Gastrointestinal Bleeding – Part 4
The most dreaded type of GI bleeding for most surgeons is bleeding from varices in the stomach or esophagus. A varix (singular of varices) is an enlarged vein that protrudes from the mucosa of the stomach or esophagus. In somewhat inelegant terms, it is very similar to a hemorrhoid.
Varices form in the stomach and esophagus most commonly as a result of liver disease. To best understand why
they form, a review of gut physiology and anatomy is helpful. After a meal, the partially digested food travels down the intestinal tract where nutrients are extracted and sent into the bloodstream through a series of capillaries that drain the mucosa of the bowel. These capillaries drain into larger venules and then larger veins until they ultimately drain into the portal vein, which feeds virtually all the venous blood into the liver.
The liver then filters the blood from the portal vein through microscopic channells where it extracts the nutrients and toxins, excretes proteins and clotting factors, and then passes it through the back side of the liver into the hepatic veins where it goes into the vena cava and then into the heart.
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