Varicose veins of the esophagus develops due to a violation of the flow of blood in the portal and upper hollow veins. There is no such pathology in the probe department of the esophagus or proximal department of a stomach. According to the nature of the appearance can be congenital and acquired. The last, incidentally, does not depend on the age of the patient and of the actuated state and the obstacles to the normal blood circulation in the system of the portal vein.
Varicose veins the extension of the esophagus veins accompanied by portal hypertension of different origin. This implies:
- portal the blockage of blood flow to the kidney;
- the exterior of the lock of the kidneys;
- a mixed form of lock.
Varicose veins, injury of veins of the esophagus at a younger age, more frequently caused by blocking of the liver, of the adult internal of the liver.
Causes of varicose veins of the esophagus
The cause of the disease, caused by the anatomical junction of the veins of the esophagus with the system of the portal vein, the vein the abdominal organs, especially the spleen. When the internal blocking of the blood flow of the liver pathology covers the lower departments of the esophagus, the reasons for this are stagnant processes portal vienna, the liver, which occur when:
- viral hepatitis;
- in peritonitis.
This blockage of blood circulation explains thrombosis of the portal vein, compression of their tumors, lymph node, cysts or stones in the bile ducts. Varicose veins in the departments it also happens when the evil secondary to goiter or diseases of the esophagus, as well as vascular when rare diseases.
More rarely, the disease develops when the pressure increases in the blood circulation system, which is commemorated in the case of chronic insufficiency cardiovascular. A typical symptom is that the vascular site when hepatic disease 2-3 times higher.
There are also inherently a form of varicose veins injury to the esophagus, the reasons for which it has not been clarified.
The symptoms of esophageal varices
When difficult blood outflow from the veins of the esophagus, they begin to develop the extension, tortuosity, and elongation. The walls of the vessels when you do this, the antarctic, and can break, which implies the development of a bleeding. Failures of light-vessel venous not swung grow, form local extension as we.
The evolution of the disease can be fast, but it can happen extremely slow. Very often confirm the disease for several years may not manifest itself. The patient is disturbed only some uncertain complaints, among them:
- a tightness in the chest;
- the phenomenon of the esophagitis.
The approximate age of patients is about 50 years old, men between the patients with two times more than women.
The development of bleeding is the most dreaded complication of varicose veins of the esophagus. It can flow seamlessly to the patient, and may represent a risk to your life. The main symptom is the vomiting of blood devil. Even non-hazardous with the mind, without the knowledge of everything, but regular blood can cause iron deficiency anemia.
The reason for the development of this bleeding can be:
- the elevation of the blood pressure;
- the weight lifting;
- febrile state.
Sometimes this bleeding can occur suddenly, among the total of health, and, having abundant of nature, lead to death. The predecessors of it are easy to feel a tickling sensation in the throat, characteristic salty bad taste in the mouth. Soon after their emergence occurs unexpectedly vomiting devil or remember coffee grounds blood. Sometimes, the bleeding leads to the execution of the disease, the who says about the need for the more possible the early diagnosis of the disease.
Varicose veins of the esophagus and cirrhosis of the liver
Varicose veins of the esophagus can be observed in 70% of cirrhotic patients. This phenomenon is due to the fact that, when a cirrhosis of the liver, occurs the formation of scarry tissues, preemptive healthy cells. This slows down the movement of the blood and causes stagnation of the phenomenon, which serve the cause of development of this pathology in the lower part of the departments of the esophagus. Varicose veins bleeding are the cause of death is suffering from cirrhosis in 10-15% of cases. The most formidable of the diagnostic symptom early recurrence.
For this reason, patients cirrhosis of the liver, should be subject to regular endoscopic observation surveys in order to identify the varicose veins. In the absence of expansion of esophagus veins the frequency of such examinations should be once in 2 years, if there is one or 2 times per year. The frequency and the degree detected varicose veins usually proportional to the severity of the cirrhosis.
In the treatment of such patients is given great importance in the prevention of recurrent bleeding. It is based on the application of medicines, reduction in portal pressure, endoscopic sclerotherapy, and surgical techniques. It should be noted that relapse prevention has more for worse results, than the prevention of the first episode of bleeding.
For the diagnosis of apply to the following types of research:
- laboratory tests;
- Ultrasound of the liver;
- examinations search.
