MCQ – 71099

An alcoholic male presented with vomitting of blood.Barium swallow of the esophagus showed the following picture.Regarding this condition,which of the following statement is true?

A.	Intrahepatic obstruction from cirrhosis
B.	Mediastinal fibrosis
C.	Lung cancer
D.	All of the above

Show Answer

Correct Answer � A Explanation

Ans:A.)Intrahepatic obstruction from cirrhosis

Image shows:

Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous filling defects primarily involving the lower one third of the esophagus with striking prominence around the gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse.

Esophageal Varices

• Dilated submucosal veins due to increased collateral blood flow from portal venous system to azygos system
• Uphill varices
• Collateral blood flow from portal vein via azygos vein into SVC (usually lower esophagus drains via left gastric vein into portal vein)
• Most common cause is portal hypertension secondary to cirrhosis
• Varices in lower half of esophagus to the level of the carina (azygos vein)
• More common than downhill varices
• Causes 
• Intrahepatic obstruction from cirrhosis
• Splenic vein thrombosis (usually gastric varices only)
• Obstruction of hepatic veins
• Portal vein thrombosis
• IVC obstruction below hepatic veins
• Marked splenomegaly / splenic hemangiomatosis (rare)
• Downhill varices
• Collateral blood flow from SVC via azygos vein into IVC / portal venous system (upper esophagus usually drains via azygos vein into SVC)
• Varices in upper 1/3 of esophagus
• Usually extend down to the level of the carina (azygos vein)
• Less common than uphill varices
• Causes 
• Obstruction of superior vena cava distal to entry of azygos vein due to
• Lung cancer (most common)
• Lymphoma
• Retrosternal goiter
• Thymoma
• Mediastinal fibrosis