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Esophageal varices seven days after banding, showing ulceration at the site of banding The upper two thirds of the esophagus are drained via the esophageal veins , which carry deoxygenated blood from the esophagus to the azygos vein , which in turn drains directly into the superior vena cava .
Depending on the amount of the blood loss, symptoms may include shock. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine the hemoglobin.
The esophageal veins drain blood from the esophagus to the azygos vein, in the thorax, and to the inferior thyroid vein in the neck. It also drains, although with less significance, to the hemiazygos vein , posterior intercostal vein and bronchial veins .
It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications. [4] [5] A related device with a larger gastric balloon capacity (about 500 ml), the Linton–Nachlas tube, is used for bleeding gastric varices. It does not have an esophageal balloon.
Signs and symptoms of portal hypertension include: Abdominal swelling and tightness due to ascites, which is free fluid in the peritoneal cavity [1] Vomiting blood (hematemesis) from gastric or esophageal varices; Anorectal varices [8] Increased spleen size (splenomegaly), [1] which may lead to lower platelet counts (thrombocytopenia)
The Sugiura procedure was originally developed to treat bleeding esophageal varices and consisted mainly of an esophagogastric devascularization. It was developed in Japan in 1973 [ 1 ] as a nonshunting technique that achieved variceal bleeding hemostasis by interrupting the variceal blood flow along the gastroesophageal junction.
Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse.
Minnesota four-lumen tube, with esophageal and gastric balloons, and esophageal and gastric aspirates. Balloon tamponade is considered a bridge to more definitive treatment modalities, and is usually administered in the emergency department or in the intensive-care unit setting, due to the illness of patients and the complications of the procedure.