Читать книгу The Esophagus - Группа авторов - Страница 197

Esophageal varices may be classified as “uphill” or “downhill.” Uphill varices are caused by portal hypertension with increased pressure in the portal venous system transmitted upward via dilated esophageal collaterals to the superior vena cava. In contrast, downhill varices are caused by superior vena cava obstruction with downward flow via dilated esophageal collaterals to the portal venous system and inferior vena cava. Uphill varices are much more common than downhill varices. Whether uphill or downhill, varices are important because of the risk of upper gastrointestinal bleeding.

Figure 6.76 Diffuse esophageal spasm. (A) Prone single‐contrast view shows multiple lumen‐obliterating, nonperistaltic contractions that compartmentalize the esophagus, producing the classic corkscrew appearance associated with diffuse esophageal spasm. Note the presence of a small hiatal hernia (black arrow). (B) Prone single‐contrast view in another patient shows multiple nonperistaltic contractions of mild‐to‐moderate severity (white arrows) with tapered, beak‐like narrowing of the distal esophagus (black arrow) secondary to lower esophageal sphincter dysfunction. This patient has diffuse esophageal spasm with impaired opening of the lower esophageal sphincter. Again note the presence of a small hiatal hernia.