Gastrointestinal varices history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Patients suffering from gastrointestinal varices may present with other co-morbid conditions which lead to portal hypertension. Chronic liver disease and portal vein thrombosis commonly lead to the development of gastrointestinal varices. Patients with a family history of venous abnormalities, hypercoaguable states, autosomal recessive polycystic kidney disease (may lead to hepatic fibrosis), nephronophthisis 1, Joubert syndrome and related disorders 5, cranioectodermal dysplasia (Sensenbrenner syndrome), Ellis-van Creveld syndrome, Jeune asphyxiating thoracic dystrophy, renal-hepatic-pancreatic dysplasia, autosomal dominant polycystic kidney disease have an increased risk of developing gastrointestinal varices. Non-bleeding gastrointestinal varices do not produce any symptoms, however bleeding gastrointestinal varices may lead to hematemesis, abdominal pain, lightheadedness, loss of consciousness, melena, bloody stools (in severe cases), shock (in case of loss of a large volume of blood).
History
Patients suffering from gastrointestinal varices may present with other co-morbid conditions which lead to portal hypertension. Patients may have the following history findings:
Family history
Patients with a family history of the following may be more prone to develop varices:[1][2][3][4][5][2]
- Venous abnormalities
- Hypercoaguable states
- Autosomal recessive polycystic kidney disease (may lead to hepatic fibrosis)
- Nephronophthisis 1
- Joubert syndrome and related disorders 5
- Cranioectodermal dysplasia (Sensenbrenner syndrome)- very rare, affects 1 in 1000,000 live births
- Ellis-van Creveld syndrome
- Jeune asphyxiating thoracic dystrophy
- Renal-hepatic-pancreatic dysplasia
- Autosomal dominant polycystic kidney disease
Past medical
Patients with following findings on past medical history may have a higher chance of developing gastrointestinal varices:[6][7][8][9][10][11]
- Chronic liver disease (cirrhosis)
- Portal vein thrombosis (Budd-Chiari syndrome)
- Splanchnic arteriovenous fistula
- Gaucher's disease
- Lymphoma
- Schistosomiasis
- Adult polycystic liver disease
- Hepatic arteriopetal fistula
- Congenital hepatic fibrosis
- Idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia)
- Zellweger syndrome
- Mastocytosis
Social history
Patients may have the following social history findings:
- Chronic alcohol intake
- Poor adherence to medications
- Smokers are more prone to develop bleeding of varices
Symptoms
Non-bleeding gastrointestinal varices do not produce any symptoms, however bleeding gastrointestinal varices may lead to the following symptoms:
Common symptoms
Common symptoms of bleeding gastrintestinal varices include the following:[12][13][14][15][16][17]
- Hematemesis
- Abdominal pain
- Lightheadedness
- Loss of consciousness
- Melena
- Bloody stools (in severe cases)
- Shock (in case of loss of a large volume of blood)
References
- ↑ Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean L, Mefford HC, Stephens K, Amemiya A, Ledbetter N, Sweeney WE, Avner ED. PMID 20301501. Vancouver style error: initials (help); Missing or empty
|title=(help) - ↑ 2.0 2.1 Gunay-Aygun M (2009). "Liver and kidney disease in ciliopathies". Am J Med Genet C Semin Med Genet. 151C (4): 296–306. doi:10.1002/ajmg.c.30225. PMC 2919058. PMID 19876928.
- ↑ Brancati F, Dallapiccola B, Valente EM (2010). "Joubert Syndrome and related disorders". Orphanet J Rare Dis. 5: 20. doi:10.1186/1750-1172-5-20. PMC 2913941. PMID 20615230.
- ↑ Ackah RL, Yoeli D, Kueht M, Galván N, Cotton RT, Rana A, O'Mahony CA, Goss JA (2017). "Orthotopic liver transplantation for Sensenbrenner syndrome". Pediatr Transplant. doi:10.1111/petr.13077. PMID 29076289. Vancouver style error: initials (help)
- ↑ Bergmann C (2012). "Educational paper: ciliopathies". Eur. J. Pediatr. 171 (9): 1285–300. doi:10.1007/s00431-011-1553-z. PMC 3419833. PMID 21898032.
- ↑ Orloff MJ, Orloff MS, Orloff SL, Girard B (1997). "Portal vein thrombosis in cirrhosis with variceal hemorrhage". J. Gastrointest. Surg. 1 (2): 123–30, discussion 130–1. PMID 9834338.
- ↑ Siablis D, Papathanassiou ZG, Karnabatidis D, Christeas N, Katsanos K, Vagianos C (2006). "Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature". World J. Gastroenterol. 12 (26): 4264–6. PMC 4087390. PMID 16830391.
- ↑ Chofle AA, Jaka H, Koy M, Smart LR, Kabangila R, Ewings FM, Mazigo HD, Johnson WD, Fitzgerald DW, Peck RN, Downs JA (2014). "Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study". BMC Infect. Dis. 14: 303. doi:10.1186/1471-2334-14-303. PMC 4065539. PMID 24894393.
- ↑ Srinath A, Shneider BL (2012). "Congenital hepatic fibrosis and autosomal recessive polycystic kidney disease". J. Pediatr. Gastroenterol. Nutr. 54 (5): 580–7. doi:10.1097/MPG.0b013e31824711b7. PMC 4369775. PMID 22197937.
- ↑ Ahmed M, Kesavan M, Jilani BN, Ahmed S, Deeb L (2016). "Systemic Mastocytosis as an Unconventional Cause of Variceal Bleeding: Think Outside the Box". Cureus. 8 (6): e629. doi:10.7759/cureus.629. PMC 4935436. PMID 27433408.
- ↑ "Zellweger Spectrum Disorder - GeneReviews® - NCBI Bookshelf".
- ↑ Cremers I, Ribeiro S (2014). "Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis". Therap Adv Gastroenterol. 7 (5): 206–16. doi:10.1177/1756283X14538688. PMC 4107701. PMID 25177367.
- ↑ Fawaz KA, Kellum JM, Deterling RA (1982). "Intraabdominal variceal bleeding". Am. J. Gastroenterol. 77 (8): 578–9. PMID 7102642.
- ↑ Sato H, Kamibayashi S, Tatsumura T, Yamamoto K (1987). "Intraabdominal bleeding attributed to ruptured periumbilical varices. A case report and a review of the literature". Jpn J Surg. 17 (1): 33–6. PMID 3494875.
- ↑ Kim YD (2014). "Management of acute variceal bleeding". Clin Endosc. 47 (4): 308–14. doi:10.5946/ce.2014.47.4.308. PMC 4130884. PMID 25133116.
- ↑ Perri GA, Khosravani H (2016). "Complications of end-stage liver disease". Can Fam Physician. 62 (1): 44–50. PMC 4721840. PMID 26796834.
- ↑ Biecker E, Heller J, Schmitz V, Lammert F, Sauerbruch T (2008). "Diagnosis and management of upper gastrointestinal bleeding". Dtsch Arztebl Int. 105 (5): 85–94. doi:10.3238/arztebl.2008.0085. PMC 2701242. PMID 19633792.