09 Esophageal Varices

What are esophageal varices?

Dilated submucosal veins, usually in the distal esophagus.

What is the most common cause of esophageal varices?

Cirrhosis.

How do esophageal varices form?

Portal hypertension creates portosystemic collateral vessels.

Why are esophageal varices dangerous?

They may rupture and cause massive upper GI bleeding.

What are manifestations of ruptured esophageal varices?

Hematemesis, melena, hematochezia, hypotension, tachycardia, syncope, and signs of shock.

What is the gold standard for diagnosing esophageal varices?

Upper endoscopy or EGD.

What imaging can assess portal hypertension and collateral pathways?

Doppler ultrasound and abdominal CT.

What is the focus of esophageal varices treatment?

Preventing the first bleed, managing acute bleeding, and preventing rebleeding.

What procedures may be used to control esophageal variceal bleeding?

Endoscopic variceal ligation and sclerotherapy.

What is downhill esophageal varices?

Varices caused by superior vena cava obstruction, usually in the upper esophagus.

What can endoscopy identify on esophageal varices?

Variceal size and high-risk stigmata such as red signs.

Why is barium esophagram less commonly used for varices today?

Endoscopy is more direct and useful for diagnosis and treatment.

What classic barium appearance can varices produce?

Serpiginous worm-eaten filling defects and thickened mucosal folds.

What can Doppler ultrasound evaluate in patients with varices?

Portal hypertension, collateral pathways, and splenomegaly.

What medications help prevent a first esophageal variceal bleed?

Nonselective beta blockers.

What is secondary prophylaxis for esophageal varices?

Long-term prevention of rebleeding, commonly with repeat ligation and medication.