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The Incidence of Esophageal Varices in Patients With Cirrhosis

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    Denata Prabhasiwi03009062

    The Incidence of Esophageal VaricesinPatients with Cirrhosis

    Denata Prabhasiwi03009062

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    Anatomy of

    hepar and

    portal veincirrhosis

    Esophageal

    varicesdiscussion

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    Anatomy of hepar and portal vein

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    PORTAL SYSTEM

    Superior mesenteric + Splenic vein+ gastric +part from inferior mesentric = Portal veinPortal Vein carries outflow from:1.) Spleen2.) Oesophagus3.) Stomach4.) Pancreas5.) Small and large intestine

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    HEPATIC BLOOD FLOW

    Very low pressure in

    the hepatic portal vein

    approx. 5-8 mmHgwithonly a small gradientacross the liver to thehepatic vein whichreturns the blood to theinferior vena cava

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    Cirrhosis

    Hepatis

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    Definition

    o Cirrhosis is a complication of many liver disease that ischaracterized by abnormal structure and function of theliver

    o It is characterized by widespread fibrosis with nodularregeneration. Its presence implies previous or continuinghepatic cell damage

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    A normal liver (left) shows no signs ofscarring. In cirrhosis (right), scar tissuereplaces normal liver tissue.

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    etiology

    1. Alcohol (>70%)2. Chronic infections hepatitis C, B, B+D

    brucellosis, syphilis3. Chr. biliary obstruction PBC, PSC, stricture, stones, cystic

    fibrosis, billiary atresia4. Autoimmune5. Drugs and chemical

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    pathogenesis

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    Clinical manifestation

    Many people with cirrhosis have no symptomsduring the early phases of the disease.Symptoms are caused by either of 2 problems:

    Gradual failure of the liver to carry out itsnatural functions

    Distortion of the liver's usual shape and sizebecause of scarring

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    Clinical manifestation

    Early cirrhosis : Tiredness ( fatigue) or even exhaustion Weakness Nausea Loss of appetite leading to weight loss Loss of sex drive

    http://www.emedicinehealth.com/script/main/art.asp?articlekey=26114http://www.emedicinehealth.com/script/main/art.asp?articlekey=26114
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    Clinical manifestationAdvance cirrhosis: Jaundice Spider naevi, caput Medusae Bloody, black stools or unusually light-colored stools Vomiting of blood In women, abnormal menstrual periods In men, enlargement of the breasts (gynecomastia) scrotal

    swelling

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    Visible sign ofadvance cirrhosis :

    gynecomastiaascites

    Caput medusae

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    Esophageal

    Varices

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    definition

    Esophageal varices are abnormal, enlarged veinsin the lower part of the esophagus. varices occurmost often in people with serious liver diseases.

    Esophageal varices can rupture, causing life-threatening bleeding.

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    etiology

    Severe liver scarring (cirrhosis). Blood clot (thrombosis). A parasitic infection

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    Sign and symtomsEsophageal varices usually don't cause signs andsymptoms unless they bleed. Signs andsymptoms of bleeding esophageal varicesinclude:

    Vomiting blood Black, tarry or bloody stools

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    Discussion

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    CIRRHOSIS PORTALHYPERTENSION

    ESOPHAGEALVARICES

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    Portalhypertensionresults from both:1.Increasedresistance toportal flow (R)2.Increasedportal venousinflow (Q)

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    Portal vein - Hepaticvein pressure gradientgreater than 5 mm Hg

    Portal Hypertension

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    Cirrhosis

    Increased

    splanchnic +

    peripheral NO

    Decreased systemic

    + splanchnic

    vascular resistance

    Decreased

    intrahepatic NO

    Increased

    intrahepatic

    resistance

    Collaterals

    Increase portal

    blood flow

    Maintains portal

    hypertension

    Sodium retention

    Fig 3. The pathogenesis of oesophageal varices

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    Collateral

    The portal venous system has several anastomosiswith the systemic venous system.Four collateral pathways Esophageal and gastric venous plexus umbilical vein from the left portal vein to theepigastric venous system retroperitoneal collateral vessels the hemorrhoidal venous plexus

    In cases of portal hypertension theseanastamoses may become engorged, dilated, orvaricosed and subsequently rupture

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    No varices Small varices Large varices

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    treatments

    Non selective beta blocker

    endoscopic variceal band ligationpreventbleeding

    ocreotide

    Somatostatin

    endoscopic sclerotherapy and bandingStop bleeding

    betablockers,

    endoscopic variceal ligation

    or the combination of beta-blockers and

    endoscopic variceal ligation

    TIPS (surgical)

    Preventbleeding

    occurance

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    conclusion Cirrhosis is a condition that is defined histopathologicallyand has a variety of clinical manifestations and complications,some of which can be life-threatening, portal hypertension is directly responsible for the majorcomplications of cirrhosis, variceal hemorrhage. Varicealhemorrhage is an immediate life-threatening problem with a2030% mortality associated with each episode of bleeding. There are treatments to stop bleeding in such as vaso-activedrugs, vasopressin, somatostatin, octreotide,endoscopic sclerotherapy and banding, and endoscopicvariceal ligation. -Blockers and endoscopic variceal bandligation are the treatments to prevent bleeding.

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    Thank You


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