Esophageal Varices: Patho, Manifestations, & Diagnostics

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Esophageal varices are complications due to liver diseases or dysfunctions. You can think of esophageal varices as the result of having a backup of plumbing.


The Septic Tank Analogy

Associating esophageal varices with having a backup of septic tank content is helpful in a way that one can compare the liver as 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.

Liver: The Body’s Septic Tank

Now that we’ve established that the liver is the body’s septic tank, we’ll now proceed to the process of how the body consumes and absorbs food, and at the same time, how the backing up of contents, happen.

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, which is 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 with regards to medications.

Hardening of the Liver

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

  • Cirrhosis that is 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.

Signs and Symptoms

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

Physical Assessment

Let’s go over the necessary physical assessment findings to confirm the diagnosis of esophageal varices.

  1. Bleeding.
  2. Decreased blood pressure due to decreased volume caused by bleeding
  3. A skyrocketing heart rate. Due to the decreased hemoglobin, the heart will compensate by pumping faster to distribute oxygen to the different systems of the body.
  4. Tachycardia.

Diagnostic Procedures

One of the main diagnostic procedures that are done with clients who have 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.

NCLEX® Tip Question

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

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

The first thing to do is to relieve the client 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