Abnormal, enlarged veins in the oesophagus

Aetiology

• Cirrhosis → portal hypertension → varices

Pathophysiology

1. Cirrhosis leads to accumulation of blood in the portal venous system → portal hypertension
2. This leads to the portosystemic shunts (anastomoses) becoming distended in an attempt to relieve increased intraluminal pressure
3. One of these anastomoses is the plexus of superficial veins around the oesophagus - vessels dilate and are often symptomatic until rupture

Clinical features

• S+S of cirrhosis/chronic liver disease
• Rupture - haematemesis, large volumes of dark red blood

Investigations

• Endoscopy

Management

Primary prophylaxis

• Non-selective β blockers
• If patient can’t tolerate β-blockers or if low compliance - EVL

Acute variceal bleeding (rupture)

1. Resuscitation - maintain pulse and blood pressure, antibiotics
2. Terlipressin (vasoconstrictor, predominantly splanchnic)
3. EVL