Esophagus
Nonneoplastic disorders
Varices

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 17 January 2018, last major update December 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Esophageal varices[TI] free full text[sb]

Cite this page: Weisenberg, E. Varices. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusvarices.html. Accessed August 19th, 2018.
Definition / general
Clinical features
  • Present in 90% of cirrhotic patients, usually due to alcoholism; acute alcohol intake may cause death, often outside the hospital (Arch Pathol Lab Med 2002;126:1197)
  • May rupture and cause massive hemorrhage (cause of death in 50% with advanced cirrhosis)
  • 40% die in first episode of bleeding varices; rebleeding occurs in 50% of survivors within 1 year with 40% mortality
  • Blood stains at death scene and unusual body positions of deceased are clues to fatal esophageal variceal hemorrhage
  • #2 cause of bleeding varices worldwide is hepatic schistosomiasis
  • "Downhill" varices occur in upper esophagus from other causes (Rev Esp Enferm Dig 2006;98:359)
Treatment
  • Repeated sclerotherapy (injection of thrombotic agents, Ann Surg 2006;244:764), banding / ligation (Arq Gastroenterol 2005;42:72), balloon tamponade, beta blockers or octreotide to reduce portal blood flow, TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure, liver transplant
Gross description
  • Varices may protrude into lumen, mucosa may be normal or inflamed
Gross images

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Linear, dark blue, submucosal dilated veins

Partially thrombosed after sclerotherapy

Microscopic (histologic) images

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Focal rupture

Inflamed varix

Differential diagnosis hematemesis