Żylaki przełyku – Charakterystyka, pielęgnacja i opieka

Żylaki przełyku
Charakterystyka, pielęgnacja i opieka

Żylaki przełyku (varices oesophagi) to poszerzone żyły w dolnej części przełyku, powstające na skutek nadciśnienia wrotnego, najczęściej w przebiegu marskości wątroby, występujące u 50-80% pacjentów z tą chorobą. Stanowią one poważne zagrożenie życia ze względu na ryzyko masywnego krwawienia, które wiąże się z około 20% śmiertelnością i wysokim ryzykiem nawrotu (33-60%). Diagnostyka opiera się na ezofagogastroduodenoskopii (EGD), która pozwala ocenić stopień zaawansowania żylaków i wdrożyć odpowiednie leczenie. Standardowe metody terapeutyczne obejmują endoskopowe zakładanie opasek (EVL), skleroterapię, farmakoterapię beta-blokerami nieselektywnymi (propranolol, nadolol, karwedilol) oraz leki obkurczające naczynia (oktreotyd, somatostatyna, wazopresyna) w ostrym krwawieniu. W przypadku niepowodzenia leczenia stosuje się TIPS lub przeszczep wątroby, szczególnie u pacjentów z zaawansowaną marskością (Child-Pugh B/C).

Wprowadzenie do Żylaków Przełyku

Żylaki przełyku (łac. varices oesophagi) to poszerzone, kręte żyły w podśluzówkowej warstwie dolnej części przełyku, które powstają w wyniku nadciśnienia wrotnego, najczęściej będącego skutkiem marskości wątroby. Tworzą się one jako naczynia krążenia obocznego, łączące krążenie wrotne z systemowym, gdy przepływ krwi przez żyłę wrotną jest utrudniony z powodu zmian włóknistych w wątrobie lub zakrzepicy żyły wrotnej¹². Żylaki przełyku stanowią poważne i potencjalnie zagrażające życiu powikłanie zaawansowanej choroby wątroby, które występuje u około 50-80% pacjentów z marskością wątroby³⁴. Pęknięcie żylaków przełyku i związane z tym krwawienie jest jednym z najpoważniejszych powikłań nadciśnienia wrotnego, wiążącym się z wysoką śmiertelnością⁵.

Opieka Pielęgnacyjna w Żylakach Przełyku

Opieka pielęgnacyjna odgrywa kluczową rolę w skutecznym zarządzaniu stanem pacjentów z żylakami przełyku. Pielęgniarki są odpowiedzialne za wczesne wykrywanie żylaków przełyku, zarządzanie związanymi z nimi ryzykami oraz edukację pacjentów w celu zminimalizowania powikłań⁶. Rozpoznając, że pacjenci z żylakami przełyku często mają złożone potrzeby zdrowotne, kompleksowy plan opieki koncentruje się na wczesnym wykrywaniu, monitorowaniu ryzyka krwawienia oraz interwencjach mających na celu zarządzanie i zapobieganie powikłaniom⁷.

Ocena Pielęgnacyjna

Kompleksowa ocena pielęgnacyjna jest podstawą opracowania indywidualnego planu opieki, ułatwiając wczesne wykrywanie i interwencję⁸. W ramach oceny należy:

Monitorować parametry życiowe, w tym ciśnienie krwi, tętno i częstość oddechów⁹
Oceniać pod kątem objawów wstrząsu¹⁰
Monitorować saturację tlenem¹¹
Dokumentować zmiany ortostatyczne¹²
Oceniać poziom świadomości, parametry życiowe i diurezę w celu oceny równowagi płynowej¹³
Badać pod kątem wybroczyn, krwawienia z nosa, plamicy i krwawiących dziąseł¹⁴

Ocena Krwawienia

Monitorowanie pod kątem krwawienia jest szczególnie istotne, ponieważ krwotok z żylaków przełyku stanowi zagrożenie życia¹⁵. Pielęgniarki powinny:

Monitorować pod kątem krwawych wymiotów (hematemeza)¹⁶
Sprawdzać kolor i konsystencję stolca¹⁷
Oceniać kolor i temperaturę skóry¹⁸
Monitorować poziomy hemoglobiny i hematokrytu¹⁹
Oceniać tempo i objętość krwawienia²⁰
Mierzyć ciśnienie krwi i tętno w pozycji leżącej i siedzącej²¹

Interwencje Pielęgniarskie w Żylakach Przełyku

Interwencje pielęgniarskie w żylakach przełyku mają na celu skuteczne zarządzanie stanem, zmniejszenie ryzyka krwawienia i zapewnienie holistycznej opieki pacjentom²². Edukacja pacjenta i rodziny jest centralnym elementem tego planu opieki, umożliwiającym osobom aktywny udział w opiece, zrozumienie stanu i podejmowanie działań zapobiegawczych²³.

Zarządzanie Krwawieniem

W przypadku krwawienia z żylaków przełyku konieczne są natychmiastowe działania²⁴. Interwencje obejmują:

Utrzymanie drożności dróg oddechowych, ułożenie pacjenta w pozycji ułatwiającej oddychanie i usuwanie krwawych wymiocin, odsysanie nadmiaru wydzieliny i krwi²⁵
Założenie dostępu dożylnego i podawanie płynów oraz produktów krwiopochodnych²⁶
Utrzymywanie dostępu dożylnego z cewnikiem o dużej średnicy, co zapewnia szybkie podawanie płynów/krwi w razie potrzeby²⁷
Pobranie krwi do badań: hemoglobiny, hematokrytu, PT, PTT, płytek krwi, próby krzyżowej, elektrolitów oraz testów funkcji nerek i wątroby²⁸
Korygowanie zaburzeń krzepnięcia świeżo mrożonym osoczem, świeżą krwią i witaminą K1²⁹
Wprowadzenie zgłębnika nosowo-żołądkowego do oceny nasilenia krwawienia i płukania treści żołądka przed endoskopią³⁰

Monitorowanie Pacjenta

Ciągłe monitorowanie jest niezbędne dla wczesnego wykrywania komplikacji³¹. Pielęgniarki powinny:

Monitorować parametry życiowe co 2 godziny lub zgodnie z zaleceniami w celu wczesnego wykrycia epizodów krwawienia³²
Utrzymywać ścisłą kontrolę bilansu płynów³³
Prowadzić ciągłe monitorowanie kardiorespiracyjne³⁴
Utrzymywać dostęp dożylny³⁵
Monitorować pacjenta podczas transfuzji krwi, jeśli jest zlecona³⁶
Oceniać drożność zgłębnika nosowo-żołądkowego, aby zapobiec aspiracji³⁷
Obserwować aspirat żołądkowy pod kątem oznak krwawienia³⁸

Procedury Medyczne w Leczeniu Żylaków Przełyku

W leczeniu żylaków przełyku stosuje się różne procedury medyczne, a pielęgniarki odgrywają kluczową rolę w przygotowaniu pacjentów do tych zabiegów oraz w opiece pooperacyjnej³⁹.

