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Varizen Grade 1



Esophageal Varices Imaging: Overview, Radiography, Computed Tomography Varizen Grade 1

Esophageal varices sometimes spelled oesophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. Esophageal varices are typically diagnosed through an esophagogastroduodenoscopy. The upper two thirds of the esophagus are drained via the esophageal veinswhich carry deoxygenated blood from the esophagus to the azygos veinwhich in turn drains directly into the superior vena cava.

These veins have no part in the development of esophageal varices. The lower Varizen Grade 1 third of the esophagus is drained into the superficial veins lining the esophageal mucosa, which drain into the left gastric vein coronary veinwhich in turn drains directly into the portal vein.

This means that collateral circulation develops in the lower esophagusabdominal wall, stomachand rectum. The small blood vessels in these areas become distended, becoming more thin-walled, and appear as varicosities. In situations where portal pressures increase, such as with cirrhosisthere is dilation of veins in the anastomosisleading to esophageal varices. Splenic vein thrombosis is a rare condition that causes esophageal varices without a raised portal pressure. Splenectomy can cure the variceal bleeding due to splenic vein thrombosis, Varizen Grade 1.

Varices can also form in other areas of the body, including the stomach gastric varicesduodenum duodenal varicesand rectum rectal varices. Treatment of these types of varices may differ, Varizen Grade 1. In some cases, schistosomiasis also leads to esophageal varices. In ideal Varizen Grade 1, patients with known varices should receive treatment to reduce their risk of bleeding.

The Varizen Grade 1 of this treatment has been shown by a number of different studies. When medical contraindications to beta-blockers exist, such as significant reactive airway disease, then treatment with prophylactic endoscopic variceal ligation is often performed.

In emergency situations, care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics such as quinolones or ceftriaxone. Blood volume resuscitation should be done promptly and with caution. Resuscitation of all lost Varizen Grade 1 leads to increase in portal pressure leading to more bleeding.

Volume resuscitation can also worsen ascites and increase portal pressure, Varizen Grade 1. Therapeutic endoscopy is considered the mainstay of urgent treatment. The two ins Leben gerufen Varizen Foto therapeutic approaches are Penisvene Thrombophlebitis ligation or banding and sclerotherapy.

In cases of refractory bleeding, balloon tamponade with a Sengstaken-Blakemore tube may be necessary, usually as a bridge to further endoscopy or treatment of the underlying cause of bleeding usually portal hypertension. Esophageal devascularization operations such as the Sugiura procedure can also be used to stop complicated variceal bleeding.

Methods of treating the portal hypertension include: Nutritional supplementation is not necessary if the patient is not eating for four days or less. Terlipressin and octreotide for 1 to 5 days have also been used. 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. Evidence of recent Forum für die Behandlung von venösen Ulzera hemorrhage includes necrosis and ulceration of the mucosa.

Varizen Grade 1 of past variceal hemorrhage includes inflammation and venous thrombosis. From Wikipedia, the free encyclopedia. N Engl J Med. Prevention and management of gastroesophageal varices Varizen Grade 1 variceal hemorrhage in cirrhosis. A randomized controlled study".

Diseases of the digestive system primarily K20—K93— Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption.

Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus. Upper Hematemesis Melena Lower Hematochezia, Varizen Grade 1. Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum. Cardiovascular disease vessels I70—I99— Arteritis Aortitis Buerger's disease. Carotid artery stenosis Renal artery stenosis. Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon.

Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia, Varizen Grade 1. Cherry hemangioma Halo nevus Spider angioma. Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer.

Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension. Retrieved from " https: Esophagus disorders Diseases of veins, lymphatic vessels and lymph nodes Medical emergencies. Views Read Edit View history. In other projects Wikimedia Commons. This page was last edited on 28 Septemberat By using this site, you agree to the Terms of Use and Privacy Policy.

Gastroscopy image of esophageal varices with prominent cherry-red spots. Inflammation Arteritis Aortitis Buerger's disease. Hypertension Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Schwangerschaft mit Krampfadern Uterus hypertension White coat hypertension.


Varizen Grade 1

Apr 25, Varizen Grade 1, Author: They are native veins that serve Varizen Grade 1 collaterals to the central venous circulation when flow through the portal venous system or superior vena cava SVC is obstructed.

