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Esophageal varices



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Gastric varices are dilated submucosal veins Vessel Due Varizen the stomachwhich Vessel Due Varizen be a life-threatening cause of bleeding in the upper gastrointestinal tract.

They are most commonly found in patients with portal hypertensionVarizen, wenn im Sport Eingriff elevated pressure in the portal vein system, which may be a complication of cirrhosis. Gastric varices may also be found in patients with thrombosis of the splenic veininto which the short gastric veins which drain the fundus of the stomach flow.

The latter may be a complication of acute pancreatitisVessel Due Varizen, pancreatic canceror other abdominal tumours, as well as hepatitis C. Gastric varices and associated bleeding are a potential complication of schistosomiasis resulting from portal hypertension.

Patients with bleeding gastric varices can present with bloody vomiting hematemesisdark, Vessel Due Varizen stools melenaor rectal Vessel Due Varizen. The bleeding may be brisk, and patients may soon develop Koffein mit Krampfadern. Treatment of gastric varices can include injection of the varices with cyanoacrylate glue, Vessel Due Varizen a radiological procedure to decrease the pressure in the portal vein, termed transjugular Vessel Due Varizen portosystemic shunt or TIPS.

Treatment with intravenous octreotide is also useful to shunt blood flow away from the stomach's circulation. More aggressive treatment including splenectomy or surgical removal of the spleen or liver transplantation may be required in some cases. Gastric varices can present in two major ways. First, Vessel Due Varizen, patients with Vessel Due Varizen may be enrolled in screening gastroscopy programs to detect esophageal varices.

These evaluations may detect gastric varices that are asymptomatic. When gastric varices are symptomatic, however, they usually present acutely and dramatically with upper gastrointestinal bleeding. The symptoms can include vomiting bloodmelena passing black, tarry stools ; or passing maroon stools or frank blood in the stools, Vessel Due Varizen. Many people with bleeding gastric varices present in shock due to the profound loss of blood, Vessel Due Varizen.

Secondly, patients with acute pancreatitis may present with gastric varices as a complication of a blood clot in the splenic vein. The splenic vein sits over the pancreas anatomically and inflammation or cancers of the Vessel Due Varizen may result in a blot clot forming in the splenic vein.

As the short gastric veins of the fundus of the stomach drain into the splenic vein, thrombosis of the Prüfung von Beine Krampfadern vein will result in increased pressure and engorgement of the short veins, leading to varices in the fundus of the stomach. Laboratory testing usually shows low red blood cell count and often a low platelet count.

If cirrhosis is present, there Vessel Due Varizen be coagulopathy manifested by a prolonged INR ; both of these may worsen the bleeding from gastric varices. In very rare cases, gastric varices are caused by splenic vein occlusion as a result of the mass effect of slow-growing pancreatic neuroendocrine tumors.

Diagnosis of gastric varices is often made at the time of upper endoscopy. The Sarin classification of gastric varices identifies four different anatomical types of gastric varices, which differ in terms of treatment modalities. Initial treatment of bleeding from gastric varices focuses on resuscitation, much as with esophageal varices.

This includes administration of fluids, blood products, and antibiotics. The results from the only two randomized trials comparing band ligation vs cyanoacrylate suggests that endoscopic injection of cyanoacrylateknown as gastric variceal obliteration or GVO is superior to band ligation in preventing rebleeding rates. Cyanoacrylate, a common component in 'super glue' is often mixed 1: GVO is usually performed in specialized therapeutic endoscopy centers.

Complications include sepsis, embolization of glue, and obstruction from polymerization in the lumen of the stomach. From Wikipedia, the free encyclopedia, Vessel Due Varizen.

This article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. January Learn how Vessel Due Varizen when to remove this template message. Diseases of the digestive system primarily K20—K93— Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption.

Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus. Upper Hematemesis Melena Lower Hematochezia. Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum. Cardiovascular disease vessels I70—I99— Arteritis Aortitis Buerger's disease, Vessel Due Varizen.

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Retrieved from " https: Stomach disorders Diseases of veins, Vessel Due Varizen, lymphatic vessels and lymph nodes. Articles lacking sources from January All articles lacking sources. Views Read Edit View history. This page was last edited on 8 Marchat By using this e keine Varizen, you agree to the Terms of Use and Privacy Policy. Isolated gastric varices of Sarin classification IGV-1 seen on gastroscopy in a patient with portal hypertension.

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Gastric varices - Wikipedia Vessel Due Varizen

Apr 25, Vessel Due Varizen, Author: They are native veins that serve as collaterals to the central venous circulation when flow through the portal venous system or superior vena cava SVC is obstructed. Esophageal varices are collateral veins within the wall of the esophagus that project directly into the lumen, Vessel Due Varizen.

