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Esophageal Varices

Maximos Attia, MD, FAAFP and Marcelle Meseeha, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Dilated submucosal esophageal veins connecting the portal and systemic circulations

  • Most commonly results from portal hypertension (typically a result of cirrhosis)

  • Variceal rupture: m...

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 resuscita...

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

ADDITIONAL READING

  • Tayyem O, Bilal M, Samuel R, et al. Evaluation and management of variceal bleeding. Dis Mon.  2018;64(7):312–320. [View Abstract on OvidMedline]

  • Zanetto A, Senzolo M, Ferrarese ...

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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