Esophageal Varices Overview
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Esophageal Varices Overview

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Questions and Answers

What condition can result from bleeding esophageal varices?

  • Hypotension (correct)
  • Severe dehydration
  • Increased libido
  • Hypertension

    • Which of the following is a common symptom of esophageal varices?

  • Excessive salivation
  • Hematemesis (correct)
  • Excessive thirst
  • Fever

    • What is a primary risk factor for the hemorrhage of esophageal varices?

  • Lifting heavy objects (correct)
  • High carbohydrate diet
  • Sedentary lifestyle
  • Excessive exercise

    • Which diagnostic method is NOT typically used to identify the bleeding site in esophageal varices?

    <p>Electrocardiogram (ECG)</p> Signup and view all the answers

    What is an expected outcome of portal hypertension in relation to esophageal varices?

    <p>Collaterals circulation development</p> Signup and view all the answers

    What characterizes hepatic cirrhosis?

    <p>Replace healthy liver tissue with fibrous tissue</p> Signup and view all the answers

    What is the most common cause of hepatic cirrhosis?

    <p>Excessive alcohol intake</p> Signup and view all the answers

    Which type of hepatic cirrhosis results from broad bands of scar tissue due to viral hepatitis?

    <p>Postnecrotic cirrhosis</p> Signup and view all the answers

    What is a common clinical manifestation of hepatic cirrhosis?

    <p>Liver contraction and reduced size</p> Signup and view all the answers

    What percentage of hepatic cirrhosis patients are typically between 40 and 60 years old?

    <p>Over 50%</p> Signup and view all the answers

    Which type of hepatic cirrhosis is associated with chronic biliary obstruction?

    <p>Biliary cirrhosis</p> Signup and view all the answers

    Which symptom is NOT typically associated with hepatic cirrhosis?

    <p>Rapid weight gain</p> Signup and view all the answers

    Which factor does NOT typically contribute to the development of hepatic cirrhosis?

    <p>High fat diet</p> Signup and view all the answers

    What is the primary purpose of pharmacological therapy in managing esophageal varices?

    <p>Decrease portal pressure</p> Signup and view all the answers

    When using a Sengstaken-Blakemore tube, what is the recommended pressure range for the balloons?

    <p>25-40 mmHg</p> Signup and view all the answers

    What is a potential complication of overinflating the Sengstaken-Blakemore tube?

    <p>Ulceration and necrosis</p> Signup and view all the answers

    Which therapy is considered the treatment of choice for managing esophageal varices?

    <p>Esophageal banding therapy</p> Signup and view all the answers

    What is a significant risk associated with surgical management of varices?

    <p>Encephalopathy</p> Signup and view all the answers

    Which of the following is NOT a common complication of endoscopic sclerotherapy?

    <p>Lacerations</p> Signup and view all the answers

    What is an essential monitoring aspect while using balloon tamponade for esophageal varices?

    <p>Balloon inflation frequency</p> Signup and view all the answers

    What action should be taken after endoscopic therapy to ensure effectiveness?

    <p>Provide antiacids</p> Signup and view all the answers

    What primarily causes the formation of cholesterol stones in the gallbladder?

    <p>Decreased bile acid and increased cholesterol synthesis</p> Signup and view all the answers

    Which demographic is most likely to develop cholesterol stones and gallbladder disease?

    <p>Women using oral contraceptives</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing gallbladder disease?

    <p>Regular exercise</p> Signup and view all the answers

    What is a common clinical manifestation of bile duct obstruction due to gallstones?

    <p>Dark urine and light-colored stools</p> Signup and view all the answers

    Which diagnostic test provides direct observation of the bile duct?

    <p>Endoscopic retrograde cholangiopancreatography (ERCP)</p> Signup and view all the answers

    Which symptom indicates obstruction of the common bile duct due to gallstones?

    <p>Murphy's sign</p> Signup and view all the answers

    What condition can occur as a consequence of fat-soluble vitamin deficiency due to gallbladder disease?

    <p>Bone disease</p> Signup and view all the answers

    Which of the following is true regarding the clinical manifestations of gallbladder disease?

    <p>They can be silent and produce mild GI symptoms</p> Signup and view all the answers

    What is a primary dietary recommendation for managing acute symptoms of gallbladder disease?

    <p>Low-fat, liquid diet</p> Signup and view all the answers

    Which pharmacological therapy is used to dissolve small cholesterol gallstones?

    <p>Ursodeoxycholic acid</p> Signup and view all the answers

    What is a required condition for a patient to be eligible for extracorporeal shockwave lithotripsy?

    <p>Less than 4 stones</p> Signup and view all the answers

    Which surgical procedure involves opening the gallbladder for drainage before stone removal?

    <p>Surgical cholecystostomy</p> Signup and view all the answers

    Which of the following is NOT a nursing diagnosis for gallbladder disease management?