The veins are of clinical concern because they Vessel Due Varizen prone to hemorrhage. Paraesophageal varices are collateral veins beyond the adventitial surface of the Vessel Due Varizen that parallel intramural esophageal veins.

Paraesophageal varices are less prone to hemorrhage. Esophageal and paraesophageal varices are slightly different in venous origin, but they are usually found together.

Using a thin-barium technique, radiographic appearances of esophageal varices were described first by Wolf in his paper, "Die Erkennug von osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices. Today, more sophisticated imaging with computed tomography CT scanning, magnetic resonance imaging MRImagnetic resonance angiography MRAVessel Due Varizen, and endoscopic ultrasonography EUS plays an important role in the evaluation of portal hypertension and esophageal varices.

Endoscopy is the criterion standard for evaluating esophageal varices and assessing the bleeding risk. The procedure involves using a flexible endoscope inserted into the patient's mouth and through the esophagus to inspect the mucosal surface, Vessel Due Varizen.

The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a significant risk for bleeding. The grading of esophageal varices and identification of red wheals by endoscopy predict a patient's bleeding risk, on which treatment is based.

Endoscopy is also used for interventions, Vessel Due Varizen. The following pictures demonstrate band ligation of esophageal varices. CT scanning and MRI are identical Krampf Geburt their usefulness in diagnosing and evaluating the extent of esophageal varices, Vessel Due Varizen.

These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm, Vessel Due Varizen. CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation.

These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for a specific etiology of esophageal varices. These modalities also have an advantage over both endoscopy and angiography because they are noninvasive. CT scanning and MRI Vessel Due Varizen not have strict criteria for evaluating the bleeding risk, and they are not as sensitive Schmerzen Krampfadern an specific as endoscopy.

CT scanning and MRI may be used as alternative methods in making the diagnosis if endoscopy is contraindicated eg, in patients with a recent myocardial infarction or any contraindication to sedation.

In the past, angiography was considered the criterion standard for evaluation of the portal venous system, Vessel Due Varizen. However, current CT scanning and MRI procedures have become equally sensitive and specific Vessel Due Varizen the detection of esophageal varices and other abnormalities of the portal venous system. Although the surrounding anatomy cannot be evaluated the way they can be with CT scanning or MRI, angiography is advantageous because its use may be therapeutic as well as diagnostic, Vessel Due Varizen.

Ultrasonography, excluding EUS, and nuclear medicine studies are of minor significance in the evaluation of esophageal varices. Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique.

Barium swallow examination is not a sensitive test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention. However, in severe disease, esophageal varices may be prominent. CT scanning and MRI are useful in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical clips may create artifacts that obscure portions of the portal venous system. Disadvantages of CT scanning include the possibility of Vessel Due Varizen reactions to the contrast agent and an inability to quantitate portal venous flow, which is an advantage of MRI and ultrasonography.

Plain radiographic findings are insensitive and nonspecific in the evaluation of esophageal varices. Plain radiographic findings may suggest paraesophageal varices, Vessel Due Varizen.

Anatomically, paraesophageal varices are outside the esophageal wall and may create abnormal opacities. Esophageal varices are within the wall; therefore, they are concealed in the normal shadow of the esophagus. Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension, [ 14 ] and the most common was obliteration of a short or long segment of the descending aorta without a definitive mass shadow.

Other plain radiographic findings included a posterior mediastinal mass and an apparent intraparenchymal mass. On other images, the intraparenchymal masses were confirmed to be varices in the region of the pulmonary ligament.

On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature. In addition, a widened, superior mediastinum may be shown. A widened, superior mediastinum may result from dilated collateral veins or the obstructing mass. Endoscopy is the criterion standard method for diagnosing esophageal varices.

Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not Vessel Due Varizen see the images below. Pay attention to technique to optimize detection of esophageal varices, Vessel Due Varizen. The procedure should be performed with the patient in the supine or slight Trendelenburg position.

These positions enhance gravity-dependent flow and engorge the vessels. The patient should be situated in an oblique projection and, therefore, in a right anterior oblique position to the Vessel Due Varizen intensifier and a left posterior oblique position to the table. This positioning Vessel Due Varizen overlap with the spine and further enhances venous flow. A thick barium suspension or paste should be used to increase adherence to the mucosal surface.

Ideally, Vessel Due Varizen, single swallows of a small amount of barium should be ingested to minimize peristalsis and to prevent overdistention of the esophagus. If the ingested bolus is too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed out, rendering esophageal varices invisible.