Endoskopowe Badanie Diagnostyczne

Ezofagogastroduodenoskopia (EGD) jest złotym standardem w diagnostyce i ocenie stopnia nasilenia żylaków przełyku⁴⁰⁴¹. Podczas tego badania:

Cienka, elastyczna rurka z kamerą jest wprowadzana przez usta do przełyku w celu wizualizacji jego wnętrza⁴²
Jeśli nie wykryje się żylaków przełyku, eksperci zazwyczaj zalecają powtórzenie EGD za 1-3 lata⁴³
Jeśli wykryje się duże żylaki, przepisuje się leki w celu zmniejszenia ryzyka krwawienia, a endoskopia zwykle nie musi być powtarzana⁴⁴
W przypadku małych żylaków przełyku często zaleca się leki, mimo że ryzyko krwawienia jest znacznie niższe niż w przypadku dużych żylaków⁴⁵

Endoskopowe Leczenie Żylaków

Dwie główne metody endoskopowe stosowane w leczeniu żylaków przełyku to endoskopowe zakładanie opasek (EVL) i skleroterapia⁴⁶:

Endoskopowe zakładanie opasek (EVL) – lekarz używa endoskopu do umieszczenia małej gumowej opaski wokół żylaków przełyku, aby zatrzymać lub zapobiec krwawieniu; metoda ta jest skuteczniejsza niż skleroterapia⁴⁷⁴⁸
Skleroterapia endoskopowa – polega na wstrzyknięciu leku do żylaków, powodując ich skurczenie i zatrzymanie krwawienia⁴⁹
Po wstępnym leczeniu opaskami, lekarz powtarza endoskopię górnego odcinka przewodu pokarmowego w regularnych odstępach czasu⁵⁰

Po skleroterapii iniekcyjnej pielęgniarki powinny oceniać pacjenta pod kątem:⁵¹

Aspiracji
Perforacji przełyku
Przedłużającego się krwawienia

Tamponada Balonowa

W przypadku masywnego krwawienia z żylaków przełyku może być stosowana tamponada balonowa⁵²:

Procedura polega na umieszczeniu w przełyku i żołądku sondy z balonem, który po napełnieniu powietrzem uciska powiększone lub krwawiące żyły w celu kontroli krwawienia⁵³
Rurka Sengstakena-Blakemore’a została zaprojektowana w celu zatrzymania krwotoku poprzez mechaniczne uciskanie żylaków przełyku i żołądka⁵⁴
Przy konieczności zastosowania tamponady balonowej istnieje niski próg dla intubacji, która jest wysoce zalecana⁵⁵

Pielęgniarki powinny zapewnić opiekę pielęgniarską pacjentowi poddawanemu zaleconej tamponadzie balonowej w celu kontroli krwawienia⁵⁶:

Wyjaśnić procedurę pacjentowi, aby zmniejszyć strach i poprawić współpracę przy wprowadzaniu i utrzymywaniu rurki tamponady przełykowej⁵⁷
Ściśle monitorować pacjenta, aby zapobiec przypadkowemu usunięciu lub przemieszczeniu rurki z wynikającą niedrożnością dróg oddechowych⁵⁸

Leczenie Farmakologiczne

Farmakoterapia odgrywa ważną rolę w zarządzaniu żylakami przełyku, zarówno w zapobieganiu, jak i kontroli krwawienia⁵⁹.

Beta-blokery

Beta-blokery nieselektywne są standardowym leczeniem w zapobieganiu pierwszemu krwawieniu z żylaków u pacjentów z żylakami średnimi lub dużymi⁶⁰:

Leki takie jak propranolol, nadolol, tymolol lub karwedilol są stosowane, jeśli nie ma przeciwwskazań do stosowania beta-blokerów⁶¹⁶²
Beta-blokery obniżają ciśnienie w żyle wrotnej, zmniejszając rzut serca, co prowadzi do skurczu naczyń trzewnych i obniżenia ciśnienia wrotnego⁶³
Zmniejszają ryzyko nawracających krwawień o 34% i śmiertelność o 26%⁶⁴
Dawkę zwiększa się stopniowo, aż do osiągnięcia redukcji spoczynkowej częstości akcji serca o 25%, ale nie poniżej 55 uderzeń na minutę⁶⁵

Leki Wazokonstrykcyjne

W ostrym krwawieniu z żylaków przełyku stosuje się leki obkurczające naczynia⁶⁶:

Oktreotyd lub somatostatyna – spowalniają przepływ krwi z narządów wewnętrznych do żyły wrotnej⁶⁷
Wazopresyna – podawana dożylnie w celu obkurczenia naczyń krwionośnych⁶⁸
Terapia skojarzona endoskopowa i farmakologiczna osiąga lepszą kontrolę ostrego krwawienia niż samo leczenie endoskopowe⁶⁹

Terapia Antybiotykowa

Ostre krwawienie z żylaków przełyku często wiąże się z zakażeniem bakteryjnym z powodu translokacji jelitowej i zaburzeń motoryki⁷⁰:

Profilaktyczna antybiotykoterapia zmniejsza ryzyko zakażeń bakteryjnych, nawrotu krwawienia i zwiększa wskaźnik przeżycia⁷¹
Profilaktyczne antybiotyki są stosowane w celu zapobiegania zakażeniom bakteryjnym, które występują podczas krwawienia i wczesnego nawrotu krwawienia⁷²

Zaawansowane Procedury w Leczeniu Żylaków Przełyku

W przypadku niepowodzenia standardowych metod leczenia lub nawrotu krwawienia stosuje się bardziej zaawansowane procedury⁷³.

Przezszyjne Wewnątrzwątrobowe Zespolenie Wrotno-Systemowe (TIPS)

TIPS jest dobrą alternatywą, gdy leczenie endoskopowe i farmakoterapia zawodzą⁷⁴:

Procedura polega na utworzeniu nowych połączeń między dwoma naczyniami krwionośnymi w wątrobie i wprowadzeniu stentu⁷⁵
Zmniejsza to ciśnienie w żyłach i zapobiega nawrotom epizodów krwawienia⁷⁶
TIPS należy rozważyć w przypadku niekontrolowanego krwawienia z żylaków dna żołądka lub nawrotu pomimo skojarzonej terapii farmakologicznej i endoskopowej⁷⁷

Transplantacja Wątroby

Przeszczep wątroby jest opcją dla osób z ciężką chorobą wątroby lub tych, którzy doświadczają nawracającego krwawienia z żylaków przełyku⁷⁸:

Jest to najlepsza możliwa metoda dla osób z krytyczną chorobą wątroby⁷⁹
Przeszczep wątroby należy zawsze rozważyć, jeśli pacjent ma stopień B lub C w skali Childa-Pugha⁸⁰

Edukacja Pacjenta i Opieka Długoterminowa

Edukacja pacjenta jest kluczowym elementem kompleksowej opieki nad pacjentem z żylakami przełyku, umożliwiającym osobom aktywny udział w zarządzaniu swoim stanem⁸¹.

Zmiany Stylu Życia

Modyfikacje stylu życia są niezbędne dla pacjentów z żylakami przełyku⁸²:

Unikanie alkoholu – jednym z najważniejszych sposobów zmniejszenia ryzyka krwawienia z żylaków jest zaprzestanie picia alkoholu; alkohol może pogorszyć marskość wątroby, zwiększyć ryzyko krwawienia i znacznie zwiększyć ryzyko zgonu⁸³
Unikanie NLPZ – niesteroidowe leki przeciwzapalne, takie jak aspiryna, ibuprofen i naproksen, mogą powodować krwawienie z górnego odcinka przewodu pokarmowego u osób z nadciśnieniem wrotnym⁸⁴
Utrata masy ciała – wielu pacjentów z marskością wątroby ma stłuszczeniową chorobę wątroby spowodowaną otyłością; utrata masy ciała może usunąć tłuszcz z wątroby i zmniejszyć dalsze uszkodzenia⁸⁵

Regularne Monitorowanie

Długoterminowe zarządzanie żylakami przełyku wymaga regularnego monitorowania i kontroli⁸⁶:

