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Tipps Varizen

Tipps Varizen 25, Author: They are native veins that serve as collaterals to the central venous circulation when flow through the portal venous system or superior vena cava SVC is obstructed. Esophageal varices are collateral veins within the wall of the esophagus that project directly into the lumen.

The veins are of clinical concern because they are prone to hemorrhage. Paraesophageal varices are collateral veins beyond the adventitial surface of the esophagus that parallel intramural esophageal veins. Paraesophageal varices are less prone to hemorrhage. Esophageal and paraesophageal varices are slightly different in venous origin, but they are usually found together.

Using a thin-barium technique, radiographic appearances of esophageal Tipps Varizen were described first by Wolf in his paper, Tipps Varizen, "Die Erkennug von osophagus varizen im rontgenbilde," or "Radiographic detection of esophageal varices. Today, more sophisticated imaging with computed tomography CT scanning, magnetic resonance imaging MRImagnetic resonance angiography MRAand endoscopic ultrasonography EUS plays an important role in the evaluation of portal hypertension and esophageal varices.

Endoscopy is the criterion standard for evaluating esophageal varices and assessing the bleeding risk. The procedure involves using a flexible endoscope inserted into the patient's mouth and through the esophagus to inspect the mucosal surface.

The esophageal varices are also inspected for red wheals, which are dilated intra-epithelial veins under tension and which carry a significant risk for bleeding. The grading of esophageal varices and identification of red wheals by endoscopy predict a patient's bleeding risk, on which treatment is based. Endoscopy is also used for interventions. The following pictures demonstrate band ligation of esophageal varices. CT scanning and MRI are identical in their usefulness in diagnosing and evaluating the extent of esophageal varices.

These modalities have an advantage over endoscopy because CT scanning and MRI can help in evaluating the surrounding anatomic structures, both above and below the diaphragm. CT scanning and MRI are also valuable in evaluating the liver and the entire portal circulation.

These modalities are used in preparation for a transjugular intrahepatic portosystemic shunt TIPS procedure or liver transplantation and in Tipps Varizen Behandlung von venösen Geschwüren Oleoresine a specific etiology of esophageal varices. These modalities also have an advantage over both endoscopy and angiography because they are noninvasive.

CT scanning and Tipps Varizen do not have strict criteria for evaluating the bleeding risk, Tipps Varizen, and they are not as sensitive Tipps Varizen specific as endoscopy, Tipps Varizen. CT scanning and MRI may be used as alternative methods in making the diagnosis if endoscopy is contraindicated eg, in patients with a recent myocardial infarction Tipps Varizen any contraindication to sedation.

Varizen nach Laser-Chirurgie the past, angiography was considered the criterion standard for evaluation of the portal venous system. However, current CT scanning and MRI procedures have become equally sensitive and specific in the detection of esophageal varices and other abnormalities of the portal venous system.

Although the surrounding anatomy cannot be evaluated the way they can be with Tipps Varizen scanning or MRI, Tipps Varizen, angiography is advantageous because its use may be therapeutic as well as diagnostic, Tipps Varizen.

Ultrasonography, excluding EUS, and nuclear medicine studies are of minor significance in the evaluation of esophageal varices, Tipps Varizen. Although endoscopy is the criterion standard in diagnosing and grading esophageal varices, the anatomy outside of the esophageal mucosa cannot be evaluated with this technique.

Barium swallow examination is not a sensitive test, and it must be performed carefully with close attention to the amount of barium used and the degree of esophageal distention, Tipps Varizen.

However, in severe disease, esophageal varices may be prominent. CT scanning and MRI are useful in evaluating other associated abnormalities and adjacent anatomic structures in the abdomen or thorax.

On MRIs, surgical Tipps Varizen may create artifacts that obscure portions Tipps Varizen the portal venous system, Tipps Varizen. Disadvantages of CT scanning include the possibility of adverse reactions to the contrast agent and an inability to quantitate portal venous Tipps Varizen, which is an advantage of MRI and ultrasonography, Tipps Varizen.