In addition, Vessel Due Varizen, a full column of dense barium may white out any findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it progresses caudally. Effervescent crystals may be used to provide air contrast, but crystals may also cause overdistention of the esophagus with gas and thereby hinder detection of esophageal varices.

In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices. The patient is asked to "bear down as if you are having a bowel movement" or asked to Vessel Due Varizen your stomach muscles Varizen Laserbehandlung in Samara if you were doing a sit-up.

The Valsalva maneuver also traps barium in the distal esophagus and allows retrograde flow for an even coating. Plain radiographic findings suggestive Forum Varizen und Blutegel paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be followed up Vessel Due Varizen CT scanning or a barium study to differentiate the findings from a hiatal hernia, Vessel Due Varizen, posterior Vessel Due Varizen mass, or other Vessel Due Varizen eg, rounded atelectasis.

Similarly, barium studies or CT scan findings suggestive of esophageal varices should be followed up with endoscopy. Endoscopic follow-up imaging can be used to evaluate the grade and appearance of esophageal varices to assess the bleeding risk. The results of this assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies.

With endoscopy, the 2 entities can be differentiated easily. The only normal variant is a hiatal hernia. The rugal fold pattern of a hiatal hernia may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction. CT scanning is an excellent method for detecting moderate to large esophageal Vessel Due Varizen and for evaluating the entire portal venous system.

CT scanning is a minimally invasive imaging modality that involves the use of only a peripheral intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images below. A variety of techniques have been described for the CT evaluation of the portal venous system. Most involve a helical technique with a pitch of 1.

The images are reconstructed in 5-mm increments. The amount of contrast material and the delay time are slightly greater than those in conventional helical CT scanning of the abdomen.

The difference in technique ensures adequate opacification of both Vessel Due Varizen portal venous and mesenteric arterial systems. On nonenhanced studies, esophageal varices may not be depicted well. Only a thickened esophageal wall may be found. Paraesophageal varices may appear as enlarged lymph nodes, Vessel Due Varizen, posterior mediastinal masses, Vessel Due Varizen, or a collapsed hiatal hernia.

On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus, Vessel Due Varizen. The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen. Paraesophageal varices are easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat. On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar to that of uphill varices, varying only in location.

Because the etiology of downhill esophageal varices is usually secondary to superior vena cava SVC obstruction, the physician must be aware of other potential collateral pathways that may suggest the diagnosis.

Stanford et al published data based on venography, [ 19 ] describing 4 patterns of flow Vessel Due Varizen the setting of SVC obstruction as follows [ 19 ]:, Vessel Due Varizen. In a retrospective investigation, Cihangiroglu et al analyzed CT scans from 21 studies of patients with SVC obstruction [ 20 ] and described as many as 15 different collateral pathways, Vessel Due Varizen.

Of their total cohorts, only 8 could be characterized by using the Stanford classification. In the setting of SVC obstruction, the most common collateral pathways were the in decreasing order of frequency: In a study by Zhao et al of row multidetector CT portal venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and esophageal varices, [ 21 ] 50 of the 52 cases showed an origin from the posterior branch of left gastric vein, whereas the others were from the anterior branch.

Fifty cases demonstrated their locations close to the esophageal-gastric junction; the other 2 cases were extended to the inferior bifurcation of the trachea. Forty-three patients in the Zhao et al study showed the communications between paraesophageal varices and periesophageal varices, Vessel Due Varizen, whereas the hemiazygous vein 43 cases and IVC 5 cases were also involved, Vessel Due Varizen.

CT scanning is a Vessel Due Varizen invasive method used to detect moderate to large esophageal varices and to evaluate the entire portal venous system. CT scans also help in evaluating the liver, other venous collaterals, Vessel Due Varizen, details of other surrounding anatomic structures, and the patency of the portal vein. In these situations, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are not useful in predicting variceal hemorrhage.

Compared with angiography, CT scanning is superior in detecting paraumbilical and retroperitoneal varices and at providing a more thorough examination of the portal venous system without the risk of intervention.

In the detection of esophageal varices, CT scanning is slightly better than angiography. CT scanning and angiography are approximately equal in the detection of varices smaller than 3 mm.

If CT scans do not demonstrate small varices, they are unlikely to be seen on angiograms. Contrast-enhanced CT scanning is essential for evaluating esophageal varices. Contrast enhancement greatly increases the sensitivity and specificity of the examination and reduces the rate of false-positive or false-negative results, Vessel Due Varizen.


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