ESOPHAGEAL VARICES

and ATRESIA

ESOPHAGUSHollow,

muscular tube9.2-10 inches

long, 0.8 inch in diameter

Located in the thoracic cavity

ESOPHAGEAL VARICES

Case StudyVincent Miller, a 62-year-old accountant, has had a "drinking problem" throughout most of his adult life. He was rushed to the emergency room with severe vomiting of bright red blood. The bleeding and vomiting started abruptly while Vincent was eating some hard, dry French bread. On examination, he had a temperature of 36°C, a pulse rate of 120 bpm that is easily obliterated, a respiratory rate of 25 cpm, a blood pressure of 60/ 30 mmHg, and a cold clammy skin. His laboratory results showed that his alkaline phosphatase is 103u/L, AST is 40 u/L, ALT is 45 u/L, and a bilirubin level of 3 mg/dl. An endoscope was placed down Vincent's esophagus, and a diagnosis of esophageal varices was quickly made.

Dilated, tortuous veins Usually caused by portal hypertension

Abnormalities of the circulation in the splenic vein or superior vena cava and hepatic venothrombosis

PATHOPHYSIOLOGY

SIGNS and SYMPTOMS Usually the dilated veins cause no

symptoms.Bleeding Esophageal Varices Hematemesis Melena S&S of Shock Deterioration of mental or physical

status

Bleeding Esophageal Varices muscular exertion

from lifting heavy objects;

straining during defecation;

sneezing, coughing , or vomiting;

esophagitis; irritation of vessels by

poorly chewed foods or irritating fluids

Salicylates

Assessment and Diagnostic Findings

Upper Gastrointestinal Fibroscopy/Esophagogastroduodenoscopy

-Allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted endoscope (gastroscope)

Laboratory TestsElevated serum aminotransferases, bilirubin, alkaline phosphatase, and decreased serum proteins.

SplenoportographyUses segmental x-rays to detect extensive collateral circulation in esophageal vessels, which would indicate varices.

GOAL: Avoidance of bleeding and hemorrhage.Prophylactic Treatment: Beta-blockers IV therapy with electrolytes and volume expandersVassopressin (Pitressin)Nitroglycerine

Medical Management

Endoscopic SclerotheraphyA sclerosing agent is introduced via endoscopy to promote thrombosis and eventual sclerosis of the veins.Banding of VaricesA small rubber band is slipped around the base of the varix.Balloon TamponadeControls the hemorrhage by mechanical compression of the varices.

Supportive MeasuresAdministration of fresh frozen

plasma and packed RBCsVitamin K (Aquamephyton)H2 Receptor BlockerProton Pump Inhibitor

Shunting ProcedureTransjugular intrahepatic

portosystemic shunt (TIPS)A nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow

Nursing Diagnosis Hemorrhage r/t rupture of esophageal

varices Altered Tissue Perfusion r/t GI bleeding Potential for Portal-Systemic

Encephalopathy

Nursing Management Monitoring of vital signs. Supportive relief of anxiety for patient

and family. Regulation of stress exposure. Health teachings on food choices.