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Oesophageal Varices

Oesophageal varices are dilated collateral blood vessels in the oesophagus that develop as a result of portal hypertension, usually in the presence of cirrhosis.

Gastroscopy image of esophageal varices with prominent red wale spots - Samir

It's typically asymptomatic on its own, and causes symptoms when it bleeds, such as:

  • Haematemesis - typically fresh red blood

  • Melaena

  • Signs of chronic liver disease e.g. cirrhosis, ascites etc.


Investigations

  • Bloods - FBC, U&Es, LFTs, CRP, INR, G&S + Crossmatch

  • Endoscopy


N.B. Glasgow-Blatchford score is used pre-endoscopy. Rockall score used post-endoscopy.


Acute Management

  • A-E assessment

  • Terlipressin - increases systemic vascular resistance, reduces CO, and reduces portal pressures (by ~20%)

    • Otcreotide is 2nd line here

  • Prophylactic Abx e.g. Ceftriaxone

  • Use Glasgow-Blatchford score to determine if to do endoscopy urgently or as an outpatient

    • Urgent endoscopy after resuscitation if the patient is unstable

    • Variceal band ligation is usually done at the same time


N.B. It’s important to stop the terlipressin once bleeding has stopped definitively.



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