Varicose expanded veins are outflow collaterals from system of a portal vein at inside - and its extrahepatic block. In children's practice they more often are a consequence of portal thrombosis because of umbilical sepsis or a viral hepatitis and are one of the most frequent reasons of gastric bleedings.
Table 1. Endoscopic differential diagnostic characters varicose expanded veins of a gullet and folds of a gullet
Resistance when pressing
Caliber of folds
Increase in diameter towards the cardia
Are not changed and break at the cardia
Color of a mucous membrane
Colourless, gray or blue
Does not differ from a mucous membrane of a gullet
Spots of cherry color
At big variksa
Inflating by air
Are seldom fallen down, usually are not fallen down
Are fallen down
"The gear line"
Fig. 1. The subepithelial arrangement of veins of a gullet in the lower part of a gullet is normal (at the left) and at their varicosity (on the right): 1 — own muscular coat; 2 — muscular demolition mucous covers; 3 — a submucosal layer; 4 — an epithelium
Main clinical symptoms: plentiful vomiting with blood, the tar-like fecal masses, decrease in volume of the circulating blood. A splenomegaly, the accruing liver failure. Lag of physical development, small appetite, disturbances of a nervous system. Retrosternal pains, dysphagy, anemia. Principles of treatment. The hematemesis is usually stopped spontaneously. Means the improving functions of a liver. Introduction of sclerosing means to expanded veins of a gullet.
Acute management. Epsilonaminokapronovy acid. Pituitrinum. Sengstaken's probe — Bleykmora. To a full stop of bleeding food only parenteral. Sandostatin (oktreotid).
Table 2 Indications for endoscopic sclerotherapy of varicose veins
Urgent treatment of bleedings at which conservative actions are inefficient
Intention to perform the shunting operation
Contraindications to the shunting operations: dekompensirovanny active cirrhosis; anatomic reasons; myelofibrosis Age till 10 flyings
The preventive purposes Refusal of the patient of the shunting operation