Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, ...EsophagealvaricesFromWikipedia,thefreeencyclopediaJumptonavigationJumptosearchEsophagealvaricesOthernamesEsophagealvarix,oesophagealvaricesGastroscopyimageofesophagealvariceswithprominentcherry-redspotsSpecialtyGastroenterologyHematologySymptomsvomitingbloodpassingblackstoolComplicationsInternalbleeding,hypovolemicshock,cardiacarrestCausesAlcoholismDiagnosticmethodEndoscopyEsophagealvaricesareextremelydilatedsub-mucosalveinsinthelowerthirdoftheesophagus.[1]Theyaremostoftenaconsequenceofportalhypertension,[2]commonlyduetocirrhosis.[3]Peoplewithesophagealvariceshaveastrongtendencytodevelopseverebleedingwhichleftuntreatedcanbefatal.Esophagealvaricesaretypicallydiagnosedthroughanesophagogastroduodenoscopy.[4]Contents1Pathogenesis2Histology3Prevention4Treatment5Seealso6References7ExternallinksPathogenesis[edit]Esophagealvaricessevendaysafterbanding,showingulcerationatthesiteofbandingTheuppertwothirdsoftheesophagusaredrainedviatheesophagealveins,whichcarrydeoxygenatedbloodfromtheesophagustotheazygosvein,whichinturndrainsdirectlyintothesuperiorvenacava.Theseveinshavenopartinthedevelopmentofesophagealvarices.Theloweronethirdoftheesophagusisdrainedintothesuperficialveinsliningtheesophagealmucosa,whichdrainintotheleftgastricvein,whichinturndrainsdirectlyintotheportalvein.Thesesuperficialveins(normallyonlyapproximately1 mmindiameter)becomedistendedupto1–2 cmindiameterinassociationwithportalhypertension.Normalportalpressureisapproximately9 mmHgcomparedtoaninferiorvenacavapressureof2–6 mmHg.Thiscreatesanormalpressuregradientof3–7 mmHg.Iftheportalpressurerisesabove12 mmHg,thisgradientrisesto7–10 mmHg.[5]Agradientgreaterthan5 mmHgisconsideredportalhypertension.Atgradientsgreaterthan10 mmHg,bloodflowingthroughthehepaticportalsystemisredirectedfromtheliverintoareaswithlowervenouspressures.Thismeansthatcollateralcirculationdevelo