Regularne wizyty u lekarza są konieczne w celu sprawdzenia krwawienia z żylaków; jeśli krwawienie wystąpi, prawdopodobnie pojawi się ponownie⁸⁷
Po wykonaniu endoskopowej terapii (zakładanie opasek) regularne kontrolne badania endoskopowe z zakładaniem opasek są wykonywane w celu całkowitego pozbycia się żylaków⁸⁸
Pacjenci powinni mieć rutynowe badania kontrolne endoskopowe w celu monitorowania stanu i progresji żylaków⁸⁹

Rozpoznawanie Powikłań

Pacjenci i ich rodziny powinni być świadomi objawów krwawienia z żylaków przełyku, które wymagają natychmiastowej pomocy medycznej⁹⁰:

Wymioty krwi lub treścią przypominającą fusy po kawie⁹¹
Czarne, smoliste lub krwawe stolce⁹²
Zawroty głowy lub omdlenia (utrata przytomności)⁹³

Krwawienie z żylaków przełyku wymaga natychmiastowego leczenia medycznego. Jeśli nie zostanie szybko leczone, może dojść do utraty dużej ilości krwi, co wiąże się ze znacznym ryzykiem zgonu⁹⁴.

Powikłania i Prognozy

Krwawienie jest najpoważniejszym ryzykiem związanym z żylakami przełyku i główną przyczyną hospitalizacji i zgonów u osób z marskością wątroby⁹⁵.

Ryzyko Nawrotu Krwawienia

Nawrót krwawienia jest częstym powikłaniem po początkowym epizodzie krwawienia z żylaków przełyku⁹⁶:

Nawrót krwawienia odnotowano u 33-60% pacjentów⁹⁷
Co najmniej 50% osób, które przeżyły krwawienie z żylaków przełyku, jest narażonych na ryzyko kolejnego krwawienia w ciągu najbliższych jednego do dwóch lat⁹⁸
Ryzyko można zmniejszyć dzięki leczeniu endoskopowemu i farmakologicznemu⁹⁹

Współpraca Interdyscyplinarna

Zarządzanie żylakami przełyku wymaga współpracy interdyscyplinarnego zespołu, w skład którego wchodzą gastroenterolog, internista, chirurg, radiolog interwencyjny i intensywista¹⁰⁰:

Wybór leczenia zależy od stopnia zaawansowania choroby i stanu pacjenta¹⁰¹
Jest to poważne, zagrażające życiu zaburzenie, a wszyscy pacjenci powinni być leczeni w warunkach monitorowanych¹⁰²
Ścisła komunikacja między członkami zespołu jest kluczowa dla poprawy wyników¹⁰³

Rokowanie

Rokowanie dla pacjentów z żylakami przełyku jest ostrożne¹⁰⁴:

Jeśli pierwotna przyczyna nadciśnienia wrotnego nie jest kontrolowana, nawroty są częste przy wszystkich metodach leczenia¹⁰⁵
Niewydolność wielonarządowa, powikłania związane z procedurami i infekcje często prowadzą do przedwczesnej śmierci¹⁰⁶
Epizod krwawienia z żylaków ma wskaźnik śmiertelności około 20%, a krwawienie często nawraca¹⁰⁷

Dzięki wdrożeniu kompleksowego planu opieki pielęgniarskiej, wczesnej diagnostyki i interwencji, ścisłemu monitorowaniu i edukacji pacjenta, dążymy do zmniejszenia ryzyka krwawienia, poprawy wyników pacjenta i wsparcia osób w skutecznym zarządzaniu tym trudnym schorzeniem¹⁰⁸.