Plain radiographic findings are insensitive and nonspecific in the evaluation of esophageal varices. Plain radiographic findings may suggest paraesophageal varices. Anatomically, paraesophageal varices are outside the esophageal wall and may create abnormal opacities. Esophageal varices are within the wall; therefore, Tipps Varizen, they Tipps Varizen concealed in the normal shadow of the esophagus. Ishikawa et al described chest radiographic findings in paraesophageal varices in patients with portal hypertension, [ 14 ] and Tipps Varizen most common was obliteration of a short or long segment of the descending aorta without a definitive mass shadow.

Other plain radiographic findings included a Tipps Varizen mediastinal mass and an Tipps Varizen intraparenchymal mass. On other images, the intraparenchymal masses were confirmed to be varices in the region of the pulmonary ligament. On plain radiographs, a downhill varix may be depicted as a dilated azygous vein that is out of proportion to the pulmonary vasculature.

In addition, a widened, superior mediastinum may be shown. A widened, superior mediastinum may result from dilated collateral veins or the obstructing mass. Endoscopy is Tipps Varizen criterion standard method for diagnosing esophageal varices. Barium studies may be of benefit if the patient has a contraindication to endoscopy or if endoscopy is not available see the images below. Pay attention to technique to optimize detection of esophageal varices. The procedure should be performed with the patient in the supine or slight Trendelenburg position.

These positions enhance gravity-dependent flow and engorge the vessels. The patient should be situated in an Werden Krampfadern projection and, therefore, in a right anterior oblique position to the image intensifier and a left posterior oblique position to the table.

This positioning prevents overlap with the spine and further enhances venous flow. A thick barium suspension or paste should be used to increase adherence to the mucosal surface. Ideally, Tipps Varizen swallows of a small amount of barium should be ingested to minimize peristalsis and to prevent overdistention of the esophagus. If the ingested bolus is too large, the esophagus may be overdistended with dense barium, and the mucosal surface may be smoothed out, rendering esophageal varices invisible.

In addition, a full column of dense barium may white out any findings of esophageal varices. Too many contiguous swallows create a powerful, repetitive, stripping wave of esophageal peristalsis that squeezes blood out of the varices as it progresses Tipps Varizen. Effervescent crystals may be used to provide air contrast, but Tipps Varizen may also cause overdistention of the esophagus with gas and thereby hinder detection of esophageal varices.

In addition, crystals may create confusing artifacts in the form of gas bubbles, which may mimic small Tipps Varizen. The Valsalva maneuver may be useful to further enhance radiographic detection of esophageal varices.

The patient is asked to "bear down as if you are having a bowel movement" or asked to "tighten your stomach muscles as if you were doing a sit-up. The Valsalva maneuver also traps barium in the distal esophagus and Tipps Varizen retrograde flow for an even coating. Plain radiographic findings suggestive of paraesophageal varices are very nonspecific. Any plain radiographic findings suggesting paraesophageal varices should be followed up Tipps Varizen CT scanning or a barium study to differentiate the findings from a hiatal hernia, posterior mediastinal mass, or other abnormality eg, rounded atelectasis.

Similarly, barium studies or CT scan findings suggestive of esophageal varices should be followed up with endoscopy. Endoscopic follow-up imaging can be used to evaluate the grade and appearance of esophageal varices to assess the bleeding risk, Tipps Varizen. The results of this assessment direct treatment. In review case studies, a single thrombosed esophageal varix may be confused with an esophageal mass on barium studies, Tipps Varizen.

With endoscopy, Tipps Varizen, the 2 entities can be differentiated easily. The only normal variant is a hiatal hernia. The rugal fold pattern of a hiatal hernia may be confused with esophageal varices; however, a hiatal hernia can be identified easily by the presence of the B line marking the gastroesophageal junction.

