Fundus varices are varicose veins in the area of the stomach that are often associated with varices of the esophagus and open a bypass circuit. The cause of this phenomenon is usually portal hypertension or outflow obstruction due to compression. In addition to interruption of the bypass circulation, causal treatment of the primary disease takes place.
What are fundic varices?
Veins drain blood from the periphery of the body and return it to the heart, where circulation and oxygenation of the blood begins again via the arterial circulation. The vessels of the circulatory system can suffer from various diseases. For example, a common disease of the veins is varicose veins. These so-called varicose veins are pathologically dilated veins that are visibly tortuous within the subcutaneous tissue. Preferably, varicose veins are located within pressure-loaded venous areas of the lower extremities. In all other cases, they are usually indicative of pathological bypass circulation. This is also the case with fundus varices. This term hides intramural submucosal venous dilatations in the area of the gastric dome. Fundus varices are often associated with varicose veins of the esophagus and in this case refer to pathological processes in the abdominal cavity. Fundus varices usually involve the venae gastricae. As with all varicose veins, the prospect of success with fundus varices increases the earlier the changes are treated. Compared with varicose veins of the legs, fundus varices are a rather rare phenomenon.
Causes
The body opens bypasses whenever individual vessels can no longer be used sufficiently to transport blood. This is the case, for example, with compression or severe vascular calcification. Fundus varices also correspond to bypass circuits and represent a rare complication of various phenomena. The bypass circuits occur, for example, in splenic venous congestion due to , venous compression in the splenic area or venous compressive pancreatic carcinoma. In addition, the appearance may suggest portal hypertension, that is, a high pressure appearance of the portal vein. Fundus varices open bypass circuits and increase the volume burden of the newly developing vessels. In portal hypertension, portocaval anastomosis provides venous outflow. In bypass circuits with fundal varices, outflow is via the gastric venae and downstream esophageal venae. Occlusions of the splenic vein reach compensation via a short circuit with the gastroomental sinistra vein. In this process, blood travels via the superior mesenteric vein to the inferior vena cava, which drains it.
Symptoms, complaints, and signs
Most patients with fundic varices do not notice the opening of a bypass loop at all. Symptoms tend to be a rarity with fundal varices. The clinical course corresponds to an asymptomatic course in nearly all cases. In most cases, varicose veins of the gastric dome form together with varicose veins of the overlying esophagus, which also remain completely asymptomatic. Symptoms appear only in the later course. All symptoms are usually preceded by a perforation of the bypass circulation. This perforation often results in bleeding, which triggers epigastric symptoms. From this point on, the pathological processes within the stomach usually manifest as feelings of pressure and pain. Melena and hematemesis may occur. That is, patients may vomit blood, or notice traces of blood in their stool. Blood in the stool manifests primarily as black staining. Depending on the causative primary disease, other symptoms may be present, such as upper abdominal pain, back pain, and nausea in venous compressive pancreatic cancer.
Diagnosis
The workup of fundal varices requires unequivocal evidence of bleeding. This evidence is provided by stool specimen with appropriate history, may include a hemoccult test, or may be obtained by endoscopic measures such as gastroscopy. If the venous dilatations are confirmed on imaging, a diagnostic evaluation of the esophagus is performed as part of further diagnostics to clarify possible esophageal varices. If the esophageal varices are also confirmed, the diagnosis of portal hypertension is obvious.In the case of isolated fundus varices, outflow disorders of the lienal vein are the more likely diagnosis. In this case, the primary disease must be clarified. Decided medical histories are required to clarify the primary disease, which are combined with laboratory-diagnostic blood testing and imaging of the individual vessels. Imaging of the portae vein and lienal vein, including surrounding tissues, is indicated. Both the liver and pancreas must be examined for possible tumors or cysts. Differentially, fundus varices must be differentiated from other causes of gastrointestinal bleeding. The prognosis for patients with fundic varices depends on the primary disease.
Complications
Fundic varices do not cause direct symptoms or discomfort in most cases. For this reason, the disease is not recognized directly and is diagnosed very late. However, symptoms become apparent as the disease progresses, when the varicose veins have fully formed. The affected person suffers from severe bleeding and pain. The pain can usually take the form of pressure pain or pain at rest and can be extremely restrictive to the patient’s daily life. It is not uncommon for bloody bowel movements to occur, which can lead to panic attacks in many patients. Likewise, pain occurs in the area of the abdomen and stomach, and this is usually also associated with nausea. As a rule, fundus varices can be treated well, so that the discomfort is limited and alleviated. However, once the symptoms have subsided, causative therapy must also be given to prevent the disease from recurring and bleeding from occurring. Life expectancy is not reduced by fundus varices in most cases. However, the affected person must undergo further examinations after the disease.
