Gastro: Oesophageal Varices: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Oesophageal Varices🎧 High-yield, focused revision of oesophageal varices – causes, symptoms, investigations, and emergency management. Essential for MSRA gastro + acute care prep.🧠 Key Learning Points📌 Definition• Dilated submucosal veins in the lower oesophagus• Most often a complication of portal hypertension due to cirrhosis📌 Causes• Portal hypertension – main cause– Cirrhosis (alcohol, hepatitis B/C, NAFLD)• Pre-hepatic: portal/splenic vein thrombosis• Intra-hepatic: idiopathic, alcoholic hepatitis• Post-hepatic: Budd-Chiari, RHF• Global: Schistosomiasis (non-cirrhotic)📌 Pathophysiology• ↑ Portal pressure → diversion via portosystemic collaterals• Veins in lower oesophagus distend → prone to rupture• Risk ↑ when HVPG >10–12 mmHg📌 Epidemiology• 10% of upper GI bleeds• 8% of cirrhotic patients develop varices• High mortality with acute bleeds in advanced liver disease📌 Symptoms & Signs• Often silent until bleeding• Classic: Haematemesis, melena• Severe: shock (hypotension, tachycardia), confusion (encephalopathy)• Liver disease stigmata: jaundice, ascites, spider naevi, asterixis📌 Diagnosis• Bloods: FBC, U&Es, LFTs, INR, Group & Save• OGD = gold standard• Supportive: chest X-ray, ultrasound, paracentesis if SBP suspected📌 Emergency Management🔴 Resuscitation (ABCDE):– Secure airway, oxygen, fluids/blood, monitor vitals💊 Medical:– Terlipressin IV– IV antibiotics (e.g. ceftriaxone)– PPI infusion– Vitamin K, FFP if coagulopathic📍 Endoscopy (within 24h):– Band ligation (first-line)– Glue injection for gastric varices🛑 If bleeding persists:– Balloon tamponade (e.g. Sengstaken-Blakemore tube)– TIPSS (shunt) for uncontrolled bleeding📌 Prevention• Primary prophylaxis:– Non-selective beta-blockers (propranolol, carvedilol)– Band ligation if intolerant• Secondary prophylaxis:– Beta-blockers + repeat banding until eradication– Routine surveillance OGD in cirrhotics📌 Complications• Hypovolaemic shock, death• Rebleeding: up to 70% within 2 years• Hepatic encephalopathy• SBP, pneumonia• Poor prognosis in Child-Pugh C cirrhosis 📎 More MSRA Resources for Oesophageal Varices📝 Revision Notes: https://www.passthemsra.com/topic/oesophageal-varices-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/oesophageal-varices-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/oesophageal-varices-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/oesophageal-varices-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/gastroenterology-for-the-msra/#MSRA #MSRARevisionNotes #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards#MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment#MSRAOnlineRevision #MSRARevisionWebsite #OesophagealVarices