1.

What mechanisms are involved in the development of this lesion in the

esophagus?
Instead of returning directly to the heart, venous blood from the Git is
delivered to the liver via the portal vein before reaching the inferior vena
cava. This circulatory pattern is responsible for the first pass effect in
which drugs and other materials absorbed in the intestines are processed
by the liver before entering the systemic circulation. Diseases that impede
this flow can cause portal hypertension and can lead to the development
of esophageal varices, an important cause if esophageal bleeding.
Severe portal HTN induces collateral bypass channels
a. b/n the portal & caval circulation
b. Congested subepithelial & submucosal veins in the distal esophagus
(varices)
Alcoholic Cirrhosis is the most common cause
c. 90% of cirrhotic patients
d. Hepatic schistosomiasis is the 2nd most common cause
2. What structural changes in the esophagus are seen in this lesion?
The tortuous dilated veins are present in the distal esophageal mucosa
a. Causes irregular protrusions of overlying mucosa
b. Superficial ulceration, inflammation /adherent blood clots

FIGURE 17-8 Esophageal varices. A, This angiogram shows several tortuous

esophageal varices. B, Collapsed varices are present in this postmortem
specimen corresponding to the angiogram in A. The polypoid areas represent
previous sites of variceal hemorrhage that have been ligated with bands. C,
Dilated varice beneath intact squamous mucosa.

Varices can be detected by venogram and appear as turtous dilated veins

lying primarily within the submucosa of the distal esophagus and proximal
stomach. Venous channels directly beneath the esophageal epithelium may
become massively dilated. Varices may not be grossly obvious in surgical or postmortem specimens, because they collapse in the absence of blood flow and
when they are not ruptured, the overlying mucosa is intact. Variceal rupture
results in haemorrhage into the lumen or esophageal wall, in which case the
overlying mucosa appears ulcerated and necrotic. If rupture has occurred in the
past, venous thrombosis, inflammation, and evidence of prior therapy may also
be present.