Assessing the Risk of Bleeding

Location

The farther proximal the varices extend, the more likely they are to bleed (Fig. 3.61 a). Concomitant fundic varices are associated with an increased risk of esophageal variceal bleeding (Fig. 3.61 b).

Fig. 3.61 Signs indicating a high risk of bleeding from esophageal varices a Varices extending up into the proximal esophagus

Fig. 3.61 Signs indicating a high risk of bleeding from esophageal varices a Varices extending up into the proximal esophagus

b Fundic varices

Shape, Size

► Small, straight varices rarely bleed

► Large, nodular, tortuous varices are prone to bleeding (Fig. 3.61 c, d)

Color

The following indicate an increased bleeding risk:

► Diffuse erythema

► Dilated subepithelial venules on the varices:

- Cherry-red spots (small, flat, red spots; Fig. 3.61 e)

- Red wale markings (longitudinal red streaks; Fig. 3.61 f)

- Hematocystic spots (larger, discrete, raised spots)

c Tortuous varices d Large varices

c Tortuous varices d Large varices

f Red wale marking e Cherry-red spots f Red wale marking

Other Signs

► Signs of reflux esophagitis increase the risk of bleeding (Fig. 3.61 g)

e Cherry-red spots

g Signs of reflux disease

TO u

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