Esophagus
Other nonneoplastic
Varices
Author: Elliot Weisenberg, M.D.
Last author update: 1 December 2012
Last staff update: 14 September 2023
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Esophageal varices[TI] free full text[sb]
Table of Contents
Definition / general | Clinical features | Treatment | Gross description | Gross images | Microscopic (histologic) images | Differential diagnosis hematemesisCite this page: Weisenberg E. Varices. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagusvarices.html. Accessed April 16th, 2024.
Definition / general
- Dilated tortuous vessels, usually submucosal, that develop due to portal hypertension (prolonged or severe), which induces formation of collaterals between portal and caval systems (Wikipedia: Esophageal Varices [Accessed 15 February 2019], eMedicine: Portal Hypertension [Accessed 15 February 2019], eMedicine: Esophageal Varices Imaging [Accessed 15 February 2019], Mayo Clinic: Esophageal Varices [Accessed 15 February 2019])
- Collaterals in lower esophagus divert flow from portal vein, through coronary veins of stomach, into esophageal veins, then azygous veins, then into vena cava
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
Images hosted on other servers:
Linear, dark blue, submucosal dilated veins
Partially thrombosed after sclerotherapy
Microscopic (histologic) images
Images hosted on other servers:
Inflamed varix
Differential diagnosis hematemesis
- Esophageal laceration
- Gastritis
- Peptic ulcer
