ICD Varizen


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Apr 25, Esophageal and paraesophageal varices are abnormally dilated veins of the esophagus. Esophageal varices are collateral veins within the wall of the esophagus that project directly into the lumen. The veins are of clinical concern because they are prone to hemorrhage, ICD Varizen. Paraesophageal varices are collateral veins beyond the adventitial surface of the ICD Varizen that parallel intramural esophageal veins.

Paraesophageal varices are less prone to hemorrhage, ICD Varizen. Esophageal and paraesophageal varices are slightly different in venous origin, but they are usually found together, ICD Varizen.

Today, more sophisticated imaging with computed tomography CT scanning, magnetic resonance imaging MRImagnetic resonance ICD Varizen MRAand endoscopic ultrasonography EUS plays an important role ICD Varizen the evaluation of portal hypertension and esophageal varices. ICD Varizen procedure involves using a flexible endoscope inserted into the patient's mouth and through the esophagus to inspect the mucosal surface.

The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a significant risk for bleeding, ICD Varizen. The grading of esophageal varices and identification of red wheals by endoscopy predict ICD Varizen patient's bleeding risk, on http: Endoscopy is also used for interventions.

The following pictures demonstrate band ligation of esophageal varices. These modalities have an advantage over endoscopy because CT scanning and MRI can help in ICD Varizen the surrounding anatomic structures, both above and below the diaphragm.

These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in evaluating for ICD Varizen specific etiology of esophageal varices. These modalities also have an advantage over both endoscopy and angiography because they are noninvasive. CT scanning and MRI may be used as alternative methods in making ICD Varizen diagnosis if endoscopy is contraindicated eg, in patients with a recent myocardial infarction or any contraindication to sedation.

In the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, ICD Varizen, current CT scanning and MRI procedures have ICD Varizen equally sensitive and specific in the detection of esophageal varices and other abnormalities of ICD Varizen portal venous system.

Although the surrounding anatomy cannot be ICD Varizen the way they can be with CT scanning or MRI, ICD Varizen, angiography is advantageous because its use may be ICD Varizen as well as diagnostic. Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique.

Barium swallow examination is not a ICD Varizen test, ICD Varizen, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention, ICD Varizen.

However, in severe disease, esophageal varices may be prominent. CT scanning and ICD Varizen are useful in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical clips may create artifacts that obscure portions of the portal venous system, ICD Varizen. Disadvantages of CT scanning include the possibility of adverse reactions to the contrast agent and an inability to quantitate portal venous flow, which is an advantage of MRI and ultrasonography. Plain radiographic findings are insensitive and nonspecific in the evaluation of esophageal varices. Plain radiographic findings may suggest paraesophageal ICD Varizen.

Esophageal varices are within the wall; therefore, they are concealed in the normal shadow of the esophagus. Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension.

Other plain radiographic findings included a posterior mediastinal mass and an ICD Varizen intraparenchymal mass. On other images, the intraparenchymal masses were confirmed to be varices in the region of the pulmonary ligament.

On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature. In addition, a widened, superior mediastinum may be shown, ICD Varizen. A widened, ICD Varizen, superior ICD Varizen may result from dilated collateral veins or the obstructing mass.

Endoscopy is the criterion ICD Varizen method for diagnosing esophageal varices. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not available see the images below. Pay attention to ICD Varizen to optimize detection of esophageal varices. The procedure should be performed with the patient in the supine or slight Trendelenburg position. These positions enhance gravity-dependent flow and engorge the vessels. The patient should be situated ICD Varizen an oblique projection and, therefore, ICD Varizen, in a right anterior oblique ICD Varizen to the image intensifier and a left posterior oblique position to the table.

This positioning prevents overlap with the spine and further enhances venous flow, ICD Varizen. A thick barium suspension or paste should be used to increase adherence to the mucosal surface. Ideally, single swallows of a small amount of barium should be ingested to minimize peristalsis ICD Varizen to prevent overdistention of the ICD Varizen. ICD Varizen the ingested bolus is too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed out, rendering esophageal varices ICD Varizen.

In addition, a full column of ICD Varizen Varizen barium may white out any findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, ICD Varizen, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it ICD Varizen caudally.

Effervescent crystals may be used to provide air contrast, ICD Varizen, but crystals may also cause overdistention of the esophagus with ICD Varizen and thereby hinder detection of esophageal varices.

In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small varices. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices.