Esophageal varices are collateral veins within the wall of the esophagus that project directly into the lumen. The veins are of clinical concern because they are prone to hemorrhage, Varizen Grade 1. Paraesophageal varices are collateral veins beyond the adventitial surface of the esophagus that parallel intramural esophageal veins.

Paraesophageal varices are less prone to hemorrhage. Esophageal and paraesophageal varices are slightly different in venous origin, Varizen Grade 1, but they are usually found together.

Using a thin-barium technique, radiographic appearances of esophageal varices were described first by Wolf in his paper, "Die Erkennug von osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices.

Today, more sophisticated imaging with computed tomography CT scanning, magnetic resonance imaging MRImagnetic resonance angiography MRAand endoscopic ultrasonography Varizen Grade 1 plays an important role in the evaluation of portal hypertension and esophageal varices.

Endoscopy is the criterion standard for evaluating esophageal varices and assessing the bleeding risk. Varizen Grade 1 procedure involves using a flexible endoscope inserted into the patient's mouth and through the esophagus to inspect the mucosal surface.

The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a significant risk for bleeding. The grading of esophageal varices and Varizen Grade 1 of red wheals by endoscopy predict a patient's bleeding risk, Varizen Grade 1, on which treatment is based.

Endoscopy is also used for interventions. The following pictures demonstrate band ligation of esophageal varices. CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation.

These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for a specific etiology of esophageal varices, Varizen Grade 1. These modalities also have an advantage over both endoscopy and angiography because they are noninvasive. CT scanning and MRI do not have strict criteria for evaluating the bleeding risk, and they are not as sensitive or specific as endoscopy.

CT scanning and MRI may be used as alternative methods in making the diagnosis if endoscopy is contraindicated eg, in patients with a recent myocardial infarction or any contraindication to sedation, Varizen Grade 1. In the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, current CT scanning Varizen Grade 1 MRI procedures have become equally sensitive and specific in the detection of esophageal varices and other abnormalities of the portal venous system.

Although the surrounding anatomy cannot be evaluated the way they can be with CT scanning or MRI, Varizen Grade 1, angiography is advantageous because its use may be therapeutic as well as diagnostic. Ultrasonography, Varizen Grade 1, excluding EUS, and nuclear medicine studies are of minor significance in the evaluation of esophageal varices, Varizen Grade 1.

Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique, Varizen Grade 1.

Barium swallow examination is not a Varizen Grade 1 test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention, Varizen Grade 1. However, in severe disease, esophageal varices may be prominent. CT scanning and MRI are useful in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical clips may create artifacts that obscure portions of the portal venous system. Disadvantages of CT scanning include the possibility of adverse reactions to the contrast agent and an inability to quantitate portal venous flow, which is an advantage of MRI and ultrasonography, Varizen Grade 1.

Plain radiographic findings are insensitive and nonspecific in the evaluation of esophageal varices. Plain radiographic findings may suggest paraesophageal varices. Anatomically, paraesophageal varices are outside the esophageal wall and may create abnormal opacities. Esophageal varices are within the wall; therefore, they are concealed in the normal shadow of the esophagus.

Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension, [ 14 ] and the most common was obliteration of Varizen Grade 1 short or long segment of the descending aorta without Varizen Grade 1 definitive mass shadow.

Other plain radiographic findings included a posterior mediastinal mass and an apparent intraparenchymal mass. On other images, the intraparenchymal masses were confirmed to be varices in the region of the pulmonary ligament. On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to Thrombophlebitis Balakovo pulmonary vasculature.

In addition, Varizen Grade 1, a widened, superior mediastinum may be shown. A widened, superior mediastinum may result from dilated collateral veins or the obstructing mass, Varizen Grade 1. Endoscopy is the criterion standard method for diagnosing esophageal varices. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not available see the images below.

Pay attention to technique to optimize detection of esophageal varices. The procedure should be performed with the patient in the supine or slight Trendelenburg position.

These positions enhance gravity-dependent flow and engorge the vessels. The patient should be situated in an oblique projection and, therefore, in a right anterior oblique position to the image Varizen Grade 1 and a left posterior oblique position to the table.

This positioning prevents overlap with the spine and further enhances venous flow. A thick barium suspension or paste should be used to increase adherence to the mucosal surface. Ideally, single swallows of a small amount of barium should be ingested to minimize peristalsis and to prevent overdistention of the esophagus.

If the ingested bolus is too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed Varizen Grade 1, rendering esophageal varices invisible. In addition, a full column of dense barium may white out any findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it progresses caudally.