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Materiały źródłowe

#1 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#2 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
VARICES OVERVIEW […] Cirrhosis is a disease in which the liver becomes severely scarred, usually as a result of many years of continuous injury. The most common causes of cirrhosis include steatotic (fatty) liver (due mostly to obesity), alcohol use disorder, and chronic hepatitis B or C virus infection. Some people have more than one cause of injury to the liver. […] Varices are enlarged or dilated blood vessels (veins) in the esophagus, the tube that connects the mouth and stomach, or in the stomach itself. Esophageal or gastric varices are a common complication of advanced cirrhosis. […] Varices are expanded blood vessels that develop most commonly in the esophagus and stomach. In people with cirrhosis, varices develop when blood flow through the liver is obstructed (blocked) by scarring, increasing the pressure inside the portal vein, which carries blood from the intestines to the liver; this condition is called portal hypertension.
#3 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Portal hypertension leads to an increase in the blood pressure inside the veins in the lower esophagus and stomach. These veins were not designed for the higher pressure, and thus they begin to expand, resulting in varices. Once varices develop, they can remain stable, increase in size (if the liver disease worsens), or decrease in size (if the liver disease improves). […] Esophageal or gastric varices are a potentially serious complication of cirrhosis. Without treatment, varices may rupture and cause severe bleeding (hemorrhage) resulting in significant illness or even death. Some people who bleed from varices will die, emphasizing the importance of preventing bleeding and treating the liver disease. […] Varices do not cause symptoms until they rupture and bleed. Signs of bleeding from varices can include vomiting blood or material that looks like coffee grounds, passing dark-colored or black stools, and lightheadedness. If bleeding is severe, the person may lose consciousness.
#4 Esophageal varices grade III: A case report – Kauvery Hospital
https://www.kauveryhospital.com/nightingale/esophageal-varices-grade-a-case-report-v1-i6/
Esophageal varices develop from Portal Hypertension, that arises from obstruction to normal portal vein flow from the alimentary (digestive) system, either by the scar tissue in the liver (ongoing cirrhosis) or a clot that blocks the regular blood flow (thrombosis in the portal vein) towards the liver. […] The development of esophageal varices has been reported previously in up to 80% of patients with liver cirrhosis. […] Early detection of esophageal varices and timely prophylactic treatment initiation can minimize the risk of variceal bleeding and associated mortality. […] Monitored level of consciousness, vital signs, and urinary output to evaluate fluid balance. […] Monitored the client during blood transfusion administration if prescribed. […] Ensured nasogastric tube patency to prevent aspiration.
#5 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 1030% of all cases of upper gastrointestinal bleeding. […] The following treatment options are available in the management of esophageal varices and hemorrhage. Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. EVL is more effective than endoscopic variceal sclerotherapy (EVS) with greater control of hemorrhage, lower rebleeding, and lower adverse events but without differences in mortality.
#6 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
Esophageal varices are a critical and potentially life-threatening medical condition often associated with underlying liver disease. […] Nurses play a pivotal role in the early detection of esophageal varices, managing their associated risks, and providing patient education to minimize complications. […] Recognizing that patients with esophageal varices often have complex healthcare needs, our care plan emphasizes early detection, monitoring for bleeding risk, and interventions to manage and prevent complications. […] This comprehensive nursing assessment for esophageal varices serves as the foundation for developing an individualized care plan, facilitating early detection and intervention, and addressing the physical and emotional needs of the patient. […] These nursing diagnoses for esophageal varices provide a foundation for developing a patient-centered care plan, emphasizing preventive measures, risk management, and support for patients and their families.
#7 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
Esophageal varices are a critical and potentially life-threatening medical condition often associated with underlying liver disease. […] Nurses play a pivotal role in the early detection of esophageal varices, managing their associated risks, and providing patient education to minimize complications. […] Recognizing that patients with esophageal varices often have complex healthcare needs, our care plan emphasizes early detection, monitoring for bleeding risk, and interventions to manage and prevent complications. […] This comprehensive nursing assessment for esophageal varices serves as the foundation for developing an individualized care plan, facilitating early detection and intervention, and addressing the physical and emotional needs of the patient. […] These nursing diagnoses for esophageal varices provide a foundation for developing a patient-centered care plan, emphasizing preventive measures, risk management, and support for patients and their families.
#8 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
Esophageal varices are a critical and potentially life-threatening medical condition often associated with underlying liver disease. […] Nurses play a pivotal role in the early detection of esophageal varices, managing their associated risks, and providing patient education to minimize complications. […] Recognizing that patients with esophageal varices often have complex healthcare needs, our care plan emphasizes early detection, monitoring for bleeding risk, and interventions to manage and prevent complications. […] This comprehensive nursing assessment for esophageal varices serves as the foundation for developing an individualized care plan, facilitating early detection and intervention, and addressing the physical and emotional needs of the patient. […] These nursing diagnoses for esophageal varices provide a foundation for developing a patient-centered care plan, emphasizing preventive measures, risk management, and support for patients and their families.
#9 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#10 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#11 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#12 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#13 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Bleeding esophageal varices are hemorrhagic processes involving dialted, tortuous veins in the submucosa of the lower esophagus. […] Non-surgical treatment is preferred because of the high mortality associated with emergency surgery to control bleeding from esophageal varices and because of the poor physical condition of most of these patients. […] Aggressive medical care includes evaluation of extent of bleeding and continuous monitoring of vital signs when hematemesis and melena are present. […] Nursing Management […] Provide ongoing assessment […] Assess for ecchymosis, epistaxis, petechiae, and bleeding gums. […] Monitor level of consciousness, vital signs, and urinary output to evaluate fluid balance. […] Monitor the client during blood transfusion administration if prescribed.
#14 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Bleeding esophageal varices are hemorrhagic processes involving dialted, tortuous veins in the submucosa of the lower esophagus. […] Non-surgical treatment is preferred because of the high mortality associated with emergency surgery to control bleeding from esophageal varices and because of the poor physical condition of most of these patients. […] Aggressive medical care includes evaluation of extent of bleeding and continuous monitoring of vital signs when hematemesis and melena are present. […] Nursing Management […] Provide ongoing assessment […] Assess for ecchymosis, epistaxis, petechiae, and bleeding gums. […] Monitor level of consciousness, vital signs, and urinary output to evaluate fluid balance. […] Monitor the client during blood transfusion administration if prescribed.
#15 Esophageal Varices: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
Esophageal varices are swollen veins in the lining of your esophagus. […] Most treatment is aimed at damage control. […] Esophageal varices are serious because they have weakened walls that can leak or break and bleed. Internal bleeding from a ruptured vein can be sudden, severe and life-threatening. […] Bleeding is the most serious risk of esophageal varices. […] But bleeding varices are the most common cause of hospitalization and death in people with cirrhosis. […] An episode of variceal bleeding has a mortality rate of around 20%, and bleeding often recurs (comes back). […] Healthcare providers have several ways of treating varices to prevent and control bleeding. Most treatment is aimed at damage control. […] The goals of treatment are to: Control active bleeding. Prevent future bleeding. Reduce portal hypertension or prevent it from worsening, if possible.
#16 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#17 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#18 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#19 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. […] These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management. […] Monitor Vital Signs […] Check blood pressure, heart rate, and respiratory rate frequently. […] Assess for signs of shock. […] Monitor oxygen saturation. […] Document orthostatic changes. […] Assess for Bleeding […] Monitor for hematemesis. […] Check stool color and consistency. […] Assess skin color and temperature. […] Monitor hemoglobin and hematocrit levels. […] Nursing Diagnosis Statement: Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
#20 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#21 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#22 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
