Varicose veins

Varicose veins of the esophagus and cardia are a common cause of gastrointestinal bleeding. In the occurrence of bleeding, the sudden increase in pressure in the enlarged veins and the erosion of the mucous membrane covering the varicose veins are important. The cause of these erosions is more often reflux esophagitis. If there is a suspicion of bleeding from varicose veins, clinical signs of liver cirrhosis should be sought: the skin and mucous membranes, ascites, telangiectasias, hepatic palms, hair loss on the breast, gynecomastia, testicular atrophy in men, liver enlargement, splenomegaly with hypersplenism. Sign of portal hypertension is the expansion of the subcutaneous veins of the abdominal wall in the form of a "jellyfish head", expressed by hemorrhoids.

With an unclear source of hemorrhage, along with anti-shock measures with blood transfusions, the cause is clarified with the help of a gastroscopy. In 10% of cases in the presence of cirrhosis, the source of bleeding may be a duodenal ulcer.

When bleeding from varicose veins, it is advisable to insert a Blackmore probe, and every 30 minutes, the stomach is washed with antacids. Intravenous drip (one or two times) 15-20 units of pituitrin (in a 5% solution of glucose) is administered dropwise. In addition, antibiotics are administered. Assign choline chloride, glutamic acid, methionine, sirepare, Essentiale, magnesium sulfate, cleansing enemas (these measures reduce the possibility of hepatic coma development). If the bleeding has been stopped, it is necessary to examine the patient in order to identify indications for portocaval bypass. To prevent the recurrence of bleeding, it is necessary to systematically take nitrates that reduce portal hypertension: either prolonged nitrates such as nitrosorbide 1 tablet 3 times a day, or nitroglycerin IV or sublingually several times a day under the control of blood pressure. In addition to nitrates, to reduce the pressure in the portal vein system, an indulgent (40 mg 2-3 times a day) can be used. In case of relapse or continued bleeding, an emergency laparotomy is shown - more often the stitching of the subcardial stomach is performed using the UKL-60, UO-60 devices separately Front and rear walls.

The forecast is poor. Patients usually die from repeated bleeding or kidney failure.