PATHOLOGY
The collateral channesl that open up
are:
*
The coronary veins that connect the azygos
and hemiazygos
veins (SV) with the oesophageal
veins (PS) which are dilated
due to the increased pressure.
*
The superior hemorrhoidal veins (PS) that connect with
the
middle and inferior hemorrhoid veins (SV)
*
Umbilical (PS) and paraumbilical veins (SV) giving rise to the
caput medusa.
*
Retroperitoneal veins.
OESOPHAGEO-GASTRIC VARICES
The
increase in pressure causes a dilatation of the
submucosal
veins.
*
Later, the mucosa atrophies and
the wall of the veins forms
the inner lining of the oesophagus.
*
The veins of the fundus of the stomach may also be involved.
*
Rupture of these vessels can
occur at any time resulting in
serious manifestation of haematemesis.
TREATMENT
Treatment is directed at prompt
control of the bleeding by :
*
Ballon tamponade with Sengstaken Blakmore tube Fig. above
*
Sclerotherapy of the bleeding veins
5-6 cc of
selorosant (Ethanomoline 5%) into
each of the
venous columns a fibroptic gastoscope is required and the
columns are injected above the
gastroesophageal junction
other sclerosants used
are absolute alcohols
sodium
morrhuate.
*
Surgical treatment attempts to reduce pressure by a
porto-
caval shunt operation or
Splenic vein can be joined to the renal vein
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