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Esophageal Varices

Maximos Attia, MD, FAAFP and Marcelle Meseeha, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Dilated submucosal distal esophageal veins connecting the portal and systemic circulations

  • Results from portal hypertension (most commonly a result of cirrhosis), resistance to portal...

DIAGNOSIS

  • First indication of varices is often GI bleeding: hematemesis, hematochezia, and/or melena.

  • Occult bleeding (anemia): uncommon

HISTORY

  • Underlying history of cirrhosis/liver disease. Variceal bl...

TREATMENT

GENERAL MEASURES

  • Treat underlying cirrhotic comorbidities.

  • Variceal bleeding is often complicated by hepatic encephalopathy and infection.

  • Active bleeding (3)[A]

    • IV access, hemodynamic resusci...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Close monitoring of vital signs

  • Endoscopic variceal ligation, every 1 to 4 weeks, until varices eradicated

  • If TIPS, repeat endoscopy to assess reb...

REFERENCES

1
1 de Franchis R; and the Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hyp...

ADDITIONAL READING

  • Kochhar GS, Navaneethan U, Hartman J, et al. Comparative study of endoscopy vs. transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding. Gastroe...

SEE ALSO

Cirrhosis of the Liver; Portal Hypertension 

CODES

ICD10

  • I85.00 Esophageal varices without bleeding

  • I85.01 Esophageal varices with bleeding

  • I85.10 Secondary esophageal varices without bleeding

  • I85.11 Secondary esophageal varices with bleeding

ICD9

  • 456...

CLINICAL PEARLS

  • Thrombocytopenia is the most sensitive marker of increased portal pressure and large esophageal varices.

  • In acute bleeding, avoid β-blockers.

  • In acute bleeding, overtransfusion can eleva...

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