II. Pathophysiology: Cirrhosis-Related Varices
- Liver disease (Cirrhosis) results in scarring
- Scarring narrows and compresses hepatic sinusoids
- Results in resistance to flow
- Increases portal pressure
- Portal pressure increases over critical threshold
- Portal-systemic venous pressure gradient >12 mmHg
- Vessels form at portal-systemic junctures
- Existing vessels dilate
- Secondary dilation of left gastric vein
- Esophageal Varices develop
III. Causes: Portal vein Hypertension
- Extrahepatic Causes (Portal VeinOcclusion)
- Umbilical vein infection
- Trauma
- Chronic Pancreatitis
- Polycythemia Vera
- Pro-thrombotic conditions
- Hepatic Causes
- Liver malignancy involving sinusoids
- Amyloidosis involving liver
- Fatty Liver
IV. Associated Conditions
- Hypersplenism
- Esophageal Varices
V. Diagnosis
- Hepatic Vein Pressure Gradient (HPVG)
- Measured with hepatic vein catheterization
- Free hepatic vein pressure - hepatic vein wedge
- HPVG >5 mmHg is Portal Hypertension
- HPVG >10 mmHg is significant Portal Hypertension
- Upper endoscopy
- Esophageal size predicts HPVG
VI. Management
- Goal is to lower risk of Bleeding Esophageal Varices
- See Esophageal Varices for Management