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Questions and Answers
A patient with liver cirrhosis develops esophageal varices. Which of the following pathophysiological sequences BEST explains the development of these varices?
A patient with liver cirrhosis develops esophageal varices. Which of the following pathophysiological sequences BEST explains the development of these varices?
- Cirrhosis → increased blood flow from the liver → systemic hypertension → esophageal vein collapse.
- Cirrhosis → obstruction of hepatic artery → decreased blood flow to the portal vein → esophageal vein constriction.
- Cirrhosis → decreased blood flow from the liver → portal hypertension → esophageal vein distention. (correct)
- Cirrhosis → decreased albumin production → ascites → increased pressure on esophageal veins.
A patient with known esophageal varices presents with sudden, profuse hematemesis. What is the PRIORITY nursing intervention?
A patient with known esophageal varices presents with sudden, profuse hematemesis. What is the PRIORITY nursing intervention?
- Initiating large bore IV catheters and administering IV fluids. (correct)
- Administering a proton pump inhibitor to reduce stomach acid.
- Preparing the patient for immediate sclerotherapy.
- Inserting a Blakemore tube to apply direct pressure.
A patient with bleeding esophageal varices is being treated with octreotide. What is the PRIMARY mechanism of action of this medication in this context?
A patient with bleeding esophageal varices is being treated with octreotide. What is the PRIMARY mechanism of action of this medication in this context?
- Constricting blood vessels to decrease portal venous pressure and bleeding. (correct)
- Dilating esophageal blood vessels to reduce resistance to blood flow.
- Reducing gastric acid production to prevent further esophageal irritation.
- Promoting platelet aggregation to facilitate clot formation.
A patient with esophageal varices experiences a moderate bleed. Besides frank hematemesis, which other clinical manifestation might indicate blood loss?
A patient with esophageal varices experiences a moderate bleed. Besides frank hematemesis, which other clinical manifestation might indicate blood loss?
Following a band ligation procedure for esophageal varices, a patient reports mild chest discomfort and difficulty swallowing. What is the MOST appropriate initial nursing intervention?
Following a band ligation procedure for esophageal varices, a patient reports mild chest discomfort and difficulty swallowing. What is the MOST appropriate initial nursing intervention?
A patient with esophageal varices is at risk for aspiration. What nursing intervention is MOST important to prevent this complication?
A patient with esophageal varices is at risk for aspiration. What nursing intervention is MOST important to prevent this complication?
A patient with cirrhosis and esophageal varices develops sudden shortness of breath and altered mental status during an episode of hematemesis. What IMMEDIATE action should the nurse take?
A patient with cirrhosis and esophageal varices develops sudden shortness of breath and altered mental status during an episode of hematemesis. What IMMEDIATE action should the nurse take?
During the administration of a packed red blood cell (PRBC) transfusion to a patient with bleeding esophageal varices, the nurse observes that the patient becomes restless, develops a sudden onset of dyspnea, and complains of chest pain. What is the nurse's MOST appropriate INITIAL action?
During the administration of a packed red blood cell (PRBC) transfusion to a patient with bleeding esophageal varices, the nurse observes that the patient becomes restless, develops a sudden onset of dyspnea, and complains of chest pain. What is the nurse's MOST appropriate INITIAL action?
Flashcards
Esophageal Varices
Esophageal Varices
Distended, fragile blood vessels in the esophagus, often due to liver cirrhosis.
Cirrhosis and Varices
Cirrhosis and Varices
Fibrosing liver tissue obstructs blood flow, leading to increased pressure in the portal vein and esophageal varices.
Portal Hypertension
Portal Hypertension
Elevated pressure in the portal vein due to obstructed blood flow from the liver.
Frank Hematemesis
Frank Hematemesis
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Coffee-Ground Emesis
Coffee-Ground Emesis
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Melena
Melena
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Hypovolemic Shock Signs
Hypovolemic Shock Signs
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Sclerotherapy
Sclerotherapy
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Study Notes
- Esophageal varices are distended, fragile blood vessels in the esophagus.
Blood flow
- Blood flows from the esophagus to the portal vein, which drains blood from the abdomen to the liver.
- Veins drain blood to the heart for reoxygenation before being pumped out through the arteries.
- The portal vein is the main vessel in the portal venous system.
Liver Cirrhosis
- Liver cirrhosis, or fibrosing liver tissue, causes enlargement of the liver and obstructs blood flow to the heart.
- Cirrhosis causes blood to flow back to the portal vein, leading to portal hypertension.
- The portal hypertension causes blood pooling, distention, and fragile blood vessels within the esophagus.
- Over time, pressure builds within these veins, increasing the risk of rupture and hemorrhage.
Clinical Features
- Liver cirrhotic patients may have asymptomatic varices
- Upper endoscopy is used to assess varices
Hemorrhage Manifestations
- Frank hematemesis - vomiting blood
- Risk for aspiration: Bleeding from the esophagus may enter the lungs
- Coffee-ground emesis may be digested, leading to melena (dark, tarry stools) for mild bleeding
- Monitor for signs of hypovolemic shock, including tachycardia and a drop in blood pressure
- Make the patient NPO (nothing by mouth)
- Protect the airway by preventing aspiration
- Intubation if bleeding is massive
Medications for Restoring Circulating Fluid Volume
- IV fluids (bolus or continuous) through large bore IV catheters
- Packed RBC to maintain blood pressure and improve perfusion
- Octreotide infusion (vasoconstrictor) constricts blood vessels to stop bleeding
- Proton Pump Inhibitors reduce stomach acid and prevent irritation on bleeding vessels
Endoscopic Interventions for Emergency Bleeding
- Sclerotherapy involves injecting medication directly into the vein to control bleeding.
- Band ligation involves placing a band around the varices to stop blood flow.
- A Blakemore tube (oropharyngeal tube) is inserted into the stomach, where a balloon is inflated to put pressure against the bleeding varices.
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