When should you see a doctor?
Because the onset of fundus varices is completely asymptomatic, affected individuals do not experience a feeling of illness or receive a warning sign from the body to which they might respond. The first signs may not be noticed until the disease is more advanced and the fundus varices are already well formed. If unusual pain occurs or the affected person feels weak repeatedly without an understandable reason, there is cause for concern. Pressure sensations in the stomach area or in the chest set in, which must be investigated and treated. If initial symptoms spread continuously or the complaints increase in intensity, it is advisable to consult a doctor as soon as possible. If changes in the appearance of the skin develop, discoloration occurs and bruises are visible on the upper body, these should be clarified by a doctor. In the case of vomiting, diarrhea, fatigue, rapid heartbeat or sleep disturbances, a visit to the doctor must be made as soon as the complaints occur repeatedly. If blood is vomited or there is blood in human excretions, it is necessary to see a doctor. Nausea, dizziness and back pain are other signs of irregularities that should be investigated. In case of a general feeling of illness, circulatory disorders, inner restlessness, as well as decreased performance, it is advisable to present the indications to a doctor in order to determine the cause.
Treatment and therapy
Varices of the esophagus are often treated by invasive procedures such as rubber band ligation. Ligatures are tourniquets that stop the bypass circulation that develops. However, if fundus varices are associated with esophageal varices, rubber band ligation is not indicated. According to scientific evidence, this treatment method increases the risk of bleeding. Therefore, instead of rubber band ligation, endoscopic [[resin sclerotherapy9]] is used to stop bleeding. If the bleeding is massive or cannot be stopped endoscopically, clinical treatment measures such as the placement of compression probes are indicated. These probes are usually Linton indulgence probes. Since such procedures correspond to a purely symptomatic treatment, a causal therapy of the underlying disease must additionally be performed. In fundus varices, this causal therapy usually corresponds to surgical excision of existing space-occupying lesions.
Prevention
Fundus varices can be prevented only to the extent that the causes of bypass circulation can be prevented.At best, preventive measures in the context of pancreatic tumors in the broadest sense may reduce the risk of developing fundal varices.
Follow-up
In the case of fundal varices, the affected person is usually not entitled to any special options for aftercare. In the first place, the disease must be treated directly by a physician to prevent further complications and discomfort. Self-healing cannot occur, and the disease can also lead to the death of the affected person if left untreated. The earlier the fundus varices are detected, the better the further course of this disease. In most cases, the patients are dependent on a surgical intervention, which is usually performed on an outpatient basis. There are usually no further complications. After this procedure, the affected person should always rest and take care of his body. In this case, the patient should refrain from exertion or stressful activities in order not to put unnecessary strain on the body. Sporting activities should also be avoided. It is not uncommon for patients to require regular examinations by a physician even after treatment of fundus varices in order to prevent further complications. Likewise, the underlying disease that was responsible for the fundus varices should be identified so that it can also be treated. It cannot be generally predicted whether fundus varices will result in a decreased life expectancy for the affected individual.
Here’s what you can do yourself
Sufferers of fundus varices should avoid overexertion and heavy loads in everyday life. Carrying and lifting heavy objects, as well as other physical overloads, can trigger sudden adverse health effects that must be prevented. In addition to physical stresses, mental as well as emotional challenges must be reduced at the same time. In the case of stress or strong emotional feelings, the patient should take care not to develop a negative attitude towards life. For one’s own inner relief, relaxation methods can be used to establish an inner balance. With methods such as yoga or meditation, a mental and psychological balance can be established, which contributes to a relief of the organism. Emotion control and change of stressful cognitive patterns help the patient to develop an optimistic basic attitude. Good self-reflection is important in everyday life in order to recognize the first signs of physical irregularities and to be able to react to them. With a healthy lifestyle as well as sufficient exercise, it is possible for the patient to maintain and improve the existing well-being. Overweight should be avoided and rigid postures should be avoided to prevent circulatory disorders. If pain occurs, it is advisable not to take painkillers independently. Consultation with a medical professional is necessary to avoid further complications. In addition, autogenic training helps in dealing with pain.
