Symptoms of esophageal varicose veins, sudden vomiting of blood should be taken seriously

The most typical symptom of esophageal varices is vomiting blood, which is usually sudden and can cause blood spurting in severe cases. Liver cirrhosis is the main cause of esophageal varices, and severe cases can cause shock or even death in patients.

1. Clinical manifestations

The most prominent symptom of esophageal varicose bleeding is vomiting blood, which often occurs suddenly, with fresh blood gushing out and even in the form of a spurt. Therefore, in acute upper gastrointestinal bleeding, if the patient suddenly goes into shock, it is often clinically caused by esophageal variceal bleeding due to portal hypertension. If the patient has a history of hepatitis, schistosomiasis or chronic alcoholism, and physical examination reveals spider angiomas, distended abdominal wall veins, splenomegaly or even ascites, and liver function tests are abnormal, it often indicates cirrhosis and portal hypertension.

2. Etiology and pathology

Any obstruction of venous return can cause esophageal varices, which is an important complication of portal hypertension because in portal hypertension, collateral circulation is formed between the portal vein and the superior vena cava. The specific collateral circulation pathways are as follows: portal vein-gastric coronary vein-esophageal venous plexus-azygos vein-superior vena cava.

3. Imaging performance

1. The mucosal wrinkles in the lower esophagus become widened or tortuous. As varicose veins progress, the lesions may extend to the middle esophagus, appearing as longitudinally oriented thick nodules or earthworm-like filling defects, and finally appearing as beaded filling defects.

2. In the later stage, varicose veins extend to the middle and upper parts of the esophagus or even the entire length of the esophagus. Due to the degeneration of the muscle layer, the esophagus is dilated and difficult to contract, the peristalsis of the tube wall is significantly weakened, and the emptying of barium is slow, but there is no obstruction.

3. Esophageal varices often occur together with gastric fundus varices, but can also exist alone. The latter is manifested as grape-shaped, polypoid, round, and lobed filling defects in the gastric fundus and cardia.