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.