Varicose veins of the esophagus develops from the disruption of blood flow in the portal vein and upper hollow veins. There is such a pathology in the distal esophagus or proximal stomach. A character's appearance can be congenital and acquired. The latter, moreover, does not depend on the age of the patient, and which are due to the state and prevent normal blood flow to the portal vein.
Varicose esophageal veins with portal hypertension of various origins. This release:
Varicose veins of the esophagus damage to the youth are more often caused by a blockade of the liver in adults – internal pay.
Causes of the disease caused by the anatomical connection of the esophagus veins with the portal vein, the veins of the abdominal organs, especially the spleen. When the internal format to the blockade of blood flow to liver disease covers the lower esophagus, the cause is stagnant processes in the portal vein to the liver, which occurs when:
This blockade of blood flow due to blockage of the portal vein, compressing his tumors, lymph nodes, cysts or stones in the bile ducts. Varicose veins the upper part is also a malignant goitre, or disease of the esophagus and vascular changes, which is a rare disease.
More rarely the disease develops when the pressure in the bloodstream, such as chronic heart failure. A typical feature is that the vascular knot of liver disease is 2-3 times higher.
There is also a congenital form, varicose ulcers of the esophagus, the causes of which are unclear.
This complex outflow of blood from the esophageal veins they begin to develop a file extension, mutkittelevuus and elongation. The walls of the vessels thus become thinner and can rupture, which entails the development of bleeding. The openings of the veins do not increase in a balanced way, the formation of the local file extension in the form of nodes.
The development of the disease can be rapid and may take place very slowly. Very often, the disease appeared within a few years can occur. Patients worried about some vague complaints, among them:
The estimated age of patients is about 50 years, the men among the patients are two times more than women.
Development bleeding is the most serious complication of varicose veins of the esophagus. It may not be noticeable to the patient and can threat to his life. The main symptom is vomiting blood. Not even the threat in mind, quietly flowing, but regular blood loss can cause iron deficiency anemia.
The reason for such bleeding can be:
Sometimes bleeding can happen suddenly, among full health, taking a generous nature to cause death. Harbingers are a little tickle in the throat, a characteristic brackish taste in the mouth. Soon after their appearance suddenly vomit a scarlet or resembles coffee grounds blood. Sometimes bleeding will lead to the execution of the disease, suggesting the need for early diagnosis of the disease.
Varicose veins of the esophagus can be detected in 70% of patients with cirrhosis of the liver. This phenomenon is explained by the fact that cirrhosis of the liver the liver is the formation of cicatricial tissue, crowding out healthy cells. This slows down the blood flow and cause traffic jams that cause this pathology development in the lower part of the esophagus. Esophageal variceal bleeding are the cause of death as cirrhosis of the liver in 10-15% of cases. Great diagnostic sign is early relapses.
For this reason, patients with cirrhosis should undergo regular endoscopic examinations to detect varicose veins. Due to the expansion of esophagus veins the frequency of such inspections should be once in 2 years, if there is one or 2 times a year. The frequency and the level of noticeable emphysema is usually proportional to the severity of liver cirrhosis.
The treatment of such patients is of great importance in the prevention of rebleeding. It is based on the use of drugs that reduce portal pressure, endoscopic sclerotherapy and surgical techniques. It should be noted that relapse prevention has worse results than the prevention of the first episode of bleeding.
Diagnosis the following studies:
The key to this is the procedure that gives you the opportunity to establish the cause of bleeding, determine the status of the venous walls and the degree of dilatation of the veins, and to predict the rupture of another aneurysm. If bleeding has already started, because it is difficult to determine, because of the difficulties to perform effective esophagoscopy.
Part of the status information of the esophagus and the nature of varicose veins can be obtained on the basis of x-ray of the esophagus, which is performed with contrast.
As the condition of varicose veins usually associated with severe liver disease, it is important to assess the extent of possible clotting disorder. To do this, perform the most Common blood tests with determination of platelet count and prothrombin index, and liver function tests. If there is bleeding should have a blood group, RH factor and cross-test compatibility with red blood cell mass.
The differential diagnosis should exclude the possibility of many other diseases, such as:
Treatment of varicose veins of the esophagus, which aim to eliminate the diseases, which has increased the pressure on the portal vein and the vena cava, as well as to remove the threat, it is possible to bleeding. Such actions also the prevention of esophageal inflammation, a gentle way of life, intake of medicines, drugs, vitamins, laxatives.
If you experience bleeding following measures:
Compensate for the loss of blood ill do it in a blood transfusion, infusion of Packed red cells or plasma-replacing solutions.
When massive bleeding is a serious surgery, which can significantly reduce mortality. It is noticed that the conservative treatment the mortality rate is 3 times greater than surgical. Share palliative and radical surgery to repair the esophagus bleeding.
Currently, there is a lot of experience using minimally invasive endoscopic procedures to correct bleeding from dilated esophageal veins.
Endoscopic sclerotherapy was first described 1939. Until 70-ies of the last century in connection with development and improvement of endoscopic units began intensive implementation of the method in practice. It will use the funds to different mechanism of action.
Improve the results of sclerotherapy using balloon tamponade.
Good results can be obtained with endoscopic doping, which was proposed in 1985. Therefore, it is the cessation of blood flow to the varicose veins of the esophagus is carried out using a mixture of tyres. Recurrence after surgery was observed only in 17% of patients, which is almost two times less than after hardening.
This method will help stop the bleeding by compressing the bleeding site. It is very dangerous and should only be performed by experienced technicians. The main tool is a special sensor-equipped cylinder. Hemostasis is achieved by inflating the gastric balloon and stretching, without the sect
Treatment of esophageal balloon. Because this is the tamponade of the varices, and decreases the amount of bleeding of the venous plexus. Inflating the esophageal balloon is carried out very rarely, because of the risk of possible complications.
The effectiveness of using balloon tamponade is 90%.
For the treatment of this disease, the following surgical techniques:
Technical TIPS is to create intrahepatic artificial channel between the hepatic and portal veins, and install it in the channel of the metal stent. Thank you it almost always does not stop the bleeding, including those who are not amenable to other treatments. The main drawback of the method is its high complexity and the necessary subsequent development of hepatic encephalopathy.
The effectiveness of the shunt close to the efficiency TIPS much greater trauma. The occurrence of hepatic encephalopathy is also a serious problem.
Some of the functions formed at the junction of the esophagus. Such an event will effectively help stop bleeding, not to remove the causes of portal hypertension, which leads to a rapid recurrence of the development of this disease.
The prognosis depends on the severity of the underlying liver disease. Generally, varicose veins is characterized by a high mortality rate, which exceeds 50%. Mortality is not determined by the bleeding severity and nature of liver diseases that led to it.
Although 80% of patients stop bleeding on their own, well in this case mainly in patients with good functional status of the liver, but in patients with severe hepatic impairment, it is often fatal.
Family after bleeding in a patient in 75% of cases in the next 1-2 years there is a relapse. To reduce this, regular medical and endoscopic treatment of varicose veins.
Generally, the prognosis for long-term survival of patients with this disease is still low, which mainly is the fault of the most important severe liver disease.
