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Saturday, 28 March 2015

Gastric Varices

A 40-year-old man who has been recently resuscitated following acute upper gastrointestinal bleeding.  His medical history is remarkable for  Polycythemia Rubra Vera, and he is on lisinopril for hypertension.
Urgent upper endoscopy showed fundal gastric varices with signs of recent bleeding.
His liver morphology and size by ultrasonographic examination was normal, and the spleen was mildly enlarged.
His full blood count and biochemistry were normal.

How would you explain the presence of gastric varices?

In a patient with isolated gastric varices (ie without esophageal varices), splenic vein thrombosis should be suspected. 
A vascular doppler study will usually confirm the diagnosis.
This patient is particularly susceptible because of his hematological disorder.

W'll meet in a coming post and a new clinical trick!

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