I86.4

Clinical Causes: Liver cirrhosis — scarring of the liver tissue impeding normal blood flow Portal vein thrombosis — blood clots blocking the portal vein Schistosomiasis — parasitic infection affecting the liver and portal circulation Alcohol-related liver disease — prolonged alcohol misuse damaging liver function Tumors involving the liver or surrounding blood vessels Other conditions leading to increased pressure in the portal venous system

Key Symptoms: No symptoms — especially in early stages Gastrointestinal bleeding — presenting as vomiting blood (hematemesis) Dark, tarry stools (melena) Signs of anemia — weakness, fatigue, dizziness Abdominal discomfort or pain in some cases Shock in severe bleeding episodes — rapid heartbeat, low blood pressure, fainting

Diagnosis Path: Diagnosing gastric varices involves a combination of medical assessments, including: - Upper gastrointestinal endoscopy (esophagogastroduodenoscopy) — the primary method to visualize varices directly - Imaging techniques such as ultrasound, CT scan, or MRI — which help evaluate liver condition and portal vein status - Blood tests — assessing anemia, liver function, and overall health status - Specialized procedures like endoscopic ultrasound or portal pressure measurement may be used in complex cases While endoscopy remains the cornerstone for confirmation, imaging studies are crucial in assessing underlying causes and planning treatment strategies.

Treatment Protocols: Management of gastric varices aims to prevent bleeding and control active hemorrhage if it occurs. Treatment options include: - Endoscopic therapy — procedures such as cyanoacrylate glue injection to obliterate varices - Pharmacological approaches — vasoconstrictive medications like octreotide or vasopressin to reduce portal pressure - Interventional radiology — procedures such as balloon-occluded retrograde transvenous obliteration (BRTO) to occlude feeding veins - Surgical options — including shunt surgeries that divert blood flow away from the liver in severe cases - Once stabilized, long-term management involves monitoring for recurrences, treating underlying liver disease, and lifestyle modifications Preventive strategies focus on managing portal hypertension and early detection before bleeding episodes happen. Regular medical follow-ups and endoscopic surveillance are key components of comprehensive care.