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| Varices | ||
| Etiology •Portal hypertension | ||
| Pathogenesis •Varices represent portal-systemic venous shunts caused by an increase in portal venous pressure secondary to obstruction in portal blood flow •Since cirrhosis is the etiology in most cases, the increase in portal venous pressure is due to compression of central veins and sinusoids by fibrosis and regenerative parenchymal nodules, in addition to arterial-portal venous anastomoses within the scarred liver, | ||
| Epidemiology •The major cause of portal hypertension is hepatic cirrhosis •In the United States the most common cause of cirrhosis is alcohol abuse while in other parts of the world hepatic toxins and parasites play a role •Other causes of portal hypertension are hepatic and portal vein obstruction, parasites and granulomatous disease | ||
| General Gross Description •Linear violaceous or red protrusions into the distal esophagus representing dilated submucosal veins •Overlying mucosa is generally intact but may show evidence of inflammation primarily erythema •The surface may show superficial erosions •If variceal rupture occurs the esophagus is filled with blood and occasionaly a blood clot may be found over the site of rupture •In the resected surgical and postmortem specimen the varices collapse and a flattened violaceous linear vascular outline is seen •Examples: | ||
| General Microscopic Description •Markedly dilated submucosal veins are present •The overlying esophageal mucosa is generally normal •Partial thrombosis of varying age may be seen in the varices •Examples: | ||
| Clinical Correlation •Esophageal varices are asymptomatic until they rupture •Rupture usually results in severe bleeding with a mortality close to 50% for the first bleed •In survivors, the incidence of rebleeding is 50% in each subsequent year with a mortality of 50% with each episode of massive bleeding •Death is caused by acute blood loss and hepatic failure precipitated by the hemorrhagic episode •Survival appears related to the severity of the underlying liver disease | ||
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 759-761, 835-836 • Sleisenger MH, Fordtran JS. Gastrointestinal disease. 5th ed. Philadelphia: Saunders, 1993, pp. 172-1 Please be patient during transfer. Medline will open in a new window. To return, close the Medline Window Varices
| Synopsis by: Martin Nadel M.D. (T62000M32600)[195]
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