Esophageal/Gastric Varices: Pathogenesis and clinical findings
Schistosomiasis
Schistosoma species enter the body through the skin and circulate to liver
Eggs lodge in terminal portal venules causing inflammation and fibrosis • 1` resistance through fibrosed and inflamed sinusoids
Cirrhosis Liver disease activates hepatic stellate cells causing hepatic fibrosis • I` resistance through fibrosed and distorted sinusoids • 1` portal inflow due to splanchnic vasodilation
Veno-Occlusive Disease Budd-Chiari Syndrome Endothelial damage Hypercoagulable in the sinusoids leads to clotting states* cause factor deposition in thrombosis of hepatic sinusoids hepatic veins 1` resistance t resistance through through hepatic occluded distal veins occluded sinusoids by thrombus

► Intra Hepatic Portal Hypertension
Post Hepatic Portal
Portal Vein Thrombosis Hypercoagulable states* cause thrombosis of portal vein
Infiltrative Lesion
• Primary or secondary malignancy localized to the portal vein
Splenic Vein Thrombosis
Pancreatitis leads to inflammation and thrombosis of the splenic vein
1 resistance through ‘1’ resistance through 1` resistance through portal vein occluded portal vein occluded by splenic vein occluded by thrombus malignancy by thrombus

Pre Hepatic Portal
Hypertension Hypertension
*Hypercoagulable states such as thrombophilia, malignancy, or connective tissue disease Portal esophageal/gastric Esophageal/Gastric blood flow backed anastomoses up into Varices As variceal pressure 1` vessels swell 4— Blood loss from circulation 1 vessel J, wall thickness 1 vessel size tension Dilation of veins in submucosa Blood oxidized and vomited or passed through GI Authors: Bigger Varices Variceal rupture Upper GI bleed Gabriel Burke Reviewers: Vadim lablokov Laura Byford-Richardson Meredith Borman* * MD at time of publication • Red Wale Mark or Cherry Red Spot Blood loss too rapid to be oxidized before emesis or passage of GI (visualized on endoscopy)
Legend:
Pathophysiology Mechanism
Sign/Symptom/Lab Finding
Complications
• Venous drainage of spleen backed up into gastric anastomoses
Tachycardia and hypotension
Anemia Death Melena Coffee ground emesis Hematemesis Bright red blood per rectum