The main thing here is the execution of a procedure, which gives the opportunity to define the causes of bleeding, determine the state of the venous walls and the degree of dilation of the veins, and also to predict the break of a aneurysm. If the bleeding has already started, its cause is difficult to install due to the difficulties in the realization of an efficient esophagoscopy.
Part of the information about the state of the esophagus, and the nature of varicose veins can get based on the x-ray of the esophagus, done with contrast.
As well as the state of the varicose veins are usually associated with serious diseases of the liver, it is important to assess the degree of possible coagulopathy. To do this, perform general blood tests with the definition of platelet count and prothrombin index, as well as liver tests. When you have bleeding should be set, blood group, rh factor and cross testing of compatibility of red blood cells.
For the differential diagnosis needs to rule out the possibility of many other diseases, such as:
- peptic ulcer;
- diseases of the heart;
- the haemorrhagic diathesis.
Treatment of esophageal varices
Treatment of esophageal varices is directed to the elimination of diseases, which led to an increase in pressure in the portal system and the vena vein, and also to eliminate the threat of a possible bleeding. The measures also include the prevention of esophagitis, saving the life style, the reception drug means – antacids, vitamins, laxatives.
When you have a bleeding are taken the following measures:
- introduction vasoconstrictor drugs;
- a tightening of the vessels of the esophagus special devices;
- a special application of the probe for cryosurgery;
To compensate for the loss of a patient's blood is run it transfusion, infusion of red blood cells or plasma - solution.
When the massive bleeding is a need for more serious surgical intervention, which can significantly reduce the mortality. Seen that, when the conservative treatment the mortality is 3 times higher in comparison with the surgery. Include palliative and radical surgery to correct the bleeding esophageal.
Endoscopic treatment methods
Currently, there is a significant experience of the use of endoscopic minimally invasive intervention for the resolution of bleeding extended esophageal veins.
Endoscopic hardening was described for the first time in 1939. Only in the 70's of the last century, in connection with the development and improvement in endoscopic facilities was developed intense the implementation of the method in practice. While he apply the means with a different mechanism of action.
To improve the results of sclerotherapy help the application of balloon tamponade.
Good results allows to achieve the method endoscopic doping, which was offered in the year 1985. Respectively you the cessation of blood flow in the veins of the esophagus is made by alloying of the rings. The relapse after the intervention were observed only in 17% of patients, which is almost the half of that after of sclerosing.
This method helps to stop the bleeding by means of contractions bleeding site. It is quite dangerous and should only be performed by an experienced technician. The main tool is a probe special, equipped with a tank. Stop the bleeding is obtained with the help of inflate gastric balloon and traction without default paragraph
The treatment of the pressure from the gas cylinder. Thanks to this feat tamponade varices, and decreases the intensity of the bleeding venous plexus. Inflating the balloon disease is very rare, which explains the risk of possible complications.
The efficiency of the use of balloon tamponade is 90%.
The surgical techniques of treatment
For the treatment of this disease apply to the following surgical methods:
- special bypass system within the liver (TIPS);
- bypass surgery;
- and Dr.
The technique of TIPS is the creation of the intrahepatic artificial channel between the hepatic and portal veins and install in your ducts metal of the stent. Thanks to her, almost always it is possible to stop the bleeding, including not to give in to other types of therapy. The main disadvantage of the technique is its high complexity and required the subsequent development of hepatic encephalopathy.
The efficiency of the bypass close to the efficiency TIPS when much greater trauma. The occurrence of hepatic encephalopathy is also a serious problem.
Some operations consist in the junction of the esophagus. This type of operation effectively help stop the bleeding, not eliminating the causes of portal hypertension, leading to rapid recurrence of the development of this pathology.
The forecast is determined the weight of being the main disease of the liver. In general, varicose veins is characterized by a high mortality exceeding 50%. Lethality is not determined by the weight of a hemorrhage, and the nature of diseases of the liver, led to it.
Although 80% of patients with bleeding stop on its own, disappears when you do this, particularly the patients, what characterizes a good functional state of the liver, but for patients with severe failure, hepatocellular, which often turns out to be fatal.
The survivors after bleeding in patients of 75% of the cases in the next 1-2 years, there was a relapse. Reduces the risk of regular medication and endoscopic treatment of varicose veins.
In general, the prediction of long-term survival of patients, the disease continues to be low, which, primarily, serves as the main cause of liver disease.