PANCE REVIEW: Varices

Let's head north of the heart for a while - I'm CV-system'd out for a bit. The esophagus. The must-know topics about the esophagus are below. I won't get to all of them on my blog... but you should def get to them in your studies!

Esophagitis

Motility d/o's

Mallory-Weiss tears

Neoplasms

Strictures

Varices

Let's chat about Varices today...

Def:

Dilations of veins (generally found distally)

Causes:

-Usual underlying cause is portal HTN which is usually secondary to cirrhosis

-Chronic viral HEP and NSAIDS can worsen bleeding

-*Budd-Chiari Syndrome may cause thrombosis of portal vein which can lead to varices

Dx:

-Usually diagnosed clinically

-Asymptomatic until they start to bleed - then they are LIFE THREATENING!

Tx:

-Hemodynamic support

-High vol IVF

-Vassopressors

-Endoscopic therapy+Pharm vasoconstriction

**30% of pts die during the 1st bleed, 50% of those that survive will die during the 2nd bleed**

Picture: http://www.bio.ri.ccf.org/Henderson/port.html

Source: AAPA/PAEA Exam Review Book