Effervescent crystals may be used to provide air contrast, but crystals may also cause overdistention of the esophagus with gas and thereby hinder detection of esophageal varices. In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices. The patient is asked to "bear down as if you are having a bowel movement" or asked to "tighten your stomach muscles as if you were doing a sit-up, Varizen Grade 1.

The Valsalva maneuver also traps barium in the distal esophagus and allows retrograde flow for an even coating.

Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be followed up with CT scanning or a barium study to differentiate the findings from a hiatal hernia, posterior mediastinal mass, or other abnormality eg, rounded atelectasis, Varizen Grade 1.

Similarly, barium studies or CT scan findings suggestive of esophageal varices should be followed up with endoscopy, Varizen Grade 1.

Endoscopic follow-up imaging can be used to evaluate the grade and appearance of esophageal varices to assess the bleeding risk. The results of this assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies.

With endoscopy, the 2 entities can be differentiated easily. The only normal variant is a hiatal hernia. The rugal fold pattern of a hiatal hernia may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction, Varizen Grade 1.

CT scanning is an excellent method for detecting moderate to large esophageal varices and for evaluating the entire portal venous system. CT scanning is a minimally invasive imaging modality that involves the use of only a peripheral intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images below.

A variety of techniques have been described for the Varizen Grade 1 evaluation of the portal venous system. Most involve a helical technique with a pitch of 1, Varizen Grade 1. The images are reconstructed in 5-mm increments. The Varizen Grade 1 of contrast material and the delay time are slightly greater than those in conventional helical CT scanning of the abdomen.

The difference in technique ensures adequate opacification of both the portal venous and mesenteric arterial systems. On nonenhanced studies, esophageal varices may not be depicted well. Only a thickened esophageal wall may be found.

Paraesophageal varices may appear as enlarged lymph nodes, posterior mediastinal masses, or a collapsed hiatal hernia. On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus. The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen.

Paraesophageal varices are easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat. On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar to that of uphill varices, varying only in location. Because the etiology of downhill esophageal varices is usually secondary to superior vena cava SVC obstruction, Varizen Grade 1, the physician must be aware of other potential collateral pathways that may suggest the diagnosis.

Stanford et al published data based on venography, [ 19 ] describing 4 patterns of flow in the Varizen Grade 1 of SVC obstruction Varizen Grade 1 follows [ 19 ]:.

In a retrospective investigation, Cihangiroglu et al analyzed CT scans from 21 studies of patients with SVC obstruction [ 20 ] and described as many as 15 different collateral pathways. Of their total cohorts, Varizen Grade 1, only 8 could be characterized by using the Stanford classification. In the setting of SVC obstruction, the most common collateral pathways were the in decreasing order of frequency: In a study by Zhao et al of row multidetector CT portal venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and esophageal varices, [ 21 ] 50 of the 52 cases showed an origin from the posterior branch of left gastric vein, whereas the others were from the anterior branch.

Fifty cases demonstrated their locations close to the esophageal-gastric junction; the other 2 cases Varizen Grade 1 extended to the inferior bifurcation of the trachea.

Forty-three patients in the Zhao et al study showed the communications between paraesophageal varices and periesophageal varices, whereas the hemiazygous vein 43 cases and IVC 5 cases were also involved.

CT scanning is a minimally invasive method used to detect moderate to large esophageal varices and to evaluate the entire portal venous system. CT scans also help in evaluating the liver, other venous collaterals, details of other surrounding anatomic structures, and the patency of the portal vein.

In these situations, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are Thrombophlebitis der unteren Gliedmaßen Vishnevsky Salbe useful in predicting variceal hemorrhage. Compared with angiography, CT scanning is superior in detecting paraumbilical and retroperitoneal varices and at providing a more thorough Varizen Grade 1 of the portal venous system without the risk of intervention.

In the detection of esophageal varices, CT scanning is slightly better than angiography. CT scanning and angiography are approximately equal in the detection of varices smaller than 3 mm, Varizen Grade 1. If CT scans do not demonstrate small varices, they are unlikely to be seen on angiograms, Varizen Grade 1.

Contrast-enhanced CT scanning is essential for evaluating esophageal varices. Contrast enhancement greatly increases the sensitivity and specificity of the examination and reduces the rate of false-positive or false-negative results.


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