with alanine transaminase (ALT) and . J.F. Juke R Saketi Internal Medicine Department, Gastroenterology Hepatology Subdivision, Medical Faculty Padjadjaran University/ Hasan Sadikin Hospital Bandung Pathophysiology • Slow, insidious, progressive, chronic • Fibrous bands replace normal liver structure • Cell degeneration occurs • Liver attempts to regenerate cells but cells are abnormal and disorganized • Causes . 1 An estimated 50% of human patients with portal hypertension caused by cirrhosis develop esophageal varices, and bleeding esophageal varices (BEV) are one of the leading causes of death in these patients. 2016 Apr 30. Acute gastric ulcer penetrating to artery, low power microscopic. Abnormally dilated vein (s) of the esophagus. 22(2 . 2. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. In the Western world cirrhosis is the most common cause, and the major site of resistance to flow is the hepatic sinusoid (table 1).Stellate cells line the perisinusoidal space and are transformed into contractile myofibroblasts in response to liver . DEFINITION Oesophageal varices are dilated and tortuous veins in the oesophageal wall, secondary to increased venous pressure in the splanchnic venous bed or in the superior vena cava. Clinical features. They are prone to rupture and often are the sources of massive haemorrhages from the upper gastro-intestinal tract and rectum. bleeding esophageal varices, etc. The liver cannot detoxify estrogen from the blood. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. Low blood pressure. Esophageal varices are the most important collateral veins secondary to portal hypertension with a prevalence of 30%-40% in compensated patients and 80% in decompensated patients . Siegel Y. Schallert E. Kuker R. Downhill esophageal varices: a prevalent complication of superior vena cava obstruction from benign and malignant causes. There is no consensus for optimum treatment of GV and because they comprise an inhomogenous entity, accurate classification is vital to determine the appropriate management. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Gastric balloon - 400-500 ml of air Esophageal balloon - 30-45 mmHg Murray, A.M. Dawson, S. Sherlock, Circulatory changes in chronic liver disease Am J Med 24: (1958) 358-367 48. What causes esophageal varices? Varices result from an increase in portal pressure. What are esophageal varices? Prevalence of Esophageal Varices in Cirrhosis % 100 60 40 20 0 Overall Child A Child B 80 Child C Pagliaro et al., In: Portal Hypertension: Pathophysiology and Management, 1994: 72 Prevalence and Size of Esophageal Varices in Patients with Newly-Diagnosed Cirrhosis % Patients with varices 100 60 40 20 0 Overall n=494 Child A n=346 Child B n=114 . Coughed up bright red blood (BRB) this morning. Esophageal Varices - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. With EGD, a tube with a camera is inserted to visualize the inside of the esophagus. ESOPHAGEAL VARICES Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). Cirrhosis. Black, tarry, or bloody stool. 1 INTRODUCTION. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). Winner of the Standing Ovation Award for "Best PowerPoint Templates" from Presentations Magazine. topics and controversies related to esophageal varices are covered, including noninvasive diagnostic methods, bleeding prophylaxis in adults and children, rescue treatments, and the clinical dilemma of portal vein thrombosis. Vomiting of blood. Esophageal varices develop when normal blood flow to the liver is blocked in such conditions as cirrhosis. Alcohol-induced liver disease and cholestatic liver diseases are other common causes of cirrhosis. Esophageal Varices: Pathophysiology, Approach and Clinical Dilemmas View this Special Issue. . Esophageal varices are veins that are abnormally enlarged and are usually found on the lower two-thirds of the esophagus. Typical esophageal varices occur in the distal esophagus, secondary to portal hypertension, and have been termed "uphill varices" because of the direction of blood flow . Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. GASTROINTESTINAL BLEEDING Hematemesis Melena Hematochezia Occult bleeding CLINICAL PRESENTATION Clinical manifestations of GI bleeding depends upon extent & rate Postural hypotension suggests acute hemorrhage & intravascular volume depletion Fatigue & exertional dyspnea typical symptoms with slow, chronic blood loss ETIOLOGY OF UGI BLEEDING Differential diagnosis is extensive Major causes; PUD . An endoscopy procedure involves inserting a long, flexible tube (endoscope) down the throat and into the esophagus. Esophageal varices appear and may bleed when the HVPG exceeds 12 mmHg. Upper Gastrointestinal Bleeding Volume 85, Number 5 Gastrointestinal Bleeding — diagnosis — — We report a case of gastrointestinal bleeding secondary to esophageal varices in . clinical presentation clinical manifestations of gi bleeding depends upon extent & rate postural hypotension suggests acute hemorrhage & intravascular volume depletion fatigue & exertional dyspnea typical symptoms with slow, chronic blood loss etiology of ugi bleeding differential diagnosis is extensive major causes; pud esophageal/gastric … If the bleeding is . . P ortal h yp ertension is initially caused by distortion of the hepatic vascular bed, which in turn leads to increased resistanc e to portal blood flow. (1) Esophageal ulcer (5-6cm but clean-based) (2) Esophageal varices (though small) (3) Gastric polyp (possible neoplasm) (4) Bluish lesion at GEJ (vascular, infection or tumor) Esophageal Ulcer "An ulcer was found in the mid esophagus 5-6cm in length . Back-up of blood into the smaller vessels causes the vessels . It accounted for 29,165 deaths in 2007, with a mortality rate of 9.7 per 100,000 persons. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. We aimed to identify patient and facility factors associated with EV screening in veterans with hepatitis C (HCV)-associated cirrhosis. Blood clot (thrombosis). Double-lumen tube used for sclerotherapy and ligation of GI varices. Appointments 216.444.7000. Portal hypertension is a common clinical syndrome defined as the elevation of hepatic venous pressure gradient (HVPG) above 5 mmHg. The gold standard for the diagnosis of varices is esophagogastroduodenoscopy (EGD). (1) Esophageal ulcer (5-6cm but clean-based) (2) Esophageal varices (though small) (3) Gastric polyp (possible neoplasm) (4) Bluish lesion at GEJ (vascular, infection or tumor) Esophageal Ulcer "An ulcer was found in the mid esophagus 5-6cm in length . Definition Portal hypertension is elevated pressure in the portal vein associated with increased resistance to blood flow through the portal venous system. They are present in up to one-third of the cases of SVC obstruction; however, only 8% of such patients manifest with upper gastrointestinal bleeding. Esophageal varices develop in patients with cirrhosis at an annual rate of 5- 8%, but the varices are large enough to pose a risk of bleeding in only 1-2% of cases. Octreotide is probably the drug of choice for pharmacologic management of bleeding esophageal varices. It is detected in about 50% of cirrhosis patients, and approximately 5-15% of cirrhosis patients show newly formed varices or worsening of varices each year. Because of this risk of bleeding, esophageal . Causes of esophageal varices include: Severe liver scarring (cirrhosis). Statistics: A multitude of different treatments for chronic liver disease have been introduced . Hepatic cirrhosis is a chronic hepatic disease characterized by diffuse destruction and fibrotic regeneration of hepatic cells. Abstract Esophageal varices are one of the most common and severe complications of chronic liver disease. J Neurogastroenterol Motil. Definition (CSP) longitudinal venous varices at the lower end of the esophagus as a result of portal hypertension; they are superficial and liable to ulceration and massive bleeding. Upper GI Bleed. The result is a backup of blood that causes many problems: • It can reroute blood through veins called "varices". The stomach, intestine, spleen, and pancreas all drain blood into a blood vessel system known as the portal vein, which gets carried to the liver. A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis. figure 2). Portal hypertension is the primary cause of esophageal varices. Slide 2-. Cirrhosis patients can develop some severe complications like excessive bleeding, portal hypertension, and esophageal varices. 1 Cirrhosis is a major risk factor for . Patients with severe and persistent upper gastrointestinal (GI) hemorrhage (ie, requiring transfusions of >5 U of packed red blood . Treatment is aimed at preventing liver damage, preventing varices from bleeding, and controlling bleeding if it occurs. not bleeding" What is the differential diagnosis? Definition. 