These nursing interventions for esophageal varices aim to manage the condition effectively, reduce the risk of bleeding, and provide holistic care for patients. […] Patient and family education is central to this care plan, empowering individuals to actively participate in their care, understand the condition, and take preventive measures. […] Through the implementation of this plan, we aim to reduce the risk of bleeding, improve patient outcomes, and support individuals in managing this challenging condition effectively.
#23 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
These nursing interventions for esophageal varices aim to manage the condition effectively, reduce the risk of bleeding, and provide holistic care for patients. […] Patient and family education is central to this care plan, empowering individuals to actively participate in their care, understand the condition, and take preventive measures. […] Through the implementation of this plan, we aim to reduce the risk of bleeding, improve patient outcomes, and support individuals in managing this challenging condition effectively.
#24 Esophageal Varices: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
Bleeding from esophageal varices is an emergency that requires immediate treatment. […] When your condition is stable, you’ll have an emergency upper endoscopy to diagnose and treat the bleeding. […] Follow-up treatment after variceal band ligation includes: Proton pump inhibitors, medications to promote healing of small wounds in your gastrointestinal tract. Regular screening for additional bleeding, and additional variceal band ligation if necessary. […] If you’ve already been treated for bleeding, or if your varices aren’t bleeding yet but are at risk, your healthcare provider will offer you preventive treatment. […] If the above treatments don’t reduce your risk of variceal bleeding, or if you’re having other complications from portal hypertension, your provider might recommend alternative procedures to reduce portal hypertension in the portal vein itself. […] Varices sometimes reduce with treatment, especially if portal hypertension can be reduced. But they rarely go away completely. […] Even with treatment, new bleeding is always a risk.
#25 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#26 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#27 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Nursing Interventions and Rationales: Monitor vital signs q2h or as ordered. Rationale: Early detection of bleeding episodes. […] Maintain IV access with large-bore catheter. Rationale: Ensures rapid fluid/blood administration if needed. […] Keep emergency supplies readily available. Rationale: Enables quick response to bleeding. […] Assess for bleeding precursors. Rationale: Allows early intervention. […] Desired Outcomes: The patient will remain free from bleeding episodes. […] The patient will maintain stable vital signs. […] The patient will demonstrate knowledge of bleeding precautions. […] Nursing Diagnosis Statement: Deficient Knowledge related to lack of exposure to information about esophageal varices management as evidenced by questions about the condition and verbalized misconceptions.
#28 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#29 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#30 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
NURSING CARE AND TREATMENT The treatment of esophageal varices is a collaborative effort that includes nursing assessment and interventions, pharmacologic therapy, and interventional procedures or surgery. Once esophageal varices rupture and begin to hemorrhage, medical treatment becomes an emergent situation requiring immediate care. […] 1. Rupture of esophageal varices requires the following interventions: Maintain an open airway, position the patient to enhance breathing and expulsion of hematemesis, and suction excess secretions and blood. Assess the rate and volume of bleeding. Assess blood pressure and pulse with the patient in the supine position and in the sitting position. Insert an IV access and administer fluids and blood products, rapid infusion of 5% dextrose, and a colloid solution until blood pressure is restored and urine output is adequate. Obtain a blood specimen for hemoglobin, hematocrit, PT, PTT, platelets, type and cross-match, electrolytes, and renal and liver function tests. Correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K1. Insert a nasogastric tube to assess the severity of bleeding and to lavage gastric contents before endoscopy. Prepare for pharmacologic therapy (octreotide or somatostatin) and endoscopy as soon as the patient has been resuscitated. The aim is to establish the cause and to control the bleeding.
#31 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Nursing Interventions and Rationales: Monitor vital signs q2h or as ordered. Rationale: Early detection of bleeding episodes. […] Maintain IV access with large-bore catheter. Rationale: Ensures rapid fluid/blood administration if needed. […] Keep emergency supplies readily available. Rationale: Enables quick response to bleeding. […] Assess for bleeding precursors. Rationale: Allows early intervention. […] Desired Outcomes: The patient will remain free from bleeding episodes. […] The patient will maintain stable vital signs. […] The patient will demonstrate knowledge of bleeding precautions. […] Nursing Diagnosis Statement: Deficient Knowledge related to lack of exposure to information about esophageal varices management as evidenced by questions about the condition and verbalized misconceptions.
#32 Esophageal Varices Nursing Diagnosis & Care Plan – NurseStudy.Net
https://nursestudy.net/esophageal-varices-nursing-diagnosis/
Nursing Interventions and Rationales: Monitor vital signs q2h or as ordered. Rationale: Early detection of bleeding episodes. […] Maintain IV access with large-bore catheter. Rationale: Ensures rapid fluid/blood administration if needed. […] Keep emergency supplies readily available. Rationale: Enables quick response to bleeding. […] Assess for bleeding precursors. Rationale: Allows early intervention. […] Desired Outcomes: The patient will remain free from bleeding episodes. […] The patient will maintain stable vital signs. […] The patient will demonstrate knowledge of bleeding precautions. […] Nursing Diagnosis Statement: Deficient Knowledge related to lack of exposure to information about esophageal varices management as evidenced by questions about the condition and verbalized misconceptions.
#33 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Patients should have routine surveillance gastroscopies to monitor status and progression of varices. […] Seek urgent medical/ ICU review/ MET (ext. 2222). […] Protect airway, support breathing as required (see Resuscitation guidelines). […] Secure large bore IV access. […] Correct hypovolaemia, remembering the potential for harm with excessive fluid administration. […] Maintain strict fluid balance. […] Continuous cardiorespiratory monitoring (see Clinical Guidelines (Nursing): Observation and Continuous Monitoring). […] If NGT in situ, place on free drainage. […] Consider treating coagulopathies (vitamin K, platelets, cryoprecipitate and FFP). […] Patient should be kept nil by mouth (NBM) until bleeding controlled and medically cleared for oral intake. […] Patients should remain nil by mouth (NBM) post variceal bleeding or banding and grade up diet as directed by treating gastroenterologist.
#34 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Patients should have routine surveillance gastroscopies to monitor status and progression of varices. […] Seek urgent medical/ ICU review/ MET (ext. 2222). […] Protect airway, support breathing as required (see Resuscitation guidelines). […] Secure large bore IV access. […] Correct hypovolaemia, remembering the potential for harm with excessive fluid administration. […] Maintain strict fluid balance. […] Continuous cardiorespiratory monitoring (see Clinical Guidelines (Nursing): Observation and Continuous Monitoring). […] If NGT in situ, place on free drainage. […] Consider treating coagulopathies (vitamin K, platelets, cryoprecipitate and FFP). […] Patient should be kept nil by mouth (NBM) until bleeding controlled and medically cleared for oral intake. […] Patients should remain nil by mouth (NBM) post variceal bleeding or banding and grade up diet as directed by treating gastroenterologist.
#35 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#36 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Bleeding esophageal varices are hemorrhagic processes involving dialted, tortuous veins in the submucosa of the lower esophagus. […] Non-surgical treatment is preferred because of the high mortality associated with emergency surgery to control bleeding from esophageal varices and because of the poor physical condition of most of these patients. […] Aggressive medical care includes evaluation of extent of bleeding and continuous monitoring of vital signs when hematemesis and melena are present. […] Nursing Management […] Provide ongoing assessment […] Assess for ecchymosis, epistaxis, petechiae, and bleeding gums. […] Monitor level of consciousness, vital signs, and urinary output to evaluate fluid balance. […] Monitor the client during blood transfusion administration if prescribed.
#37 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#38 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#39 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
2. In nonemergency situations, determine whether the patient is hemodynamically stable or unstable. […] 4. Infuse IV fluid replacement with isotonic fluids (avoid lactate solutions) and monitor response to fluid replacement. […] 6. Prepare for possible procedures such as endoscopic variceal sclerotherapy. […] 12. Pharmacologic therapy: Patients with esophageal varices and no prior history of variceal hemorrhage should be treated with nonselective beta-adrenergic blockers (e.g., propranolol, nadolol, timolol), provided that the use of beta blockers is not contraindicated. Garcia-Tsao (2006) found that, Therapy with nonselective beta blockers is the gold standard in the prevention of first variceal hemorrhage in patients with medium to large varices and has been compared to endoscopic variceal ligation in several randomized trials. Beta blocker therapy has proven to reduce the risk of first bleeding in patients with evidence of varices and recurrent bleeding and mortality in patients with a history of previous variceal hemorrhage. Beta blockers lower portal hypertension by reducing cardiac output, which leads to splanchnic vasoconstriction and a reduction in portal pressures. Beta blockers reduce the risk of recurrent bleeding by 34% and mortality by 26% (Wilbur Sidhu, 2005).
