Esophageal Varices

Definition/Etiology:

Dilated submucosal esophageal veins that become tortured leading to an increased risk of rupture

Causes:

• Liver disease
• Cirrhosis = (scarring of the liver)
• Portal HTN = (portal vein is the main vein that runs to the liver. More scarring = increased pressure)

Pathophysiology:

Liver scarring causes increased pressure in the vein, vein travels to the path of least resistance which is usually the esophageal veins. Pressure increases in the esophageal veins leading to dilation and potentially rupture.

Clinical Presentation:

• Vomiting blood
• Abd pain
• Possible Jaundice
• Hx of alcoholism or liver disease
• Black/ tar like stool from swallowing small amt of blood
• If they have been bleeding, patient shows shock symptoms:
  • tachycardia
  • low BP
  • pale/clammy skin
  • irregular breathing

Collaborative Management:

• Stabilize
• Hypovolemic shock
• Fluids
• Blood transfusion (make sure type and cross completed)

• Labs – may show anemia, dehydration, elevated AST/ALT, thrombocytopenia
• Treatment – Upper endoscopy, band ligation, monitor BP to prevent rebleeding (vasoconstrictors as needed)

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring
• 70% chance of rebleeding, monitor for additional bleeding
• Need good outpatient follow up
• If they abuse ETOH/ avoid any further use

Linchpins: (Key Points)

• Caused from portal HTN
• Monitor for hypovolemic shock
• Esophageal band ligation
• Rebleed likely
• Rupture = patient can go into hypovolemic shock/ bleed out