    <p>Chronic fatigue</p> Signup and view all the answers

    What type of complications should a nurse monitor for following gallbladder surgery?

    <p>Gastrointestinal symptoms</p> Signup and view all the answers

    Which is an important aspect of patient assessment before gallbladder surgery?

    <p>Knowledge and teaching needs</p> Signup and view all the answers

    Which of the following goals is NOT typically included in the planning phase post-surgery for gallbladder disease?

    <p>Increased physical activity immediately</p> Signup and view all the answers

    Study Notes

    Esophageal Varices

    • Dilated, tortuous veins in the submucosa of the lower esophagus
    • Caused by portal hypertension due to portal venous circulation obstruction
    • Can lead to hemorrhagic shock, decreased cerebral, hepatic, and renal perfusion
    • Increased risk of encephalopathy due to increased nitrogen load in the GI tract from bleeding and increased serum ammonia levels
    • Bleeding can be triggered by: lifting heavy objects, straining at stool, coughing, vomiting, poorly chewed food, irritating fluids, reflux of stomach contents, and medication.
    • 30-50% mortality rate in the first bleeding episode
    • Pathophysiology: blood seeks new routes (collateral circulation) due to obstruction in vessels in the submucosal layer

    Clinical Manifestations

    • Hematemesis
    • Melena
    • General deterioration in mental or physical status
    • Cold, clammy skin
    • Hypotension
    • Tachycardia

    Assessment & Diagnostic Findings

    • Endoscopy: NPO until gag reflex returns
    • Barium swallow
    • Ultrasonography
    • CT scan
    • Angiography

    Portal Hypertension Measures

    • Indirect insertion of fluid-filled balloon catheter into the antecubital or femoral vein to the hepatic vein.
    • Reading over 20 ml saline is abnormal.

    Laboratory Tests

    • Liver function tests
    • Blood flow and clearance studies to assess cardiac output and hepatic blood flow

    Managing Esophageal Varices

    • Monitor vital signs and signs of hypovolemia.
    • Administer oxygen.
    • Pharmacological therapy to decrease portal pressure (Vasopressin and Beta Blockers).
    • Balloon tamponade: Sengstaken-Blakemore tube

    Medical Management of Bleeding Esophageal Varices

    • Monitor circulating volume with a central line.
    • Monitor vital signs.
    • Administer oxygen.
    • IV fluids: caution for overhydration.
    • Balloon tamponade: controls bleeding by applying pressure on the cardiac portion of the stomach and against the bleeding varices using a double-balloon tamponade (Sengstaken-Blakemore tube).
      • Has four openings: Gastric aspiration, esophageal aspiration, inflating of the gastric balloon, and inflating of the esophageal balloon.
      • The pressure in the balloon should be 25-40 mmHg and checked every 2-4 hours.
      • Overinflating or leaving the balloon in place for a long time may cause injury from ulceration and necrosis of the mouth, nose, or stomach mucosa.
      • Displacement of the tube may result in airway obstruction and asphyxia from aspiration.
      • Overinflating may result in sudden rupture and aspiration of gastric content into the lungs.
      • Frequent assessment for bleeding and inflation of balloons are needed to minimize complications.

    Endoscopic Therapy (Injection Sclerotherapy)

    • Useful in GI bleeding
    • Less effective in the first and subsequent variceal bleeding
    • Complications: esophageal stricture, perforation, aspiration pneumonia.
    • Give antacids post-procedure to control sclerosing and reduce acid reflux

    Esophageal Banding Therapy (Band Ligation)

    • Treatment of choice
    • Can be combined with pharmacologic treatment
    • Less risky than sclerosing
    • Complications: lacerations, dysphagia, stricture (rare)

    TIPS (Transjugular Intrahepatic Portosystemic Shunt)

    • Used for cases where other treatments have failed.
    • Less risky than surgery

    Surgical Management of Varices

    • Surgical bypass: to reduce portal pressure
    • Devascularization and transection
    • Very risky: can cause encephalopathy
    • Second-line management if everything else fails

    Hepatic Cirrhosis

    • Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.
    • An irreversible process.

    Types of Hepatic Cirrhosis

    • Alcoholic cirrhosis: Scar tissue surrounds the portal areas and is the most common type.
    • Postnecrotic cirrhosis: Broad bands of scar tissue occur as a late result of acute viral hepatitis.
    • Biliary cirrhosis: Scarring occurs in the liver around the bile ducts, usually due to chronic biliary obstruction and infection (Cholangitis). Less common type.

    Pathophysiology of Hepatic Cirrhosis

    • Nutritional deficiency with reduced protein intake.
    • Excessive alcohol intake (most common cause).
    • Exposure to certain chemicals (carbon tetrachloride, chlorinated naphthalene, arsenic, or phosphorus) or exposure to infection.
    • Twice as many men as women are affected.
    • Most patients are between 40 and 60 years of age.

