ESOPHAGEAL VARICES

1. E S O P H A G E A L
VA R I C E S
Jamilah saad alqahtani
Nurse lecturer,MSN,OR specialist, BSN,RGN,

2. ESOPHAGEAL VARICES
• Develop from elevated venous pressure that drain into
the portal system.
• May rupture causing massive bleeding in the upper and
lower GIT.
• Life-threatening; 30-50% mortality rate
– Contributory factors: lifting heavy objects, straining during
defecation, reflux of stomach contents
• Manifestations: Hematemesis, melena (black tarry
stools), pain , shock

3. ESOPHAGEAL VARICES

4. ASSESSMENT & DIAGNOSTIC FINDINGS
• Endoscopy
–Purpose: to identify the cause and site of
bleeding
–Post procedure: no fluids until gag reflex
returns and give lozenges
• Liver Function Tests

5. MEDICAL MANAGEMENT
• Monitor vitals signs if with hematemesis and melena
• Note for signs of hypovolemic shock
1. HYPOtension
2. TACHYcardia
3. Cold clammy skin
4. Decreased urine output
• Administer oxygen for hypoxia
• Give IV fluids to replace fluid and electrolytes loss
• Blood transfusion if necessary
• Monitor urine output with catheter

6. PHARMACOLOGIC MANAGEMENT
Give drugs that decreases portal pressure and bleeding:
•Vasopressin
–Monitor I&O and electrolytes due to its
antidiuretic effect causing hyponatremia
•Propranolol and Nadolol
–NOTE! Not effective in variceal hemorrhage.

7. SENGSTAKEN-BLAKEMORE TUBE
• Purpose: to control hemorrhage
NOTE!
1.With 90% effectiveness but 60-70%
re-bleeding tendencies
2. Use it for no longer than 24 hours.

8. SCLEROTHERAPY
• Injection of sclerosing agent (polidocanol) through an endoscope
into the bleeding esophageal varices
• Purpose: to cause thrombosis (clotting) and sclerosis.
• Post procedure: observe for bleeding

9. ESOPHAGEAL BANDING THERAPY
TREATMENT OF CHOICE!
• An endoscope loaded with elastic rubber band is passed directly onto
the varix (varices) to be banded.
• Purpose: to reduce the rebleeding and mortality rate.

10. GENERAL NURSING
MANAGEMENT
1. Total Parenteral Nutrition if client is on complete bed rest.
2. Gastric suction to keep the stomach empty and prevent vomiting.
3. Frequent oral hygiene and moisten lips for severe thirst
4. Vitamin K and blood transfusion for blood loss.
5. Provide a quiet environment to relieve client’s anxiety.