Varices oesophageal

Substantial shunting of portal venous blood into the systemic circulation through oesophageal varices and other systemic connexions, including those surgically established, restricts the hepatic clearance of nitrogenous waste products, and the formation of... 

It is a sclerosing agent for bleeding oesophageal varices, varicose veins, bleeding gastroduodenal ulcers etc. 

It is indicated in the treatment of small, uncomplicated varicose veins of the lower extremities, haemangioma, ganglionoma, oesophageal varices. 

Ioannou GN, Doust J, Rockey DC. Systematic review ter-lipressin in acute oesophageal variceal haemorrhage. Aliment Pharmacol Ther 2003 17 53-64. 

Pugh RNH, Murray-Lyon IM, Dawson JL et al. (1973) Transection of the oesophagus for bleeding oesophageal varices. Brit J Surg 60 646-649... 

Terlipressin is the lysine ester of vasopressin. Vasopressin is a vascular constrictor particularly in the portal vein. It prevents oesophageal varices from enlarging by decreasing portal vein blood flow. It also counteracts peripheral vasodilatation and generally diverts blood flow back to the kidneys. 

High blood pressure in the portal veins (due to scarring), causing dilated, twisted veins to form at the lower end of the oesophagus (oesophageal varices), in the stomach (gastric varices) or... 

Gastric and oesophageal varices are abnormally dilated collateral vessels in the stomach or oesophagus which arise as a result of increased portal vein pressure (portal hypertension) in cirrhosis or portal vein obstruction. The collateral vessels, or varices, enable blood to bypass... 

In a controlled trial involving eight decompensated cirrhotic patients (compared to six cancer patients with normal liver/kidney function), the half-life of morphine was increased and the clearance was reduced. The differences were statistically significant. Patients in this trial were administered a single dose of 4 mg FV morphine and, on a separate occasion, a single dose of 10 mg oral morphine. All patients had a history of encephalopathy, six had ascites, and two had oesophageal varices. There were many inadequacies in this trial one patient only received 5 mg oral morphine one received the IV dose but not the oral dose one did not receive the IV dose and the control group was administered 20 mg oral morphine rather than 10 mg [59]. 

Consensus guidelines on the management of osteoporosis associated with chronic liver disease recommend oral calcium and vitamin D supplementation plus transdermal HRT as first-line therapy for women with established osteoporosis. Transdermal oestradiol should be used at a dose of 50 pg/day (equivalent to 2 mg daily of oral oestradiol). This should be given in combination with a progestogen in women with an intact uterus [4]. Oral bisphosphonates should be avoided in cirrhotic patients who may have portal hypertension and oesophageal varices because of their potential to precipitate a variceal bleed [4, 27],... 

BUSULFAN TIOGUANINE t risk of nodular regenerative hyperplasia of the liver, oesophageal varices and portal hypertension Mechanism uncertain Monitor liver function and for clinical and biochemical indices of liver toxicity (e.g. ascites, splenomegaly). Ask patients to report any symptoms suggestive of oesophageal bleeding... 

Alimentary active peptic ulcer, active inflammatory bowel disease, oesophageal varices, imcompensated hepatic cirrhosis... 

In bleeding oesophageal varices in hepatic cirrhosis, use is made of the vasoconstrictor effect of vasopressin (as terlipressin, a vasopressin prodrug) see page 654. 

Vasopression (antidiuretic hormone) is used both for its vasoconstrictor effect (in the treatment of oesophageal varices) and for its antidiurecic action. 

Proof of collateral flow in bleeding oesophageal varices... 

Vitamin A intoxication Prolonged and marked vitamin A intoxication leads to a substantial increase in individual Ito cells. This in turn causes constriction of the sinusoids the accompanying fatty degeneration of the hepatic cells supports this obstructive effect. The Ito cells are responsible for perisinusoidal fibrosis. The liver surface is strikingly smooth despite marked portal hypertension (often with considerable oesophageal varices). (119) (s. figs. 14.2, 14.3)... 

Endoscopic sonography is ideally suited for displaying intramural and perimural oesophageal varices. (134) (s. fig. 19.6) Endoscopic colour Doppler sonography is... 

Forms Portal pressure WHVP Spleno- megaly Oesophageal varices Asdtes... 

Oesophageal variceal pressure The size of the oesophageal varices does not correlate with the magnitude of the portal venous pressure, but it does correlate with the oesophageal variceal pressure. This measurement is defined as the difference in pressure between the oesophageal lumen and the varix lumen. Measuring is done by fine-needle aspiration of a varix and the use of an extracorporeal pressure recorder. The procedure is technically simple and reliable ... 

The frequency, localization and severity of oesophageal varices determine the life span of patients with portal hypertension. Oesophageal varices can be detected in about 80% of patients (i.e. some 20% of patients surprisingly do not present varices). In 90-95% of cases, the varices are located in the lower and central thirds of the oesophagus. The simultaneous occurrence of gastric fundic varices is only observed in 5-10% of patients. Regression of oesophageal varices (e.g. after alcohol abstinence) may occur. 

The radiographic detection or monitoring of oesophageal varices using contrast medium is only carried out in rare cases (after immobilizing the oesophagus by medication). When this procedure is applied, the areas of the cardiac and fornix fundus should be carefully examined, (s. fig. 14.9)... 

Portosystemic collaterals can divert up to 80% of the portal vein blood away from the liver. This initially results in haemodynamic disorders with subsequent (multifactorial) hyperdynamic splanchnic circulation. More and more varices develop around the bypasses in various venous areas, primarily in the form of oesophageal varices. Damage to the mucous membrane in the stomach and in the colon takes the form of hypertensive... 

Oesophagogastroscopy An ascites-related gastro-oeso-phageal reflux can result in reflux oesophagitis. However, this does not provoke the onset of bleeding from oesophageal varices. 

Results The results of paracentesis have generally been good up to now the number of successfully treated patients was higher, inpatient hospitalization was shorter, and complications were less frequent or less severe. The response to diuretic therapy improved considerably discontinued diuretic therapy could be successfully taken up again. (158,159) Plasma values of renin, aldosterone and norepinephrine dropped. There was an improvement in lung volume (141,143) as well as in cardiac function values. (152,153,156) The pressure in the oesophageal varices fell. (150) Paracentesis of 6 litres of ascitic fluid removes 6 X 130 mmol sodium. 

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