Esophageal Varices and Atresia
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Transcript of Esophageal Varices and Atresia
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.