ESOPHAGE

AL VARICES
and
ATRESIA

ESOPHAGUS
Hollow,

muscular tube
9.2-10 inches
long, 0.8 inch
in diameter
Located in the
thoracic
cavity

ESOPHAGEAL VARICES

Case Study
Vincent 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 36C, 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/Esophagogastroduodenosco
py
-Allows direct visualization of the
esophageal, gastric, and duodenal mucosa
through a lighted endoscope (gastroscope)

 Laboratory

Tests

Elevated serum aminotransferases,

bilirubin, alkaline phosphatase, and
decreased serum proteins.
Splenoportography

Uses segmental x-rays to detect extensive

collateral circulation in esophageal
vessels, which would indicate varices.

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

 Endoscopic

Sclerotheraphy

A sclerosing agent is introduced via endoscopy

to promote thrombosis and eventual sclerosis of
the veins.
Banding

of Varices

A small rubber band is slipped around the base

of the varix.
Balloon

Tamponade

Controls the hemorrhage by mechanical

compression of the varices.

Supportive Measures
Administration

of fresh frozen
plasma and packed RBCs
Vitamin K (Aquamephyton)
H2 Receptor Blocker
Proton Pump Inhibitor

Shunting Procedure
Transjugular

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.