The patient is asked ICD Varizen "bear down as if you are having a bowel movement" or asked to "tighten your stomach muscles as if you were doing a sit-up. Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings ICD Varizen paraesophageal varices should be followed up visit web page CT scanning or a barium study to differentiate the findings from a hiatal hernia, posterior mediastinal mass, or other abnormality eg, rounded atelectasis.

Similarly, barium studies or CT scan findings suggestive of esophageal varices should be followed up with endoscopy. Endoscopic follow-up imaging can be used to evaluate the grade and appearance of esophageal varices to assess the bleeding risk.

The results of this assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies. With endoscopy, ICD Varizen, the 2 entities can be differentiated easily. The only normal variant is a hiatal hernia. The rugal fold pattern of a hiatal hernia may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction.

CT scanning is ICD Varizen excellent method for detecting moderate to large esophageal varices and for evaluating the entire portal venous system. CT scanning is a minimally invasive imaging modality that involves the use of only a peripheral intravenous line; therefore, ICD Varizen, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images ICD Varizen.

This web page variety of techniques have been described for the ICD Varizen evaluation of the portal venous system. Most involve a helical technique with a pitch of 1. The images are reconstructed in 5-mm increments. The amount of contrast material and the delay time are ICD Varizen greater than those in conventional helical CT scanning of the abdomen.

The difference in technique ensures adequate opacification of both the portal venous and mesenteric arterial systems. On nonenhanced studies, esophageal varices may not be depicted well, ICD Varizen. Only a thickened esophageal wall interne Krampfadern in den Leisten be found.

Paraesophageal varices may appear as enlarged lymph nodes, posterior mediastinal masses, or a collapsed hiatal hernia. On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus.

The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen. ICD Varizen varices are easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat, ICD Varizen.

On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar to that of uphill varices, varying only in location, ICD Varizen.

Because the etiology of downhill esophageal varices is usually secondary to superior vena cava SVC obstruction, the physician must be aware ICD Varizen other potential collateral pathways that may suggest the diagnosis. Stanford et al ICD Varizen data based on venography. Of their total cohorts, ICD Varizen, only 8 could be characterized by using the Stanford classification.

In a study by Zhao et al of row multidetector CT ICD Varizen venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and http: Fifty ICD Varizen demonstrated their locations close to the esophageal-gastric junction; the other 2 cases were extended to the inferior bifurcation of the trachea.

CT scans also help in evaluating the liver, other venous collaterals, ICD Varizen, details of other surrounding anatomic structures, ICD Varizen, and the patency of the portal vein. In these ICD Varizen, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are not useful in predicting variceal hemorrhage. Compared with angiography, CT scanning is superior ICD Varizen detecting paraumbilical and retroperitoneal varices and at providing a more thorough ICD Varizen of the portal venous system without the risk of intervention.

In the detection of esophageal varices, CT scanning is slightly better than angiography, ICD Varizen. CT scanning and angiography are approximately equal in the detection of varices smaller verheilten trophischen Geschwüren 3 mm.

If ICD Varizen scans do not demonstrate small varices, they are unlikely to be seen on angiograms. Contrast-enhanced CT scanning is essential for evaluating esophageal ICD Varizen. Contrast enhancement greatly increases the sensitivity and specificity of the examination and ICD Varizen the rate of false-positive or false-negative results. On nonenhanced CT scans, esophageal varices may mimic soft-tissue masses, enlarged lymph nodes, or other gastrointestinal tract abnormalities eg, ICD Varizen, hiatal ICD Varizen.

MRI is ICD Varizen excellent noninvasive method for imaging the portal venous system and esophageal varices see the images below. This appearance makes them easily distinguishable from soft tissue masses, ICD Varizen. Flow voids appear as well-defined circular structures outside of or within the wall of the esophagus on axial images or serpiginous on sagittal or coronal images, ICD Varizen. MRA and MR portal venography are used to further characterize the portal venous system and its surrounding structures.

Improved images can be obtained by using a contrast-enhanced, breath-hold, fat-saturated, segmented, 3-dimensional 3-Dgradient-echo technique. This approach involves imaging during 3 sequential breath holds, 6 ICD Varizen apart, after ICD Varizen injection of paramagnetic contrast material.

Data from the 3 acquisitions are processed by using a maximum intensity projection MIP algorithm. The MIP technique provides imaging of the entire vascular anatomy at different phases, and it provides excellent resolution in a short time see the images below.

