Gastric varices 1033288 225250538 2008-07-12T18:19:07Z ClueBot 4928500 Reverting possible vandalism by [[Special:Contributions/72.153.250.97|72.153.250.97]] to version by Arcadian. False positive? [[User:ClueBot/FalsePositives|Report it]]. Thanks, [[User:ClueBot]]. (438668) (Bot) {{Unreferenced|date=January 2008}} {{DiseaseDisorder infobox | Name = Gastric varices| Image = IGV1.jpg | Caption = Isolated gastric varices of Sarin classification IGV-1 seen on [[gastroscopy]] in a patient with [[portal hypertension]] | ICD10 = {{ICD10|I|86|4|i|80}} | ICD9 = | }} '''Gastric varices''' are dilated submucosal [[vein]]s in the [[stomach]], which can be a life-threatening cause of [[upper gastrointestinal hemorrhage]]. They are most commonly found in patients with [[portal hypertension]], or elevated pressure in the [[portal vein]] system, which may be a complication of [[cirrhosis]]. Gastric varices may also be found in patients with thrombosis of the [[splenic vein]], into which the short gastric veins which drain the [[fundus]] of the stomach flow. The latter may be a complication of [[acute pancreatitis]], [[pancreatic cancer]], or other abdominal tumours. Patients with bleeding gastric varices can present with bloody vomiting ([[hematemesis]]), dark, tarry stools ([[melena]]), or frank rectal bleeding. The bleeding may be brisk, and patients may soon develop [[Shock (medical)|shock]]. Treatment of gastric varices can include injection of the varices with [[cyanoacrylate]] glue, or a radiological procedure to decrease the pressure in the portal vein, termed [[transjugular intrahepatic portosystemic shunt]] or TIPS. Treatment with intravenous [[octreotide]] is also useful to shunt blood flow away from the stomach's circulation. More aggressive treament including [[splenectomy]] (or surgical removal of the [[spleen]]) or [[liver transplantation]] may be required in some cases. ==Clinical presentation== Gastric varices can present in two major ways. First, patients with [[cirrhosis]] may be enrolled in screening [[gastroscopy]] programs to detect [[esophageal varices]]. These evaluations may detect gastric varices that are asymptomatic. When gastric varices are symptomatic, however, they usually present acutely and dramatically with [[upper GI hemorrhage]]. The symptoms can include [[hematemesis]], or [[vomiting]] blood; [[melena]], passing black, tarry stools; or passing maroon stools or frank blood in the stools. Many patients with bleeding gastric varices present in shock due to the profound loss of blood. Finally, patients with [[acute pancreatitis]] may present with gastric varices as a complication of thrombosis of the [[splenic vein]]. The splenic vein sits over the pancreas anatomically and inflammation or cancers of the pancreas may result in thrombosis, or clotting of the splenic vein. As the short gastric veins of the [[fundus]] of the stomach drain into the splenic vein, thrombosis of the splenic vein will result in increased pressure and engorgement of the short veins, leading to varices in the fundus of the stomach. Laboratory testing usually shows [[anemia]] and often [[thrombocytopenia]] (a low [[platelet]] count). If cirrhosis is present, there may be [[coagulopathy]] manifested by a prolonged [[INR]]; both of these may worsen the hemorrhage from gastric varices. ==Diagnosis and classification== [[Image:Sarin classification.jpg|right|thumb|The Sarin classification of gastric varices identifies two types of '''gastroesophageal varices''', where [[esophageal varices]] are found concurrently, and two types of '''isolated gastric varices''', found in the absence of [[esophageal varices]].]] [[Image:Antral varices.jpg|thumb|right|200px|Antral varices, of Sarin classification IGV-2, an unusual class of '''gastric varices'''.]] Diagnosis of gastric varices is often made at the time of upper [[endoscopy]]. The Sarin classification of gastric varices identifies four different anatomical types of gastric varices, which differ in terms of treatment modalities. ==Treatment== Initial treatment of bleeding from gastric varices focuses on resuscitation, much as with [[esophageal varices]]. This includes administration of fluids, blood products, and antibiotics. The results from the only two randomized trials comparing band ligation vs cyanocarylate suggests that endoscopic injection of [[cyanoacrylate]], known as '''gastric variceal obliteration''' or GVO is superior to band ligation in preventing rebleeding rates. Cyanoacrylate, a common component in [[super glue]] is often mixed 1:1 with [[lipiodol]] to prevent polymerization in the endoscopy delivery optics, and to show on radiographic imaging. GVO is usually performed is specialized therapeutic endoscopy centers. Complications include sepsis, embolization of glue, and obstruction from polymerization in the lumen of the [[stomach]]. Other techniques for refractory bleeding include: *[[Transjugular intrahepatic portosystemic shunts]] (TIPS) *Balloon occluded retrograde transvenous obliteration techniques (BORTO) *Gastric variceal ligation, although this modality is falling out of favour *Intra-gastric [[balloon tamponade]] as a bridge to further therapy **a caveat is that a larger balloon is required to occupy the [[fundus]] of the stomach where gastric varices commonly occur *[[Liver transplantation]] {{gastroenterology}} {{Vascular diseases}} [[Category:Gastroenterology]]