    Clinical Manifestations of Hepatic Cirrhosis

    • Liver enlargement: early symptom, liver loaded with fatty tissue (firm and has a sharp edge, producing abdominal pain), later the liver decreases in size due to contraction of scar tissue and the edges become nodular.
    • Portal obstruction and ascites.
    • Infection and peritonitis.
    • Gastrointestinal varices.
    • Edema.
    • Vitamin deficiency and anemia.
    • Mental deterioration.

    Gallstones (Cholelithiasis)

    • Decreased bile acid and increased cholesterol synthesis in the liver cause bile supersaturation with cholesterol, which precipitates and forms stones.
    • Four times more women than men develop cholesterol stones and gallbladder disease (due to estrogen and contraceptive use, which increase cholesterol saturation).
    • Risk factors: obesity, multiparous, frequent changes in weight, rapid weight loss, oral contraceptives, estrogens, cystic fibrosis, diabetes mellitus, and increased risk with age due to more cholesterol synthesis and decreased bile acid synthesis.

    Clinical Manifestations of Gallstones

    • Silent, may produce no pain and only mild GI symptoms (detected accidentally).
    • Pain and biliary colic, jaundice, change in urine (dark) and stool color (light), vitamin deficiency (fat-soluble)
    • Two types of symptoms (which may be acute or chronic)
      • From disease of the gallbladder itself: epigastric distress following fatty meal (fullness, abdominal distention), vague pain in the RUQ
      • From obstruction of the bile passage by gallstone: fever, palpable mass, colicky pain (right abdominal pain radiating to the back or right shoulder), nausea and vomiting, Murphy’s sign (inspiratory pain): positive, jaundice (commonly occurs with obstruction of common bile duct), changes in urine color (dark color) and stool color (clay-colored), vitamin deficiency (fat-soluble vitamins)

    Diagnostic Tests for Gallstones

    • Abdominal X-ray
    • Ultrasound
    • Radionuclide imaging: intravenous radioactive agent
    • Cholecystography: oral iodine contrast agent used 10-12 hours before X-ray, NPO
    • Endoscopic retrograde cholangiopancreatography (ERCP): direct observation through fiberoptic scope inserted through esophagus into the duodenum. Discuss nursing implications.
    • Percutaneous transhepatic cholangiography: inject the dye directly into the biliary tree.

    Medical Management of Gallstones

    • Treatment of acute symptoms.
    • Nutritional and supportive treatment: low-fat, liquid diet, rest, IV fluids, nasogastric suction, analgesia, and antibiotics.
    • Pharmacological therapy to dissolve small, radiolucent gallstones composed primarily of cholesterol: ursodeoxycholic acid and chenodeoxycholic acid.

    Nonsurgical Removal of Gallstones

    • Dissolving gallstones: infusion of solvent into the gallbladder.
    • Extracorporeal shockwave lithotripsy (through water bath): Patient should have < 4 stones, < 3 cm in diameter, and no liver or pancreas disease. Contraindicated in inflammatory diseases of the biliary system.
    • Intracorporeal lithotripsy: by ultrasound, pulsed laser
    • By instrumentation: such as ERCP

    Surgical Management of Gallstones

    • Laparoscopic cholecystectomy.
    • Cholecystectomy.
    • Mini-cholecystectomy.
    • Choledochostomy.
    • Surgical cholecystostomy: opening the gallbladder to remove the stones or the pus by drainage when severely inflamed before removal.
    • Percutaneous cholecystostomy.

    Nursing Process: Undergoing Surgery for Gallbladder Disease: Assessment

    • Patient history.
    • Knowledge and teaching needs.
    • Respiratory status and risk factors for postoperative respiratory complications.
    • Nutritional status.
    • Monitor for potential bleeding.
    • GI symptoms: after laparoscopic surgery, assess for loss of appetite, vomiting, pain, distention, fever - potential infection or disruption of the GI tract.

    Nursing Diagnoses

    • Acute pain.
    • Impaired gas exchange.
    • Impaired skin integrity.
    • Imbalanced nutrition.
    • Deficient knowledge.

    Collaborative Problems/Potential Complications

    • Bleeding.
    • Gastrointestinal symptoms.
    • Complications as related to surgery in general: atelectasis, thrombophlebitis.

    Planning for Gallbladder Disease

    • Goals may include relief of pain, adequate ventilation, intact skin, improved biliary drainage, optimal nutritional intake, absence of complications, and understanding of self-care routines.

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    Description

    This quiz covers the critical aspects of esophageal varices, including their causes, clinical manifestations, and diagnostic findings. Understand the pathophysiology behind portal hypertension and recognize the symptoms and risks associated with bleeding. Enhance your clinical knowledge related to this serious condition.

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