CT scanning is an Tipps Varizen method for detecting moderate to large esophageal varices and for evaluating the entire portal venous system, Tipps Varizen. CT scanning is a minimally invasive Tipps Varizen modality that involves the use of only a peripheral intravenous line; therefore, it is a more attractive method than angiography or endoscopy in the evaluation of the portal venous system see the images below. A variety of techniques have been described for the CT evaluation of the portal venous system.

Most involve a helical technique with a pitch of 1. The images are reconstructed in 5-mm increments. The amount of contrast material and the delay time are slightly greater than those in conventional helical CT scanning of the abdomen.

The difference in technique ensures adequate opacification of both the portal venous and mesenteric arterial systems. On nonenhanced studies, esophageal varices may not be depicted Tipps Varizen. Only a thickened esophageal wall may be found. Paraesophageal varices may appear as enlarged lymph nodes, Tipps Varizen mediastinal masses, or a collapsed hiatal hernia.

On contrast-enhanced images, esophageal varices appear as homogeneously enhancing tubular or serpentine structures projecting into the lumen of the esophagus. The appearance of paraesophageal is identical, but it is parallel to the esophagus instead of projecting into the lumen, Tipps Varizen.

Paraesophageal varices Tipps Varizen easier to detect than esophageal varices because of the contrast of the surrounding lung and mediastinal fat.

On contrast-enhanced CT scans, downhill esophageal varices may have an appearance similar to that of uphill varices, varying only in location, Tipps Varizen.

Because the etiology of downhill esophageal varices Tipps Varizen usually secondary to superior vena cava SVC obstruction, the physician must be aware of other potential collateral pathways that Tipps Varizen suggest the diagnosis. Stanford et al published data based on venography, [ 19 ] describing 4 patterns of flow in the setting of SVC obstruction as follows [ 19 ]:.

In a retrospective investigation, Cihangiroglu et al analyzed CT scans from 21 studies of patients with SVC obstruction [ 20 ] and described as many as 15 different collateral pathways. Of their total cohorts, only 8 could be characterized by using the Stanford classification.

In the setting of SVC obstruction, the most common collateral pathways were the in decreasing order of frequency: In a study by Zhao et al of row multidetector CT portal venography for characterizing paraesophageal varices in 52 patients with portal hypertensive cirrhosis and esophageal varices, [ 21 ] 50 of the 52 cases showed an origin from the posterior branch of left gastric vein, whereas the others were from the anterior branch, Tipps Varizen.

Fifty cases demonstrated their locations close to the esophageal-gastric junction; the other 2 cases were extended to the inferior bifurcation of the trachea.

Forty-three patients in the Zhao et al study showed the communications between paraesophageal varices and periesophageal varices, whereas the hemiazygous vein 43 cases and IVC 5 cases were also involved, Tipps Varizen. CT scanning is a minimally invasive method used to detect moderate to large esophageal varices and to evaluate the entire portal venous system.

CT scans also help in evaluating the liver, other venous collaterals, details of other surrounding anatomic structures, Tipps Varizen, Tipps Varizen the patency of the portal vein.

In these situations, Tipps Varizen, CT scanning has a major advantage over endoscopy; however, unlike endoscopy, CT scans are Tipps Varizen useful in predicting variceal hemorrhage. Compared with angiography, CT scanning is superior in detecting paraumbilical and retroperitoneal varices and at providing a more thorough examination of the portal venous system without the risk of intervention.

Sehr gute Hilfe von Krampfadern the detection of esophageal varices, CT scanning is slightly better than angiography.

CT scanning and angiography are approximately equal in the detection of varices smaller than 3 mm. If CT scans do not demonstrate small varices, they are unlikely to be seen on angiograms, Tipps Varizen. Contrast-enhanced CT scanning is essential for evaluating esophageal varices.

Contrast enhancement greatly increases the sensitivity and specificity of the examination and reduces the rate of false-positive or false-negative results.

Tipps Varizen

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