Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2008, vol. 17, nr 3, May-June, p. 351–357

Publication type: review article

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

Esophageal Varices Part I – Pathophysiology, Diagnostics, Conservative Treatment and Prevention of Bleeding

Żylaki przełyku Część I – Patofizjologia, diagnostyka, leczenie zachowawcze i zapobieganie krwawieniom

Marek Bochnia1,, Annabhani Abdulhabib2,, Maciej Zatoński3,, Sławomir Baliński4,, Wojciech Dziewiszek5,

1 Department of Otolaryngology, Faculty of Dentistry, Silesian Piasts University of Medicine in Wrocław, Poland

2 Department of Gastrology and Hepatology, Silesian Piasts University of Medicine in Wrocław, Poland

3 Hospital No. 1 of Silesian Piasts University of Medicine in Wrocław, Poland

4 Dental Practice, Świdnica, Poland

5 Department of Pharmacology, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Prevention of the development of esophageal varices is controversial and not fully documented. At the same time, variceal bleeding is the most dangerous complication of portal hypertension. It appears suddenly and presents as rapid, massive hematemesis and leads to hemovolemic shock if not properly treated. The direct cause is often hard to find. Varix rupture may be caused by local trauma or a sudden increase in portal pressure. Therefore it is critical to introduce proper treatment immediately. Cessation of bleeding and restoration of adequate blood volume is life−saving and prepares the patient for upper digestive tract endoscopy. Endoscopy performed immediately (or after controlling possible hypovolemic shock) allows location of the site of bleeding and rapid introduction of causative treatment.

Streszczenie

Zapobieganie powstawaniu żylaków przełyku jest nadal dyskusyjne i nie do końca udokumentowane. Krwawienie z nich to najniebezpieczniejsze powikłanie nadciśnienia wrotnego. Pojawia się zwykle nagle i przebiega jako gwałtowne, obfite wymioty krwawe, prowadzące, przy braku odpowiedniego postępowania, do wstrząsu. Bezpośrednia przyczyna jest często trudna do ustalenia. Pęknięcie żylaka może spowodować zarówno miejscowy uraz, jak i nagły wzrost ciśnienia wrotnego. Wdrożenie leczenia musi być wówczas jak najszybsze. Powstrzymanie krwawienia i uzupełnienie ilości krwi krążącej ratuje i przygotowuje pacjenta do wziernikowania górnego odcinka przewodu pokarmowego. Wykonana natychmiast (ew. po wyprowadzeniu chorego ze wstrząsu) endoskopia umożliwia ustalenie miejsca krwawienia i jak najszybsze wdrożenie leczenia przyczynowego.

Key words

portal hypertension, complication, treatment, prophylaxis

Słowa kluczowe

nadciśnienie wrotne, powikłanie, leczenie, profilaktyka

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