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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