Oesophageal varices are dilated collateral blood vessels that develop as a direct consequence of portal hypertension as a progressive complication of cirrhosis.

• Cirrhosis - 50% of patients with cirrhosis ➡️ gastrooesophegeal varices

Aetiology

Once cirrhosis has developed, obstructed blood flow can lead to increasing hepatic vein pressure gradient and deteriorating liver function may result in the formation of oesophageal varices

Rupture of these varices can cause life-threatening bleeding. The development of bleeding carries significant morbidity and mortality.

PC

Key diagnostic factors:

*presence of risk factors for variceal bleeding - Larger varices and presence of red wale marks (on endoscopy), more severe liver disease, alcohol, IV drug use (⬆️ risk of hep B/C), hep B/C

• Haematemesis
• Malaena, haematochezia

Examination:

• Signs of liver disease - Ascites, Spider naevi, Caput medusa, jaundice, encephalopathy
• Hepatosplenomegaly

Investigations

1st Ix to order:

• FBC - Microcytic anaemia +/- thrombocytopenia
• U&Es – hyponatraemia, ⬆️ urea and creatinine (volume overload)