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ESOPHAGEAL VARICES Esophageal varices develop in response to an increase in venous pressure in a location distal to the azygos vein and the right ventricle. The impedance to flow may be functional, as in a hyperdynamic circulatory state, or mechanical, as with a blood clot or tumor. Further vasodilation of the splanchnic venous system may also result from secondary changes in vascular circulatory mediators such as nitric oxide and vasoactive intestinal peptide. A variety of disorders, ranging from splenic, portal, or hepatic vein thrombosis (Budd­Chiari syndrome) to right­sided heart failure, may lead to esophageal varices. The most common cause of esophageal varices is portal hypertension secondary to intrahepatic causes, such as cirrhosis. In cirrhosis, there is fibrosis of the sinusoids and shunting that leads to portal vein backflow. As many as half of patients presenting with a new diagnosis of hepatic cirrhosis have esophageal varices on initial evaluation. The vast majority of patients with cirrhosis will also develop esophageal varices over the course of the disease if they do not undergo liver transplantation. If varices are present, there is a greater risk for bleeding with risk factors such as larger varices, increased portal hypertension, hepatic failure, and endoscopic signs of recent or impending bleeding (e.g., red wale signs). Bleeding from esophageal varices may be brisk and massive, and the risk of death is considerable. Many treatments are available for esophageal varices and are used on the basis of whether they are needed for management of acute bleeding, prevention of recurrent bleeding. or prophylaxis in patients with diagnosed nonbleeding varices. Amongst these clinical scenarios, treatments are divided into the broad categories of variceal obliteration (endoscopic banding and sclerosis), pharmacologic reduction of portal venous pressure (beta­antagonists, nitrates, somatostatin), and mechanical reduction of portal venous pressure (transhepatic intravascular portosystemic shunt [TIPS], surgical portacaval shunt, liver transplantation). Acute and chronic treatments may be a combination of obliterative and pharmacologic treatments. For example, acute bleeding may be managed by esophageal variceal banding and intravenous octreotide, whereas chronic prevention may rely on banding and use of beta­antagonists. Prophylactic therapy tends to be pharmacologic, but obliterative techniques may be used in addition. Therapies such as TIPS and transplant are reserved for more severe and/or refractory cases of variceal bleeding.

In this article, you will learn what sirtuins are. You will understand how sirtuins impact mitochondria and aging and how to optimize them.

Spinomed is a back brace for the therapy of osteoporosis. Thanks to the ergonomically pre-formed shoulder straps, it is easy to don.

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Emma McConville (14) and Caris Smith (11) did well at the event in Liverpool.

Az állapotfelmérés során a legtöbb edző BMI-t számol a magasság és súly alapján, esetleg egy há...

A good working knowledge of core anatomy is essential for designing safe and effective exercise programs for your clients. Study the core muscles and understand what they do and how they work together.

Muscle strength is a requirement for building and protecting your bones. The positive stress that muscles place on bone stimulates new bone development, as described by Wolff's Law. That alone … Continue Reading →

If Peloton is too pricey, the Prime Bike might just be what your home gym needs.

The infraspinatus muscle is an important part of the rotator cuff. It helps stabilize the shoulder joint by acting against the deltoid muscle and the teres m...

China's Lin Dan holds a trophy after winning his All England Open Badminton Championships men's singles final match against China's Tian Houwei in Birmingham, central England, on March 13, 2016. -...

Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.

While we're enjoying the tennis fashion spectacle at the Australian Open, there are new high-quality brands which we can't wait to see on WTA players and one

WoodenBoat magazine for wooden boat owners and builders, focusing on materials, design, and construction techniques and repair solutions.