Gullet varicosity — the pathological change of veins of a gullet which is characterized by uneven increase in their gleam with protrusion of a wall, development of uzlovatopodobny crimpiness of vessels.
Epidemiology The disease meets rather often, however true frequency is not known.
Etiology and pathogeny The varicosity of a gullet arises owing to: a) the increased receipt of blood in them through an anastomosis in the field of the cardia with v. v. gastricae at portal hypertensia at patients with cirrhosis, her tumors, at thrombophlebitis of hepatic veins (Kiari's syndrome), anomalies and prelums of a portal vein etc.; b) prelums of an upper vena cava; c) the general increase of pressure in a big circle of blood circulation at heart failure.
At pathoanatomical research find expanded gyrose veins of a gullet and quite often cardial department of a stomach. The mucous membrane over veins is often thinned, can be inflamed, an erozirovana. After severe bleedings of a vein are fallen down owing to what a perforation opening from which there was bleeding, imperceptibly.
Clinical picture, preliminary diagnosis Usually the gullet varicosity before developing of bleeding proceeds asymptomatically or with insignificant symptoms (unsharply expressed dysphagy, heartburn etc.) which pale into insignificance with signs of a basic disease (cirrhosis, cancer, heart failure, etc.). Varicose veins of a gullet can be found at X-ray inspection: scalloped gear contours of a gullet, rough gyrose folds of a mucous membrane, small roundish or longitudinal defects of filling, serpantinopodobny sites of the lowered shadow density are characteristic. However more reliable data are obtained at an ezofagoskopiya which should be carried out carefully because of danger of bleeding at a vein wall injury. An indirect way the conclusion can be drawn on a possibility of a varicosity of a gullet in the presence at the patient of other symptoms of portal hypertensia.
Complications: chronic esophagitis, esophageal bleeding. The last quite often happens sudden and profuse, in 25 — 50% of cases is a cause of death of the patient. Esophageal bleeding is shown by vomiting the dark not changed blood, at less severe bleeding and accumulation of blood in a stomach — "a coffee thick". Then the melena joins.
At the formulation of the diagnosis specify the basic disease which caused this syndrome then in the beginning — a varicosity of a gullet and complication (at their existence).
Differential diagnosis, verification of the diagnosis At X-ray inspection there can be differential and diagnostic difficulties with an esophagitis, a gullet tumor. Esophageal bleeding even in the presence of a varicosity can be caused by a round ulcer of a gullet, the breaking-up tumor, Mallory's syndrome — Weiss (who is characterized by a sudden rupture of a mucous membrane in a cardia zone, usually against vomiting) and other reasons. The final diagnosis of a varicosity of a gullet is established on the basis of data of contrast roentgenoscopy (or a X-ray analysis), by ezofagoskopiya.
Treatment Treatment of patients with a varicosity of a gullet is directed to elimination of threat of esophageal bleeding. In more exceptional cases it is reached by effective treatment of a basic disease (heart failure, a parasitic invasion of a liver, etc.), in the same cases when it is impossible, recommend (at portal hypertensia) surgical treatment — imposing of the porto-caval or splenorenalny anastomosis providing an additional outflow tract of blood from a portal vein in lower hollow. More often the patient of a sparing diet should be limited to appointment, reduction of exercise stresses and periodic use of the knitting and antiacid drugs for the purpose of prevention and treatment of a peptic esophagitis (the last owing to transition of an inflammation to expanded walls of veins of a gullet usually and leads to bleeding).
Fight against esophageal bleeding is carried out by means of a special probe like Sengstaken — Blackmore with two cylinders which in the inflated state well are fixed in the cardia and squeeze esophageal veins. In the absence of that the hard tamponade of a gullet via the esophagoscope is carried out.
At the same time carry out haemo static therapy (transfusion of blood substitutes, administration of calcium chloride, solutions of aminocapronic acid on 100 — 200 ml of 6% of solution intravenously or intramusculary with the subsequent introduction of 2 — 3 g of fibrinogen, 1 — 2 ml of 1% of solution of Vikasolum no more than 3 — 4 days). Kapelno is intravenously entered by 15 — 20 PIECES of Pituitrinum into 200 ml - 5% of solution of glucose which temporarily lowers the ABP. Further for prevention of repeated bleedings imposing of a porto-caval or splenorenalny anastomosis is recommended.