Oesophageal Varices
Oesophageal varices: Develop in 90% of cirrhotic patients, ~50% die from first bleed; alcoholic cirrhosis is the most common cause, schistosomiasis is second worldwide.
Oesophageal Varices
- Pathogenesis: Portal hypertension → collateral channels → portal blood shunts into caval system → subepithelial and submucosal venous plexuses in distal oesophagus enlarge = varices.
- Develop in 90% of cirrhotic patients ; most common cause = alcoholic liver disease .
- Worldwide: hepatic schistosomiasis = second most common cause.
- Tortuous dilated veins in submucosa of distal oesophagus and proximal stomach.
- Collapse when no blood flow.
Read this in GASTROINTESTINAL PATHOLOGY (Part 3)
What our notes say
- Oesophageal varices: Develop in 90% of cirrhotic patients, ~50% die from first bleed; alcoholic cirrhosis is the most common cause, schistosomiasis is second worldwide. (GASTROINTESTINAL PATHOLOGY (Part 3))
- Oesophageal varices; resuscitation, a vasoactive drug such as terlipressin or octreotide, antibiotics and endoscopic band ligation (Endocrinology and Gastroenterology Question Bank: 12 Clinical MCQs)
- Complications: portal hypertension, ascites, oesophageal varices, hepatic encephalopathy, hepatocellular carcinoma (Pathology Practical Revision Guide)
- Complications arising from this morphology: portal hypertension (leading to ascites, splenomegaly, oesophageal varices, caput medusae), hepatocellular failure (jaundice, coagulopathy, hypoalbuminaemia, hepatic encephalopathy), and increased risk of hepatocellular carcinoma. (General & Systemic Pathology SAQ Paper II — 15 July 2025 (MBPA 3500, MKU Year 3,)
- Oesophageal varices — from portal hypertension (covered in GI pathology notes) (VASCULAR PATHOLOGY — Must-Know Notes)
- Oesophageal varices: 90% of cirrhotics; 50% die from first bleed; alcoholic cirrhosis most common (GASTROINTESTINAL PATHOLOGY (Part 2))
Study material on Oesophageal Varices
Practice questions on Oesophageal Varices
A patient with advanced alcoholic cirrhosis develops sudden massive haematemesis. Emergency endoscopy reveals ruptured oesophageal varices. What is the mortality rate from this first bleeding episode?
- Approximately 70–80% without surgical ligation
- Approximately 25–30% with optimal medical management
- Approximately 50% despite intervention
- Approximately 10–15% even without treatment
Answer: C. Approximately 50% of patients die from the first variceal bleeding episode from direct haemorrhage or hepatic coma from the protein load combined with hypovolaemic shock. ---