The oesophageal veins form a plexus in the submucosa and around the outside of the oesophagus. The upper part drains to the inferior thyroid veins, the middle part to the azygos and hemiazygos veins, and the lower part to the left gastric vein, which belongs to the portal system. The lower oesophagus is therefore a meeting point between the portal and systemic venous systems.
| Origin | Submucosal and periesophageal venous plexuses of the oesophagus |
|---|---|
| Course | Drain the cervical part into the inferior thyroid veins, the thoracic part into the azygos and hemiazygos veins, and the abdominal part into the left gastric vein |
| Branches |
|
In portal hypertension, usually from cirrhosis, blood is diverted from the portal system through the left gastric vein into the oesophageal veins, which swell into oesophageal varices. Ruptured varices cause massive vomiting of blood and are a leading cause of death in liver disease. Treatment includes vasoactive drugs such as terlipressin, endoscopic band ligation, balloon tamponade and TIPS, with beta blockers or banding to prevent first or repeat bleeding.
Dilated submucosal veins of the lower oesophagus caused by portal hypertension. Rupture causes life-threatening haematemesis that needs resuscitation, vasoactive drugs, antibiotics and urgent endoscopic band ligation.
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