Esophageal varices and other portosystemic collateral vessels are demonstrated as serpiginous contrast-enhanced vessels in the portal venous ICD Varizen. Downhill esophageal varices appear similar to uphill varices. The only major disadvantages of MRI compared with CT are its limited availability and cost; otherwise, CT and MRI are equal in imaging the portal venous system and in detecting esophageal varices.

Other advantages include better characterization of liver tumors and avoidance of iodinated contrast material.

Krampfader – Wikipedia

Gastric varices are dilated submucosal veins in the stomachwhich can be a life-threatening cause of bleeding in the upper gastrointestinal tract. They are most commonly found in patients with portal hypertensionor elevated pressure in the portal vein system, which may be a complication of cirrhosis, ICD Varizen. Gastric varices may also be found ICD Varizen patients with thrombosis of the splenic veininto which the short gastric veins which drain the fundus of the stomach flow.

The latter ICD Varizen be a complication of acute pancreatitispancreatic canceror other abdominal tumours, as well as hepatitis C. Gastric varices and associated bleeding are ICD Varizen potential complication of schistosomiasis resulting from portal hypertension. Patients with bleeding gastric varices can present with bloody vomiting hematemesisdark, tarry stools melenaor rectal bleeding. The bleeding may be brisk, ICD Varizen, and patients may soon develop shock.

Treatment of ICD Varizen 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 treatment including splenectomy or surgical removal of the spleen or liver transplantation may be required in some cases, ICD Varizen. Gastric varices can present in two major ways. First, ICD Varizen, 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 hockt auf Krampfadern dramatically with upper gastrointestinal bleeding. The symptoms can include vomiting bloodmelena passing black, tarry stools ; or passing maroon stools or frank blood in the stools.

Many people with bleeding gastric varices present in shock due to the profound loss of blood. Secondly, patients with acute pancreatitis may present with gastric varices as a complication of a blood clot in the splenic vein.

The splenic vein sits over the pancreas anatomically and inflammation or cancers of the pancreas may result in a blot clot forming in 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, ICD Varizen, leading to varices in the fundus of the stomach. Laboratory testing usually shows low red blood cell count and often a low platelet count. If cirrhosis is present, there may be coagulopathy manifested by a prolonged INR ; both of these may worsen the bleeding from gastric varices.

In very rare cases, gastric varices are caused by splenic vein occlusion as a result of the mass effect of slow-growing pancreatic neuroendocrine tumors. Diagnosis of gastric varices ICD Varizen often made at the time of upper endoscopy, ICD Varizen.

The Sarin classification of gastric varices identifies four different anatomical types of gastric varices, which differ in terms of treatment modalities. Initial treatment of bleeding from gastric varices focuses on resuscitation, much as with esophageal varices. This includes administration of fluids, blood products, ICD Varizen, and antibiotics. The results from the only two randomized trials comparing band ligation vs cyanoacrylate suggests that endoscopic injection of cyanoacrylateknown 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: GVO is usually performed in specialized therapeutic endoscopy centers. Complications include sepsis, embolization of glue, and obstruction from polymerization in the lumen of the stomach. From Wikipedia, the free encyclopedia. This article does not cite any sources. Please help improve this article by adding citations to reliable sources.

Unsourced material may be challenged and removed. January Learn how and when to remove this template message. ICD Varizen of the digestive system primarily K20—K93— Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy ICD Varizen Bile acid malabsorption.

Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus. Upper Hematemesis Melena Lower Hematochezia. Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum. Cardiovascular disease vessels I70—I99Ursache von Krampfadern Behandlung Arteritis Aortitis Buerger's disease, ICD Varizen.

Carotid artery stenosis Renal artery stenosis. Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon. Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia. Cherry hemangioma Halo nevus Spider angioma, ICD Varizen. ICD Varizen venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena ICD Varizen syndrome Venous ulcer.

Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension, ICD Varizen.

Retrieved from " https: Stomach disorders Diseases of veins, lymphatic vessels and lymph nodes, ICD Varizen. Articles lacking sources from January All articles lacking sources. Views Read Edit View history. This page was last edited on 8 Marchat By using this site, ICD Varizen, you agree to the Terms of Use and Privacy Policy. Isolated gastric varices of Sarin classification IGV-1 Rifampicin für venöse Geschwüre on gastroscopy in a patient with portal hypertension.

Inflammation Arteritis Aortitis Buerger's disease. Hypertension Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension.

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