The Diagnosis of Esophageal Varices in Portal Hypertension

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The roentgen demonstration of esophageal varices is important in establishing a diagnosis of portal hypertension. In atypical cases varices may be the first demonstrable evidence of this disease. The roentgen demonstration of varices may be difficult and will frequently be missed if a thorough examination of the esophagus is not made. Recent advances in the clinical management of portal hypertension and in the control of hemorrhage from esophageal varices by surgical procedures render an early diagnosis essential in the treatment of this condition.

We have reviewed a series of 25 cases with an established diagnosis of portal hypertension. These cases re-emphasize the clinical and diagnostic features that have been described by Schatzki, 1,2 Templeton,3 and other writers. 4,5,6 Two case reports which stress the importance of the roentgen demonstration of varices are presented.

The physiologic changes that take place in the development of esophageal varices have been demonstrated by McIndoe7 and Kegaries.8 In the presence of obstruction to the portal system a collateral circulation returns the venous blood to the systemic circulation. The most common route of this venous return is through the communications between the coronary vein of the stomach, the splenic vein, and the esophageal venous plexus. Obstruction to the portal system, such as occurs in cirrhosis or in thrombosis of the splenic vein, results in an increase in pressure and in a reverse of the flow of blood through the coronary vein and the esophageal venous plexus. As a result of this, varices develop. The coronary veins. . .



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