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Axial CT showing esophageal varices in liver cirrhosis with portal hypertension. Dilated submucosal veins are the most prominent histologic feature of esophageal varices. The expansion of the submucosa leads to elevation of the mucosa above the surrounding tissue, which is apparent during endoscopy and is a key diagnostic feature.
Endoscopic image of esophageal varices being ligated with rubber bands. The varix being ligated has a longitudinal red mark on it, termed the wale mark. A wale mark, red wale sign or wale sign is an endoscopic sign suggestive of recent hemorrhage, or propensity to bleed, seen in individuals with esophageal varices at the time of endoscopy.
Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the ...
The diagnosis of gastric varices is often made at the time of upper endoscopy. [1]The Sarin classification of gastric varices identifies two types of gastroesophageal varices, where esophageal varices are found concurrently, and two types of isolated gastric varices, found in the absence of esophageal varices.
Treatment (banding/sclerotherapy) of esophageal varices; Injection therapy (e.g., epinephrine in bleeding lesions) Cutting off of larger pieces of tissue with a snare device (e.g., polyps, endoscopic mucosal resection) Application of cautery to tissues; Removal of foreign bodies (e.g., food) that have been ingested
Forrest's classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality.It is also a significant method of prediction of the risk of rebleeding and very often is used for evaluation of the endoscopic intervention modalities. [3]
Those with chronic PVT may undergo upper endoscopy (esophagogastroduodenoscopy, EGD) to evaluate the presence of concurrent dilated veins (varices) in the stomach or esophagus. [3] Other than perhaps slightly elevated transaminases, laboratory tests to evaluate liver function are typically normal. [1]
The esophageal balloon should not remain inflated for more than six hours, to avoid necrosis. The gastric lumen is used to aspirate stomach contents. [citation needed] Generally, Sengstaken–Blakemore tubes and Minnesota tubes are used only in emergencies where bleeding from presumed varices is impossible to control with medication alone.