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Esophagus has a shape of
pipe connecting throat, located in the area of the neck, with stomach. In adults
it is 25 cm in length. Its main function is transporting food from oral cavity
to stomach, it does not take part in digestion and absorption.
Liver is the biggest gland in the human organism. It
is located at the right side of abdominal cavity, under the
diaphragm. It consists of two big liver lobes, the right and the left, divided by sickles ligament. The main function of liver is detoxification of the
body of toxins.
Cirrhosis is a chronic
disease. It is progressive fibrosis of liver parenchyma, destroying the structure of this organ. It is characterized by the
replacement cells by connective tissue fibers,
which interferes its structure, leading
to metabolic dysfunctions, impediment to the
outflow of bile and portal hypertension.
The causes of cirrhosis are:
- chronic hepatitis
B, C and D
- autoimmune hepatitis
- primary biliary cirrhosis
- liver toxicity
- metabolic diseases
- disease of
the venous outflow hindrance.
The first symptoms of cirrhosis is the loss of appetite, loss of weight, discomfort in abdominal
cavity, intolerance of fatty foods, nausea, persistent constipation,
sometimes diarrhea and flatulence. It can cause the pain in the area of liver, feeling of being tired and
weakness. Later, appears ascites, increased body temperature, bleeding from
mucous membranes and coma, as a
result of disorders of
carbohydrate metabolism. Hormonal disorders
in men manifest by ginecomasty and in women by menstrual cycle disorders.
Firstly, the growth of liver is observed and in the last stage it becomes small
with rough surface. Moreover, the spleen is enlarged.
In diagnosis of liver diseases the following tests are
- haematological tests
- urine test
and non-invasive imaging studies.
is the result of cirrhosis or cirrhosis of the venous connected functionally
with the liver, so that clinical symptoms of hypertension are closely connected
with symptoms of insufficiency of the liver parenchyma. The
most dangerous complication of portal hypertension is haemorrhage from
oesophageal varices, which concerns 30% patients. The hemorrhage formation can
be caused by alcohol abuse and liver insufficiency. Endoscopy can help to
predict haemorrhage. Extensive,
enlarging oesophageal varices with characteristic livid points, erosions and petechiae on the mucous membrane can indicate the possibility of hemorrhage.
Clinical picture of hemorrhage from oesophageal varices means mainly vomiting blood or
clots. Patients often suffer from jaundice, ascites, Hepatitis or alcoholism.
Treatment of hemorrhage from oesophageal varices rely on:
- stop bleeding with endoscopic
- hemodynamic compensation
- administration by intravenous infusion of
vasopressin to reduce tension in portal vein and narrow the visceral arteries.
methods for inhibition of bleeding from oesophageal varices are:
- donning rubber suspenders and vascular clips.
varices tamponade with
Sengstaken-Blakemor or Linton-Nachlas tube are used for the temporary detention of
haemorrhage. They effectively stop haemorrhage, but often comes to the recurrence of
bleeding after the tube is removed.
treatment of esophageal varices as a venous anastomosis,
for example spleen- kidneys is taken rarely, because of high risk and
high death rate.