#40 Esophageal Varices: Pathophysiology, Symptoms, and Diagnostics
https://simplenursing.com/esophageal-varices-pathophysiology-diagnostics/
Esophageal varices are complications due to liver diseases or dysfunctions. Itâs important to identify and treat the underlying cause of them to prevent complications such as bleeding and improve patient outcomes. […] 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. […] Aside from suctioning, there are other procedures done to stop the bleeding, namely: Medications, Inserting a balloon catheter into the esophagus.
#41 Esophageal varices: common complications resulting from cirrhosis
https://www.myamericannurse.com/esophageal-varices/
Cirrhosis of the liver causes scaring, shrinking, and hardening. […] Complications of cirrhosis include portal hypertension, esophageal varices, hepatic encephalopathy, jaundice, renal failure, and splenomegaly. […] Esophagogastroduodenoscopy is the gold standard for diagnosing and grading esophageal varices. […] Cirrhosis of the liver increases portal hypertension, which can lead to esophageal varicesdilated submucosal veins in the esophagus. If left untreated, varices can cause life-threatening bleeding. Treatment includes vasodilator and vasoconstrictor medications, sclerotherapy, and endoscopic ligation with banding. Fluid volume resuscitation should be used to achieve and maintain a hemoglobin of 7 to 8 g/dL; however, aggressive fluid resuscitation may increase the portal pressure and cause rebleeding. To decrease the pressure, a transjugular intrahepatic portosystemic shunt can be used to reroute blood. […] Patients should be referred to addiction specialists and should see a gastroenterologist for continued evaluation.
#42 Esophageal varices – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544
During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. […] If someone is diagnosed with cirrhosis, a healthcare professional will then typically screen for esophageal varices. […] The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding happens, treatments are available to try to stop the bleeding. […] Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. […] If the esophageal varices appear to have a high risk of bleeding, or if the varices have bled before, a healthcare professional might recommend a procedure called endoscopic band ligation. […] Bleeding esophageal varices are life-threatening, and immediate treatment is essential.
#43 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
If no esophageal varices are detected, experts usually recommend repeating the upper endoscopy in one to three years. […] If large varices are detected, a medication is prescribed to reduce the risk of bleeding, and the endoscopy does not usually need to be repeated. […] If small esophageal varices are detected, although the risk of bleeding is much lower than with large varices, medication is frequently recommended because it may prevent the development of other complications of portal hypertension. […] The timing of repeat endoscopy depends upon the appearance of the varices, the cause of the liver disease, and the person’s overall health. […] STRATEGIES TO PREVENT BLEEDING FROM VARICES […] Avoid alcohol â One of the most important ways to reduce the risk of bleeding from varices is to stop drinking alcohol. Alcohol can worsen cirrhosis, increase the risk of bleeding, and significantly increase the risk of dying.
#44 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
If no esophageal varices are detected, experts usually recommend repeating the upper endoscopy in one to three years. […] If large varices are detected, a medication is prescribed to reduce the risk of bleeding, and the endoscopy does not usually need to be repeated. […] If small esophageal varices are detected, although the risk of bleeding is much lower than with large varices, medication is frequently recommended because it may prevent the development of other complications of portal hypertension. […] The timing of repeat endoscopy depends upon the appearance of the varices, the cause of the liver disease, and the person’s overall health. […] STRATEGIES TO PREVENT BLEEDING FROM VARICES […] Avoid alcohol â One of the most important ways to reduce the risk of bleeding from varices is to stop drinking alcohol. Alcohol can worsen cirrhosis, increase the risk of bleeding, and significantly increase the risk of dying.
#45 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
If no esophageal varices are detected, experts usually recommend repeating the upper endoscopy in one to three years. […] If large varices are detected, a medication is prescribed to reduce the risk of bleeding, and the endoscopy does not usually need to be repeated. […] If small esophageal varices are detected, although the risk of bleeding is much lower than with large varices, medication is frequently recommended because it may prevent the development of other complications of portal hypertension. […] The timing of repeat endoscopy depends upon the appearance of the varices, the cause of the liver disease, and the person’s overall health. […] STRATEGIES TO PREVENT BLEEDING FROM VARICES […] Avoid alcohol â One of the most important ways to reduce the risk of bleeding from varices is to stop drinking alcohol. Alcohol can worsen cirrhosis, increase the risk of bleeding, and significantly increase the risk of dying.
#46 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 1030% of all cases of upper gastrointestinal bleeding. […] The following treatment options are available in the management of esophageal varices and hemorrhage. Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. EVL is more effective than endoscopic variceal sclerotherapy (EVS) with greater control of hemorrhage, lower rebleeding, and lower adverse events but without differences in mortality.
#47 Esophageal varices – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544
During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. […] If someone is diagnosed with cirrhosis, a healthcare professional will then typically screen for esophageal varices. […] The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding happens, treatments are available to try to stop the bleeding. […] Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. […] If the esophageal varices appear to have a high risk of bleeding, or if the varices have bled before, a healthcare professional might recommend a procedure called endoscopic band ligation. […] Bleeding esophageal varices are life-threatening, and immediate treatment is essential.
#48 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 1030% of all cases of upper gastrointestinal bleeding. […] The following treatment options are available in the management of esophageal varices and hemorrhage. Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. EVL is more effective than endoscopic variceal sclerotherapy (EVS) with greater control of hemorrhage, lower rebleeding, and lower adverse events but without differences in mortality.
#49 Esophageal Varices (Inpatient Care)
https://www.drugs.com/cg/esophageal-varices-inpatient-care.html
Liver pressure monitoring is recorded through a small tube placed into a vein in your liver. Healthcare providers measure liver pressure. Your healthcare provider will know that your treatment is working if the pressure is lower. […] Balloon tamponade is a procedure used to control bleeding. A balloon is placed in the esophagus and inflated. The balloon puts pressure on the varices to control bleeding. This allows your healthcare provider to decide what treatment is best for you. The balloon is not permanent. […] Endoscopic variceal band ligation is done to slow down or stop the bleeding. Bands are placed around the large varices in your esophagus. The pressure of the bands causes the varices to shrink. […] Endoscopic sclerotherapy uses medicine in the varices to make them smaller and stop the bleeding.
#50 Esophageal varices – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544
Beta blockers and endoscopic band ligation are the recommended treatments to help prevent rebleeding. […] After initial banding treatment, a healthcare professional will repeat an upper endoscopy at regular intervals. […] Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices.
#51 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#52 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#53 Esophageal Varices (Inpatient Care)
https://www.drugs.com/cg/esophageal-varices-inpatient-care.html
Liver pressure monitoring is recorded through a small tube placed into a vein in your liver. Healthcare providers measure liver pressure. Your healthcare provider will know that your treatment is working if the pressure is lower. […] Balloon tamponade is a procedure used to control bleeding. A balloon is placed in the esophagus and inflated. The balloon puts pressure on the varices to control bleeding. This allows your healthcare provider to decide what treatment is best for you. The balloon is not permanent. […] Endoscopic variceal band ligation is done to slow down or stop the bleeding. Bands are placed around the large varices in your esophagus. The pressure of the bands causes the varices to shrink. […] Endoscopic sclerotherapy uses medicine in the varices to make them smaller and stop the bleeding.
#54 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#55 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#56 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#57 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#58 Esophageal Varices Nursing Management – RNpedia
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/esophageal-varices-nursing-management/
Institute measure to address bleeding. […] Use small-gauge needles, and apply pressure or cold for bleeding. […] Provide nursing care for the client undergoing a prescribed balloon tamponade to control bleeding. […] Explain the procedure to the client to reduce fear and enhance cooperation with insertion and maintenance of the esophageal tamponade tube. […] Monitor the client closely to prevent accidental removal or displacement of the tube with resultant airway obstruction. […] Provide nursing intervention for the client undergoing a prescribed iced saline lavage. […] Ensure nasogastric tube patency to prevent aspiration. […] Observe gastric aspirate for evidence of bleeding. […] Protect the client from chilling. […] After injection sclerotherapy, assess for: […] Aspiration
