Esophageal Varices; Symptoms, Diagnosis & Operative Treatment

How are esophageal varices diagnosed?

Diagnosing esophageal varices has improved over the years. Doctors now even look for them in all patients with liver conditions. Your doctor will ask you a few questions about your condition including the amount of blood you vomited and symptoms of liver disease you may have. Afterwards, they will examine you and your abdomen to check for signs of liver disease and portal hypertension. One of the commonly done procedures during examination is ultrasonography. Your doctor will check the condition of your liver and the amount of fluid you may have in your abdomen.

After that, they may order some lab tests including:

  • A complete blood count: A complete blood count is an indispensable test that is done in virtually all conditions. In esophageal varices, it can help assess the severity of variceal hemorrhage and the need for blood transfusion.
  • Liver function tests: Liver function tests are needed to assess the general condition of the liver. They include liver enzymes such as ALT and AST which rise in liver damage. In addition, prothrombin time is a measure of liver function, which assesses the efficiency of blood clotting.
  • Kidney function tests: Kidney function tests are not essential for the diagnosis of varices, but they can be affected in liver disease that is severe enough to cause esophageal varices.
  • Tests for viral hepatitis: One of the commonest causes of liver cirrhosis is viral hepatitis, and testing for it is essential in all patients with esophageal varices. It includes:
    • Hepatitis B surface antigen test (HBsAg)
    • Hepatitis C antibodies
    • Hepatitis C DNA (PCR) test
  • Alcohol level in the blood: Alcoholic liver disease is the commonest in western societies, and testing blood alcohol level is needed to diagnose the condition.

In addition to the above lab tests, some imaging studies may be needed:

  • Abdominal ultrasound
  • CT scan of the liver: CT scanning of the liver is not routinely done. It is usually needed when there is an abnormality of the liver seen by ultrasound scanning. One of the complications of liver cirrhosis is the occurrence of liver cancer. It can cause rapid worsening of the condition. CT scanning becomes a must in such conditions. In addition, a special type of CT scanning is called “Triphasic CT scanning” which is needed to differentiate between benign and malignant tumors.

Another essential investigative and treatment tool is endoscopy. Endoscopy is when your doctor uses a special tube and camera to examine your esophagus and stomach. It helps detect the site of bleeding and can help in its management. The procedure is done under anesthesia and is completely safe. It usually takes about half an hour and has minimal or no complications.