Esophageal Varices: Patho, Manifestations, & Diagnostics

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1. What is a Varice?
2. Esophageal Varices Causes
3. Signs and Symptoms of Esophageal Varices
4. Esophageal Varices Assessment & Diagnostics
5. Esophageal Varices NCLEX Question

Esophageal varices are complications due to liver diseases or dysfunctions. It’s important to identify and treat the underlying cause of them to prevent complications such as bleeding and improve patient outcomes.

You can think of esophageal varices as the result of having a plumbing backup.

What is a Varice? (The Septic Tank Analogy)

Associating esophageal varices with having a backup of septic tank content is helpful since you can compare the liver to the body’s septic tank. If the septic tank becomes clogged or has hardened, there will be an immediate backup from the system. 

Toilets and sinks will have a backflow of waste products – water will not drain properly from the shower.

The Liver: The Body’s Septic Tank

As food is chewed inside the mouth, it goes down the esophagus, then into the stomach to be broken down by gastric juices. Digested food now goes inside the duodenum, the first part of the small intestine. 

After the duodenum, the contents are sucked into the portal vein that goes through the pancreas. This process is referred to as the first-pass phenomenon concerning medications.

Hardening of the Liver

When the liver hardens due to some type of scarring, for instance:

• Cirrhosis that’s basically the production of scar tissue in the liver
• Hepatitis

Whatever the condition is, the backing up of blood into the portal vein is the main cause of esophageal varices.

Esophageal Varices Causes

Esophageal varices are primarily caused by increased pressure in the portal vein system, which can result from various underlying medical conditions. Some common causes of esophageal varices include:

• Cirrhosis: Cirrhosis scarring can obstruct blood flow through the liver, leading to increased pressure in the portal vein system.
• Hepatitis: Chronic hepatitis, a viral infection that causes inflammation and scarring of the liver, can also lead to esophageal varices.
• Congenital disorders: Rare genetic disorders, such as Budd-Chiari syndrome or portal vein thrombosis, can obstruct the portal vein and lead to increased pressure in the portal vein system.
• Thrombosis: Blood clots in the portal vein or its branches can cause portal hypertension and lead to the development of esophageal varices.
• Schistosomiasis: A parasitic infection common in parts of Africa and South America, schistosomiasis can cause liver damage and develop esophageal varices.

Signs and Symptoms of Esophageal Varices

Since there is the backing up of blood or fluid inside the esophagus, the following manifestations will occur:

• Esophageal bleeding 
• Vomiting with blood
• Bloody stools
• Decreased blood pressure (due to decreased volume caused by bleeding)
• A skyrocketing heart rate. Due to the decreased hemoglobin, the heart will compensate by pumping faster to distribute oxygen to the body’s different systems.
• Tachycardia

Esophageal Varices Assessment & Diagnostics

One of the main diagnostic procedures for patients with esophageal varices is esophagogastroduodenoscopy (EGD). With EGD, a tube with a camera is inserted to visualize the inside of the esophagus.

Liver function tests are also done to check the status of the liver through abnormalities with alanine transaminase (ALT) and aspartate aminotransferase (AST).

The hemoglobin and hematocrit levels are also tested because if there is bleeding anywhere in the body, the lab results for H&H will be low.

Esophageal Varices NCLEX Question

When a patient comes in with perfused bleeding from his mouth, should you do an EGD?

Answer: No. The airway is the priority in any situation. In this case, if the patient is vomiting blood, stopping the bleeding is paramount.

The first thing to do is to relieve the patient of the blood by suctioning its mouth, and once the bleeding ceases, that’s when an EGD is done.

Aside from suctioning, there are other procedures done to stop the bleeding, namely:

• Medications
• Inserting a balloon catheter into the esophagus

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