Esophageal Varices Study Guide PDF

STUDY GUIDE – MEDICAL SURGICAL ESOPHAGEAL VARICES Varices - any distended, fragile blood vessels develop within the esophagus How Blood Flows from the Esophagus to the Vein Esophagus from stomach to the portal vein. Veins drain blood from the body to the heart...

STUDY GUIDE – MEDICAL SURGICAL ESOPHAGEAL VARICES Varices - any distended, fragile blood vessels develop within the esophagus How Blood Flows from the Esophagus to the Vein Esophagus from stomach to the portal vein. Veins drain blood from the body to the heart for reoxygenation and sent out through the arteries. The portal vein is the main vessel in the portal venous system, which drains blood from the abdomen to the liver. For patient with liver cirrhosis Cirrhosis (fibrosing liver tissue) causes enlargement of the liver. This enlargement obstruct the blood flow from the liver into the heart. This causes distention on the esophageal veins. Cirrhosis--> blood flow goes back to portal vein-->leading to portal hypertension-->blood pooling causes distention , fragile blood vessels within the esophagus Overtime, this pressure builds and increase within these veins they can become more and more fragile and distended causing rupture. High Risk: Rupture -->hemorrhage CLINICAL FEATURES: Liver cirrhotic patient may have asymptomatic varices Upper endoscopy HEMORRHAGE MANIFESTATIONS Frank hematemesis Risk for aspiration – bleeding on esophagus may enter the lungs causing aspiration Coffee-ground emesis, may be digested leading to melena for mild bleeding Monitor signs of hypovolemic shock – monitor for tachycardia and drop of blood pressure. Make the patient NPO Protect airway by preventing aspiration Intubation if bleeding is massive MEDICATION FOR RESTORING CIRCULATING FLUID VOLUME: IV fluids (bolus or continuous) - large bore IV catheters Packed RBC to maintain BP and improve perfusion Octreotide infusion (vasoconstrictor) constrict blood vessel to stop bleeding. Proton Pump inhibitor may be used to reduce stomach acid and prevent irritation on bleeding vessels. EGD FOR EMERGENCY - ENDOSCOPIC TO CONTROL BLEEDING Sclerotherapy - medication injecting directly into the vein to control bleeding Band ligation- placing band around varices to stop blood flow Blakemore tube (oropharyngeal tube) once it passes to the stomach, a balloon is inflated to put pressure against those bleeding varices to stop blood flow.