1). Esophageal varices (EV) form when the HVPG exceeds 10 mm Hg . This syndrome is characterised by a pathological increase of the portal venous pressure, which leads to the formation of portal-systemic collaterals. Bleeding from varices occurs in 30% of . Esophageal varices are a major complication of portal hypertension (increased blood pressure in the portal venous system ). ESOPHAGEAL TOPICS Norman M. Simon, M.D., F.A.C.G. H. Maruyama and O. Yokosuka review the current concepts of the pathophysiology of portal hypertension and esophageal . Esophageal variceal bleeding is a complication of portal hypertension and a major cause of death in patients with liver cirrhosis. 3. Due to portal hypertension, the spleen becomes congested, which leads to hypersplenism and increased platelet sequestration. Prevention of the development of esophageal varices is controversial and not fully documented. D004932. Some varices can be Esophageal varices are enlarged or swollen veins on the lining of the esophagus. Esophageal vari-ces are present in about 50% of patients with cirrhosis, and variceal hemorrhage occurs at a rate of 5% to 15% per year depending on the severity of the liver disease. Esophageal/Gastric Varices: Pathogenesis and clinical findings. Risk Factors Cirrhosis Mechanical obstruction (e.g. Cirrhosis is the fifth leading cause of death in adults. Disease or Syndrome ( T047 ) , Acquired Abnormality ( T020 ) MSH. New aspects in epidemiology, pathogenesis, and treatment of varices are reviewed. Background and aim: The American Association for the Study of Liver Disease (AASLD) recommends screening for esophageal varices (EV) by esophagoduodenoscopy (EGD) in patients with cirrhosis to guide decisions regarding primary prophylaxis for EV hemorrhage. . The increased pressure can cause sudden and severe bleeding. thrombosis, tumor) Pathophysiology Obstruction of portal venous flow through the liver leads to: Formation of esophageal, gastric, and hemorrhoidal varicosities due to increased venous . Esophageal varices 1. Esophageal Varices. International Journal of Hepatology Esophageal varices are the major complication of portal hypertension. Slide 1-. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Previous Next: Prognosis. Bleeding most commonly occurs in the distal 5 cm of the esophagus. They arise from the blockage of the portal vein of the liver. Esophageal varices (EV) are a leading cause of death in people with cirrhotic hepatic disease and occur in dogs secondary to a number of disease processes resulting in obstruction or abnormal portal or caval blood flow. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. Varices can be life-threatening if they break open and bleed. However, this treatment fails in about 10% to 15% of these . The prognosis is better in noncirrhotic . • Budd-Chiari syndrome. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. esophageal varices. This is called portal hypertension. Liver function tests are also done to check the status of the liver through abnormalities with alanine transaminase (ALT) and . CASE STUDY Esophageal Varices • 45 y/o male, alcoholic with 2 years sobriety: Attends AA • 20 years heavy drinking, cirrhotic liver not recovered • Bad cough for the last two days. thrombosis have esophageal varices.1,2Variceal hemorrhaging occurs in 17% to 29% of children with biliary atresia over a 5- to 10-year period3and in up to 50% of children with portal vein thrombosis by 16 years of age.2Predictors of variceal bleeding in children include the variceal size assessed by Gastric adenocarcinoma, gross. b. gynecomastia- growth of abnormally large breasts. Hepatic Causes Cirrhosis is the most common cause of portal hypertension, and chronic viral hepatitis C is the most common cause of cirrhosis in the United States. Case Study 23 Esophageal Varices Pathophysiology 2 1. a. Spider angiomas- nevus, teleangiectasis found beneath the skin surface containing a central red spot and reddish extensions like a spider web. . • Coughing/bleeding subsiding for now • IV of D5 ½ NS w/20mEq. Among these, gastroesophageal varices are of special interest, since are responsible for the main complication of portal hypertension, massive gastrointestinal bleeding. Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. dr. arun aggarwal gastroenterologist: pediatric gi- surgery conference- the most common causes of caustic esophageal burns are alkaline household cleaning products, such as oven and drain cleaners, strong lyes that contain sodium and potassium hydroxides, and laundry detergents and cleaning agents with sodium phosphate, sodium carbonate, and … Esophageal varices are dilated submucosal veins that develop in patients with underlying portal hypertension and may result in serious upper gastrointestinal bleeding. • 3 ports: gastric balloon, gastric suction port, & esophageal balloon. • Budd-Chiari syndrome. Causes-> Obstruction of superior vena cava distal to entry of azygos vein due to Lung cancer . Cirrhosis is the most common cause of esophageal varices in adults. Esophageal varices are enlarged veins that occur in the walls of the esophagus. The pressure in the swollen veins is higher than normal. Lightheadedness. Acute duodenal ulcer, gross [ENDOSCOPY] Anti-parietal cell autoantibody, immunofluorescence microscopy. Signs of recent . Esophageal variceal hemorrhage refers to the bleeding of dilated sub- mucosal veins ( varices) of the distal esophagus; and is a dangerous consequence of portal hypertension. A tiny camera on the end of the endoscope lets the doctor examine the esophagus, stomach and the beginning of the small intestine (duodenum). In contrast, varices of the upper esophagus are rare and have distinct pathophysiology. While SVC obstruction is most commonly secondary to malignant causes, our review of the . A comprehensive review of the clinical manifestations of portal hypertension is presented by S. A. Al-Busafi et al. (EIS), remains the standard treatment for high-risk varices and bleeding varices [4, 5], but does not influence the pathophysiology of portal hypertension. If you have cirrhosis, your doctor should screen you for esophageal varices . Sclerotherapy is the first-line treatment for acute hemorrhage. Gastric adenocarcinoma with ulceration, gross. The Northern Italian Endoscopic Club for the Study, Treatment of Esophageal Varices, Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices N Engl J Med 319: (1988) 983-989 49. Pathophysiology of portal hypertension. PATHOPHYSIOLOGICAL MECHANISMS Esophageal varices are dilated blood vessels in the wall of the esophagus; they are often described as hemorrhoids of the esophagus. Esophageal varices are submucosal distal esophageal veins, connecting the portal circulation and systemic circulation, that are dilated because of portal hypertension, most commonly because of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Esophageal varices may be graded endoscopically as in Box 2. Gastroesophageal varices (GOV) are classified as GOV1 (EV extending down to cardia . In addition, these varices do not communicate with the . Portal vein thrombosis and secondary biliary cirrhosis are the most common causes of esophageal varices in children. The pathological hallmark of cirrhosis is the development of scar tissue that replaces normal parenchyma, leading to blockade of portal blood flow and disturbance of normal liver function. Gastroenterology. This condition occurs most often in people with serious liver diseases. The blood backs up into the smaller fragile vessels of the esophagus as well as the stomach and rectum. As necrotic tissue yields to fibrosis, this disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency. The initiating factor in the development of portal hypertension is increased resistance to portal flow. Combined treatment with vasoactive drugs, prophylactic antibiotics, and endoscopic band ligation is the standard of care for patients with acute bleeding. Active bleeding is usually obvious (Fig. Much of this . That causes things like a loss of bilirubin and protein metabolism, a loss of clotting factors, and poor detoxification and blood sugar regulation. Less common causes include hemochromatosis, alpha 1-antitrypsin deficiency, BARRETT'S ESOPHAGUS A change in the lining of the esophagus from the normal squamous lining to an intestinal type lining called intestinal metaplasia. Esophageal varices appear and may bleed when the HVPG exceeds 12 mmHg. Obstruction of portal venous flow results in increase in portal pressure. Statistics: A multitude of different treatments for chronic liver disease have been introduced . • Minnesota tube has 4 ports - adds esophageal suction port. Factors predicting the risk of variceal bleeding include continued alcohol use, poor liver function, large varices, and red wale markings on varices at endoscopy. Helicobacter pylori in stomach, Methylene blue stain, microscopic. 3. Gastric varices (GV) occur in 20% of patients with portal hypertension either in isolation or in combination with esophageal varices (EV). It. This rare condition causes blood clots that can block the veins that carry blood out of your liver. Herbella FA, Colleoni R, Bot L, Vicentine FP, Patti MG. High-resolution manometry findings in patients after sclerotherapy for esophageal varices. Esophageal varices are swollen veins in the lining of the lower esophagus near the stomach. Concepts. 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