- Be suspicious of Portal Vein Thrombosis
- Present with bleed in ~ 10-30%
Types
- Type 1: Fundal Varices
- Pressure transmitted via Short Gastrics and Posterior Gastric Veins to Fundal Veins
- Isolated varices (i.e. not with oesophageal varices) occur due to Splenic thrombosis
- Splenic blood flows retrograde through short and posterior gastrics into varices and then through coronary veins into portal vein
- Type 2: Ectopic Varices
- Located elsewhere (from flow through Gastroepiploic vein)
Management
- GOJ as per oesophageal varices
- Isolated gastric varices
- Poorly treated endoscopically, can try Cyanoacrylate injection
- Polymerises to form firm clot
- Otherwise Splenectomy
