Download - Esophageal Varices
ESOPHAGEAL VARICES
Presented by: Ariane Joy Magnaye
Karla Mejia &
Sarah Jane Petalio
Varices> are varicosities that develop from elevated pressure in the veins that drain into the portal system
ESOPHAGEAL VARICES are dilated, tortuous veins that are usually
found in the submucosa of the lower esophagus but many develop higher in the esophagus or extend into the stomach
this condition is almost always caused by portal hypertension
Portal Hypertension- is the increased pressure throughout the portal venous system that result from obstruction of blood flow through the damaged liver
CLINICAL MANIFESTATION Hematemesis Melena General detorioration in mental or
physical statusS/S Shock(cool clammy skin,hypotension,
tachycardia)
ASSESSMENT & DIAGNOSTIC TEST
Endoscopy, barium swallow ultrsosography CT, and angiography- to identify the cause and the site of bleeding
Portal Hypertension Measurement 1. Indirect measurement
The measurement requires insertion of a catheter with a balloon into the antecubital or femoral vein.
2. Direct measurementa. During the laparotomy, a needle may be
introduced into the spleen; a manometer reading of more that 20 ml saline is abnormal
b. Insertion of a catheter into the portal vein or one of its branches
Laboratory Test - Liver function test
- Splenoportography- Hepatoportography- Celiac angigraphy
MEDICAL MANAGEMENT Pharmacologic Therapy
- VasopressinIt produce constriction of the
splanchnic arterial bed and decrease portal pressure- Somatostatin
Cause selective splanchnic vasoconstriction and are used mainly in the management of active hemorrhage
- Propranolol & NadololBeta-blocking agents that
decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in patient with known varices and to prevent rebleeding
- NitratesLower portal pressure by
venodilation and decreased cardiac output and may be used in combination with beta-blockers
Balloon Tamponade- In this procedure, pressure is exerted on the cardia(upper orifice of the stomach) and against the bleeding varices by a double –ballon tamponade.
Endoscopic Therapies
Endoscopic Sclerotherapy - also referred to as injection sclerotheraphy - a sclerosing agent is injected through a fiberoptic endoscope into the bleeding esophageal varices to promote thrombosis and eventual sclerosis.
Esophageal Banding Therapy- also referred to as esophageal variceal ligation (EVL)- a modified endoscope loaded with an elastic rubber band is passed through an overtube directly onto the varix (or varices) to the banded
Transjugular Intrahepatic Portosystemic Shunting- Is indicated for the treatment of an
acute episode of variceal bleeding refractory to pharmacologic or endoscopic therapy.
SURGICAL MANAGEMENT Surgical Bypass Procedures
- can prevent variceal bleeding if the shunt remains patentDistal Splenorenal shunt
Is made between the splenic vein and the left renal vein after splenectomy.
Devascularization and Transection- Is a procedure to separate the bleeding site from the high-pressure portal system to have been used in the emergency management of variceal bleeding
NURSING MANAGEMENT Monitoring the patient’s physical
condition and evaluating emotional responses and cognitive status
Monitors and record vital signs and assesses the patient’s nutritional and neurologic status
Monitor blood pressure Provide support and explanations about
medical and nursing intervention Close monitoring of the patient helps in
directing and managing complications.