#59 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
2. In nonemergency situations, determine whether the patient is hemodynamically stable or unstable. […] 4. Infuse IV fluid replacement with isotonic fluids (avoid lactate solutions) and monitor response to fluid replacement. […] 6. Prepare for possible procedures such as endoscopic variceal sclerotherapy. […] 12. Pharmacologic therapy: Patients with esophageal varices and no prior history of variceal hemorrhage should be treated with nonselective beta-adrenergic blockers (e.g., propranolol, nadolol, timolol), provided that the use of beta blockers is not contraindicated. Garcia-Tsao (2006) found that, Therapy with nonselective beta blockers is the gold standard in the prevention of first variceal hemorrhage in patients with medium to large varices and has been compared to endoscopic variceal ligation in several randomized trials. Beta blocker therapy has proven to reduce the risk of first bleeding in patients with evidence of varices and recurrent bleeding and mortality in patients with a history of previous variceal hemorrhage. Beta blockers lower portal hypertension by reducing cardiac output, which leads to splanchnic vasoconstriction and a reduction in portal pressures. Beta blockers reduce the risk of recurrent bleeding by 34% and mortality by 26% (Wilbur Sidhu, 2005).
#60 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
2. In nonemergency situations, determine whether the patient is hemodynamically stable or unstable. […] 4. Infuse IV fluid replacement with isotonic fluids (avoid lactate solutions) and monitor response to fluid replacement. […] 6. Prepare for possible procedures such as endoscopic variceal sclerotherapy. […] 12. Pharmacologic therapy: Patients with esophageal varices and no prior history of variceal hemorrhage should be treated with nonselective beta-adrenergic blockers (e.g., propranolol, nadolol, timolol), provided that the use of beta blockers is not contraindicated. Garcia-Tsao (2006) found that, Therapy with nonselective beta blockers is the gold standard in the prevention of first variceal hemorrhage in patients with medium to large varices and has been compared to endoscopic variceal ligation in several randomized trials. Beta blocker therapy has proven to reduce the risk of first bleeding in patients with evidence of varices and recurrent bleeding and mortality in patients with a history of previous variceal hemorrhage. Beta blockers lower portal hypertension by reducing cardiac output, which leads to splanchnic vasoconstriction and a reduction in portal pressures. Beta blockers reduce the risk of recurrent bleeding by 34% and mortality by 26% (Wilbur Sidhu, 2005).
#61 Esophageal varices – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/esophageal-varices/
Obtain EGD to screen for esophageal varices at the time of cirrhosis or portal hypertension diagnosis. […] Assess for high-risk features for esophageal variceal hemorrhage (see Risk stratification). […] Identify and treat the underlying cause of portal hypertension. […] EGD surveillance is indicated every 13 years for patients with low-risk features for esophageal variceal bleeding to screen for the development of high-risk varices. […] Patients with esophageal varices have a 10-15% annual risk of variceal hemorrhage; the risk increases with the severity of liver disease, size of varices, and presence of variceal wall thinning. […] Medium or large esophageal varices: Provide either pharmacological prophylaxis or EVL. […] Small esophageal varices with high-risk features for esophageal variceal hemorrhage: Provide pharmacological prophylaxis as indicated.
#62 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Avoid NSAIDs â Nonsteroidal antiinflammatory drugs, or „NSAIDs,” include aspirin, ibuprofen, and naproxen. These drugs do not cause variceal bleeding but may cause upper gastrointestinal (GI) bleeding in people with portal hypertension. […] Weight loss/control of associated conditions â Many people with cirrhosis have steatotic liver disease due to obesity. Obesity may be the sole cause of liver damage, or may be a contributing factor. Losing weight can remove fat from the liver and may reduce further injury. […] Beta blockers â Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside the varices, which can reduce the risk of bleeding. […] Variceal band ligation â Variceal band ligation is a procedure that is done during endoscopy. A physician places small rubber bands around esophageal varices to prevent them from bleeding or stop active bleeding.
#63 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
2. In nonemergency situations, determine whether the patient is hemodynamically stable or unstable. […] 4. Infuse IV fluid replacement with isotonic fluids (avoid lactate solutions) and monitor response to fluid replacement. […] 6. Prepare for possible procedures such as endoscopic variceal sclerotherapy. […] 12. Pharmacologic therapy: Patients with esophageal varices and no prior history of variceal hemorrhage should be treated with nonselective beta-adrenergic blockers (e.g., propranolol, nadolol, timolol), provided that the use of beta blockers is not contraindicated. Garcia-Tsao (2006) found that, Therapy with nonselective beta blockers is the gold standard in the prevention of first variceal hemorrhage in patients with medium to large varices and has been compared to endoscopic variceal ligation in several randomized trials. Beta blocker therapy has proven to reduce the risk of first bleeding in patients with evidence of varices and recurrent bleeding and mortality in patients with a history of previous variceal hemorrhage. Beta blockers lower portal hypertension by reducing cardiac output, which leads to splanchnic vasoconstriction and a reduction in portal pressures. Beta blockers reduce the risk of recurrent bleeding by 34% and mortality by 26% (Wilbur Sidhu, 2005).
#64 14. ESOPHAGEAL VARICES | Nurse Key
https://nursekey.com/14-esophageal-varices/
2. In nonemergency situations, determine whether the patient is hemodynamically stable or unstable. […] 4. Infuse IV fluid replacement with isotonic fluids (avoid lactate solutions) and monitor response to fluid replacement. […] 6. Prepare for possible procedures such as endoscopic variceal sclerotherapy. […] 12. Pharmacologic therapy: Patients with esophageal varices and no prior history of variceal hemorrhage should be treated with nonselective beta-adrenergic blockers (e.g., propranolol, nadolol, timolol), provided that the use of beta blockers is not contraindicated. Garcia-Tsao (2006) found that, Therapy with nonselective beta blockers is the gold standard in the prevention of first variceal hemorrhage in patients with medium to large varices and has been compared to endoscopic variceal ligation in several randomized trials. Beta blocker therapy has proven to reduce the risk of first bleeding in patients with evidence of varices and recurrent bleeding and mortality in patients with a history of previous variceal hemorrhage. Beta blockers lower portal hypertension by reducing cardiac output, which leads to splanchnic vasoconstriction and a reduction in portal pressures. Beta blockers reduce the risk of recurrent bleeding by 34% and mortality by 26% (Wilbur Sidhu, 2005).
#65 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances. Prophylactic antibiotic therapy has been shown to reduce bacterial infections, variceal rebleeding, and increase the survival rate. […] Long-term endoscopic control and banding or sclerotherapy of recurrent varices every 36 months. If endoscopic band ligation is not available or contraindicated, non cardioselective -blockers (propranolol, nadolol, or carvedilol) starting at a low dosage and if necessary increasing the dosage step by step until a reduction in the resting heart rate by 25%, but not lower than 55 beats/min, is achieved. […] TIPS should be considered in uncontrollable fundovariceal bleeding or recurrence despite combined pharmacological and endoscopic therapy.
#66 Bleeding esophageal varices – UF Health
https://ufhealth.org/conditions-and-treatments/bleeding-esophageal-varices
The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death. […] If massive bleeding occurs, a person may need to be put on a ventilator to protect their airway and prevent blood from going down into the lungs. […] To stop the bleeding, the provider may pass an endoscope(tube with a small light at the end) into the esophagus: A clotting medicine may be injected into the varices. A rubber band may be placed around the bleeding varices (called banding or band ligation). Banding is the most common endoscopic treatment for esophageal varices. […] Other treatments to stop the bleeding: A medicine to tighten blood vessels may be given through a vein. Examples include octreotide or vasopressin. Rarely, a tube may be inserted through the nose into the stomach and inflated with air. This produces pressure against the bleeding veins (balloon tamponade).
#67 Azthena logo with the word Azthena
https://www.news-medical.net/health/Treatment-for-Esophageal-Varices.aspx
Blood transfusion is done for a patients with high hemorrhage. Prophylatic antibiotics are used to prevent bacterial infection that occurs during bleeding and early rebleeding. […] Endoscopic therapy is the main treatment for managing the esophageal varices and liver cirrhosis. […] In case of rebleeding, the suggested treatments are the administration of beta blockers and elastic band ligation method to prevent further hemorrhage. […] Liver transplantation is the best possible method for people with critical liver disease. […] In case of failure of control and rebleeding, rescue therapy with balloon tamponade or TIPS is needed.
#68 Bleeding esophageal varices – UF Health
https://ufhealth.org/conditions-and-treatments/bleeding-esophageal-varices
