Anatomy

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Esophageal varices are distended submucous veins that project into the esophageal lumen. They are part of the collateral circulation that develops between the portal vein and vena cava in response to portal hypertension. They develop from the plexus of esophageal veins that drain into the azygos and hemiazygos veins. They receive blood from the left gastric vein and its esophageal branches and also from the short gastric veins via the splenic vein (Fig. 3.56).

Azygos vein Esophagus

Esophageal veins

Hemiazygos vein

Short gastric veins

Liver

Left gastric vein

Portal vein Superior mesenteric vein

Inferior mesenteric vein

Azygos vein Esophagus

Esophageal veins

Hemiazygos vein

Short gastric veins

Liver

Left gastric vein

Spleen

Splenic vein Stomach

Fig. 3.56 Portocaval anastomoses in portal hypertension

Spleen

Splenic vein Stomach

Fig. 3.56 Portocaval anastomoses in portal hypertension

- Distended vein located at the level of the mucosa or raised slightly above it

- May collapse when the esophagus is inflated with air

- Affected vein may be bluish, grayish, occasionally whitish, or of normal color

- One or more straight varices

- Varices project markedly into the lumen

- Varices do not collapse completely in response to air insufflation

- Tortuous, "string of beads", irregular calibers, may show circumscribed nodularity

- Occlude most or all of the esophageal lumen

- Convoluted varices with nodular thickening

- "Red signs" indicating a high bleeding risk (see p. 87)

Differential diagnosis

► Dilated veins

► With circumscribed nodular varices: hemangioma, leiomyoma (Fig. 3.59)

Checklist for endoscopic evaluation

► Location and extent in centimeters from the incisor teeth

► Grading: size in millimeters and in relation to esophageal lumen

► Color, signs of high bleeding risk

► Shape: straight, nodular, convoluted

► Fundic varices? Hypertensive gastropathy?

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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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