Fifth Hospitalization At age 58, Vincent was rushed to the emergency room with s

Question

Fifth Hospitalization

At age 58, Vincent was rushed to the emergency room with severe vomiting of bright red blood. On examination, he had a blood pressure of 60 mmHg / 30 mmHg. The bleeding and vomiting started abruptly while Vincent was eating some hard, dry French bread. An endoscope (i.e. a flexible tube equipped with a camera) was placed down Vincent's esophagus, and a diagnosis of esophageal varices was quickly made.

Questions:

1. What are esophageal varices?

2. Where are esophageal varices typically located? (Be specific.)

3. On the hospital chart you see two other "secondary diagnoses" listed:

(1) cirrhosis of the liver, and (2) portal hypertension.

Does this additional information help explain why Vincent developed esophageal varices? Explain your answer.

4. Why is bleeding particularly dangerous for Vincent?

Explanation / Answer

1 )ESOPHAGEAL VARICES : In Portal hypertension the portocaval anastomotic channels at the lower end of the esophagus become DILATED and TORTUOUS. These dilated vessels at the lower end of the esophagus are called ESOPHAGEAL VARICES.

2 ) Esophageal varices are located at the junction of eopesophus and stomach ( esophagogastric junction ) { Ref : Robbins pathology ). It is one of the important sites of portocaval anastomosis . Veins from the abdominal part of the esophagus partly drain into portal and partly into systemic circulation . The veins drain into pprtpo circulation through LEFT GASTRIC VEIN and into the systemic circulation through HEMIAZYGOUS VEIN .

3) Esophageal varices are due to elevated pressure in the portal circulation termed as PORTAL HYPERTENSION . Portal hypertension is most commonly found in the presence of liver cirrhosis , although it may also be present in patients with extrahepatic portal vein obstruction , intrahepatic portal vein obstruction or occlusion of main hepatic veins as in BUDD-CHIARI syndrome.

4) Bleeding is danger in this case because the blood pressure is very low . If bleeding continues patient may land in HYPOVOLEMIC SHOCK , if untreated will lead to death . Bleeding esophageal varices is a medical emergency and the patient should be admitted in ICU . Venous access should be obtained through 2 large bore peripheral cannulae . Colloids should be administered while adequate blood is obtained .

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