Esophageal Varices
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1. What mechanisms are involved in the development of this lesion in the esophagus? Instead of returning directly to the heart, venous blood from the Git is delivered to the liver via the portal vein before reaching the inferior vena cava. This circulatory pattern is responsible for the first pass effect in which drugs and other materials absorbed in the intestines are processed by the liver before entering the systemic circulation. Diseases that impede this flow can cause portal hypertension and can lead to the development of esophageal varices, an important cause if esophageal bleeding. Severe portal HTN induces collateral bypass channels a. b/n the portal & caval circulation b. Congested subepithelial & submucosal veins in the distal esophagus (varices) Alcoholic Cirrhosis is the most common cause c. 90% of cirrhotic patients d. Hepatic schistosomiasis is the 2 nd most common cause 2. What structural changes in the esophagus are seen in this lesion? The tortuous dilated veins are present in the distal esophageal mucosa a. Causes irregular protrusions of overlying mucosa b. Superficial ulceration, inflammation /adherent blood clots
description
systemic pathology
Transcript of Esophageal Varices
1. What mechanisms are involved in the development of this lesion in the esophagus?Instead of returning directly to the heart, venous blood from the Git is delivered to the liver via the portal vein before reaching the inferior vena cava. This circulatory pattern is responsible for the first pass effect in which drugs and other materials absorbed in the intestines are processed by the liver before entering the systemic circulation. Diseases that impede this flow can cause portal hypertension and can lead to the development of esophageal varices, an important cause if esophageal bleeding.
Severe portal HTN induces collateral bypass channelsa. b/n the portal & caval circulationb. Congested subepithelial & submucosal veins in the distal esophagus (varices)Alcoholic Cirrhosis is the most common causec. 90% of cirrhotic patientsd. Hepatic schistosomiasis is the 2nd most common cause
2. What structural changes in the esophagus are seen in this lesion?The tortuous dilated veins are present in the distal esophageal mucosaa. Causes irregular protrusions of overlying mucosab. Superficial ulceration, inflammation /adherent blood clots
FIGURE 17-8 Esophageal varices. A, This angiogram shows several tortuous esophageal varices. B, Collapsed varices are present in this postmortem specimen corresponding to the angiogram in A. The polypoid areas represent previous sites of variceal hemorrhage that have been ligated with bands. C, Dilated varice beneath intact squamous mucosa.
Varices can be detected by venogram and appear as turtous dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach. Venous channels directly beneath the esophageal epithelium may become massively dilated. Varices may not be grossly obvious in surgical or post-mortem specimens, because they collapse in the absence of blood flow and when they are not ruptured, the overlying mucosa is intact. Variceal rupture results in haemorrhage into the lumen or esophageal wall, in which case the overlying mucosa appears ulcerated and necrotic. If rupture has occurred in the past, venous thrombosis, inflammation, and evidence of prior therapy may also be present.
