Varicose veins of lower esophagus

Introduction Esophageal varices have special significance for Chinese people, because China is the first pandemic country of hepatitis B, and many patients eventually enter the liver cirrhosis stage of liver failure. Due to the high pressure of the portal system, one of the main sources of blood supply to the liver, its function is abnormal. The venous blood that should have been introduced into the system and returned to the heart cannot flow in. The siltation in the lumen causes the vein to expand abnormally and cannot be retracted to normal, the so-called varicose veins. The source of blood from the portal venous system includes the esophageal vein, umbilical vein, and iliac vein. These vasodilatation will form varicose veins in the corresponding part, that is, esophageal varices, vein dilation near the navel, and hemorrhoids.

Cause

Any part of the venous return disorder can cause esophageal varices, the latter is an important complication of portal hypertension, because in the portal hypertension, there is a collateral circulation between the portal vein and the superior vena cava. The specific collateral circulation path is as follows: portal vein-gastric coronary vein-esophageal venous plexus-odd vein-superior vena cava.

an examination

Related inspection

Esophagography electronic gastroscope fiber endoscopy

1. The mucosal folds in the lower part of the esophagus are widened or distorted. As the varicose veins progress, the lesions can extend to the middle part of the esophagus, which is characterized by a longitudinal to large nodular or sacral filling defect, and finally a beaded filling defect.

2. Later, the varicose veins extend to the middle and upper segments and even the full length of the esophagus. Due to the deterioration of the muscular layer, the esophagus is dilated, it is not easy to contract, the peristalsis of the wall is obviously weakened, and the emptying of the expectorant is slow, but there is no obstruction.

3. Esophageal varices often appear in combination with gastric varices, and can also exist alone. The latter showed a grape-like, polypoid, round, and lobulated filling defect in the fundus and cardia.

Differential diagnosis

Esophageal varices should be differentiated from proliferative esophageal cancer in the middle or lower segment:

(1) Esophageal proliferative carcinoma with a polypoid or lobulated filling defect, the wall of the tube is stiff, unable to expand, the lesion range is short and the boundary with the normal esophagus is clear.

(2) Esophageal varices are extensively braided or beaded filling defects, the tube wall is uneven, soft and expandable.

(3) Tincture examination: esophageal proliferative cancer sputum is blocked by the stenosis, the upper esophagus is dilated; esophageal varicose sputum is delayed by the esophagus, no obstruction.

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