Overview Varices Esophageal Varices Esophageal varices result from portal hypertension, usually as a direct result of hepatic cirrhosis. Other causes of portal hypertension which must also be considered include portal vein thrombosis, obstruction by carcinoma of the pancreas, chronic pancreatitis, and inflammatory diseases of the retroperitoneum. The resulting increase in portal pressure causes increased collateral blood flow through the right, left, and short gastric veins, into the periesophageal plexus before reaching the azygous, hemiazygous, superior vena cava and right atrium. The periesophageal venous plexus dilates with time to accommodate the increased flow resulting in the tortuous varices observed in the distal esophagus and gastric cardia.
Esophageal varices are prone to bleed resulting in massive hematemisis and blood loss.
The situation is commonly complicated by clotting abnormalities in these patients who are typically malnourished with severe liver disease. These result from obstruction of the superior vena cava due to tumor mass or mediastinal fibrosis. Venous return occurs via collateralization through the azygous and hemiazygous system to the periesophageal plexus and then into the portal circulation. The resulting varices are located in the proximal and mid esophagus as opposed to the distal esophagus and gastric cardia. To view a gross specimen of esophageal varices, click here .