Oesophageal varices

Veins in the lower oesophagus bulge into the lumen and are liable to bleed.

Cause

Pathognomic of portal hypetension. Blood from the postal circulation enters the systemic circulation via portosystemic anastomoses. In the oesophagus, this is between the left gastric and the azygous system via the oesophageal venous plexus.

Treatment

Large bore cannula. Crossmatch blood. Infuse colloid until blood arrives or use O− blood. Vit-K.
Desmopressin or octreotide to promote splanchnic arteriolar constriction. Endoscopy sclerotherapy. Sengstaken tube (baloon tamponade).

Prophylaxis

Transjugular intrahepatic stenting (TIPS). The risk is portosystemic encephalopathy.