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Gullet varicosity at children

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  


Endoscopic sign

Varicose veins

Gullet folds

Resistance when pressing

Is

No

Nodosity

»

»

Caliber of folds

Increase in diameter towards the cardia

Are not changed and break at the cardia

Endoscopic sign

Varicose veins

Gullet folds

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

No

Gullet peristaltics

Accelerated

Slow

Valsalva's test

Phlebectasia

Without changes

Inflating by air

Are seldom fallen down, usually are not fallen down

Are fallen down

"The gear line"

No

Is

Субэпителиальное расположение вен пищевода в нижней части пищевода
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  


Absolute indications

Relative indications

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

 
"Variable immunodeficiency   Gastritis"