The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death. […] If massive bleeding occurs, a person may need to be put on a ventilator to protect their airway and prevent blood from going down into the lungs. […] To stop the bleeding, the provider may pass an endoscope(tube with a small light at the end) into the esophagus: A clotting medicine may be injected into the varices. A rubber band may be placed around the bleeding varices (called banding or band ligation). Banding is the most common endoscopic treatment for esophageal varices. […] Other treatments to stop the bleeding: A medicine to tighten blood vessels may be given through a vein. Examples include octreotide or vasopressin. Rarely, a tube may be inserted through the nose into the stomach and inflated with air. This produces pressure against the bleeding veins (balloon tamponade).
#69 WGO Esophageal Varices Guideline Summary
https://www.guidelinecentral.com/guideline/1090246/
Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. […] A transjugular intrahepatic portosystemic shunt (TIPS) is a good alternative when endoscopic treatment and pharmacotherapy fail. […] The use of balloon tamponade is decreasing, as there is a high risk of rebleeding after deflation and a risk of major complications. […] Combined endoscopic and pharmacologic treatment is shown to achieve better control of acute bleeding than endoscopic treatment alone. […] Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances.
#70 WGO Esophageal Varices Guideline Summary
https://www.guidelinecentral.com/guideline/1090246/
Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. […] A transjugular intrahepatic portosystemic shunt (TIPS) is a good alternative when endoscopic treatment and pharmacotherapy fail. […] The use of balloon tamponade is decreasing, as there is a high risk of rebleeding after deflation and a risk of major complications. […] Combined endoscopic and pharmacologic treatment is shown to achieve better control of acute bleeding than endoscopic treatment alone. […] Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances.
#71 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances. Prophylactic antibiotic therapy has been shown to reduce bacterial infections, variceal rebleeding, and increase the survival rate. […] Long-term endoscopic control and banding or sclerotherapy of recurrent varices every 36 months. If endoscopic band ligation is not available or contraindicated, non cardioselective -blockers (propranolol, nadolol, or carvedilol) starting at a low dosage and if necessary increasing the dosage step by step until a reduction in the resting heart rate by 25%, but not lower than 55 beats/min, is achieved. […] TIPS should be considered in uncontrollable fundovariceal bleeding or recurrence despite combined pharmacological and endoscopic therapy.
#72 Azthena logo with the word Azthena
https://www.news-medical.net/health/Treatment-for-Esophageal-Varices.aspx
Blood transfusion is done for a patients with high hemorrhage. Prophylatic antibiotics are used to prevent bacterial infection that occurs during bleeding and early rebleeding. […] Endoscopic therapy is the main treatment for managing the esophageal varices and liver cirrhosis. […] In case of rebleeding, the suggested treatments are the administration of beta blockers and elastic band ligation method to prevent further hemorrhage. […] Liver transplantation is the best possible method for people with critical liver disease. […] In case of failure of control and rebleeding, rescue therapy with balloon tamponade or TIPS is needed.
#73 WGO Esophageal Varices Guideline Summary
https://www.guidelinecentral.com/guideline/1090246/
In patients with variceal hemorrhage in the gastric fundus: endoscopic variceal obliteration using tissue adhesives (such as cyanoacrylate) is preferred; the second choice is EVL. […] Long-term endoscopic control and banding or sclerotherapy of recurrent varices every 36 months. […] Portosystemic shunts are associated with lower rates of variceal rebleeding in comparison with sclerotherapy/banding, but they increase the incidence of hepatic encephalopathy. […] Liver transplantation should always be considered if the patient has ChildPugh grades B or C.
#74 WGO Esophageal Varices Guideline Summary
https://www.guidelinecentral.com/guideline/1090246/
Although they are effective in stopping bleeding, none of these measures, with the exception of endoscopic therapy, has been shown to affect mortality. […] Endoscopic sclerotherapy and variceal band ligation are effective in stopping bleeding in up to 90% of patients. […] A transjugular intrahepatic portosystemic shunt (TIPS) is a good alternative when endoscopic treatment and pharmacotherapy fail. […] The use of balloon tamponade is decreasing, as there is a high risk of rebleeding after deflation and a risk of major complications. […] Combined endoscopic and pharmacologic treatment is shown to achieve better control of acute bleeding than endoscopic treatment alone. […] Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances.
#75 Bleeding esophageal varices – UF Health
https://ufhealth.org/conditions-and-treatments/bleeding-esophageal-varices
Once the bleeding is stopped, other varices can be treated with medicines and medical procedures to prevent future bleeding. These include: Drugs called beta blockers, such as propranolol, nadolol, and carvedilol that reduce portal vein pressure and the risk of bleeding. A rubber band can be placed around the varices during an EGD procedure. Also, some medicines can be injected into the varices during EGD to cause them to clot. Transjugular intrahepatic portosystemic shunt (TIPS). This is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the varices and prevent bleeding episodes from happening again. […] In rare cases, emergency surgery may be used to treat people if other treatment fails. Portacaval shunts or surgery to reduce the pressure in the esophageal varices are treatment options, but these procedures are risky. […] People with bleeding varices from liver disease may need more treatment for their liver disease, including a liver transplant.
#76 Bleeding esophageal varices – UF Health
https://ufhealth.org/conditions-and-treatments/bleeding-esophageal-varices
Once the bleeding is stopped, other varices can be treated with medicines and medical procedures to prevent future bleeding. These include: Drugs called beta blockers, such as propranolol, nadolol, and carvedilol that reduce portal vein pressure and the risk of bleeding. A rubber band can be placed around the varices during an EGD procedure. Also, some medicines can be injected into the varices during EGD to cause them to clot. Transjugular intrahepatic portosystemic shunt (TIPS). This is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the varices and prevent bleeding episodes from happening again. […] In rare cases, emergency surgery may be used to treat people if other treatment fails. Portacaval shunts or surgery to reduce the pressure in the esophageal varices are treatment options, but these procedures are risky. […] People with bleeding varices from liver disease may need more treatment for their liver disease, including a liver transplant.
#77 English | World Gastroenterology Organisation
https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english
Acute variceal hemorrhage is often associated with bacterial infection due to gut translocation and motility disturbances. Prophylactic antibiotic therapy has been shown to reduce bacterial infections, variceal rebleeding, and increase the survival rate. […] Long-term endoscopic control and banding or sclerotherapy of recurrent varices every 36 months. If endoscopic band ligation is not available or contraindicated, non cardioselective -blockers (propranolol, nadolol, or carvedilol) starting at a low dosage and if necessary increasing the dosage step by step until a reduction in the resting heart rate by 25%, but not lower than 55 beats/min, is achieved. […] TIPS should be considered in uncontrollable fundovariceal bleeding or recurrence despite combined pharmacological and endoscopic therapy.
#78 Esophageal varices – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544
Beta blockers and endoscopic band ligation are the recommended treatments to help prevent rebleeding. […] After initial banding treatment, a healthcare professional will repeat an upper endoscopy at regular intervals. […] Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices.
#79 Azthena logo with the word Azthena
https://www.news-medical.net/health/Treatment-for-Esophageal-Varices.aspx
Blood transfusion is done for a patients with high hemorrhage. Prophylatic antibiotics are used to prevent bacterial infection that occurs during bleeding and early rebleeding. […] Endoscopic therapy is the main treatment for managing the esophageal varices and liver cirrhosis. […] In case of rebleeding, the suggested treatments are the administration of beta blockers and elastic band ligation method to prevent further hemorrhage. […] Liver transplantation is the best possible method for people with critical liver disease. […] In case of failure of control and rebleeding, rescue therapy with balloon tamponade or TIPS is needed.
#80 WGO Esophageal Varices Guideline Summary
https://www.guidelinecentral.com/guideline/1090246/
In patients with variceal hemorrhage in the gastric fundus: endoscopic variceal obliteration using tissue adhesives (such as cyanoacrylate) is preferred; the second choice is EVL. […] Long-term endoscopic control and banding or sclerotherapy of recurrent varices every 36 months. […] Portosystemic shunts are associated with lower rates of variceal rebleeding in comparison with sclerotherapy/banding, but they increase the incidence of hepatic encephalopathy. […] Liver transplantation should always be considered if the patient has ChildPugh grades B or C.
#81 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
These nursing interventions for esophageal varices aim to manage the condition effectively, reduce the risk of bleeding, and provide holistic care for patients. […] Patient and family education is central to this care plan, empowering individuals to actively participate in their care, understand the condition, and take preventive measures. […] Through the implementation of this plan, we aim to reduce the risk of bleeding, improve patient outcomes, and support individuals in managing this challenging condition effectively.
#82 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Avoid NSAIDs â Nonsteroidal antiinflammatory drugs, or „NSAIDs,” include aspirin, ibuprofen, and naproxen. These drugs do not cause variceal bleeding but may cause upper gastrointestinal (GI) bleeding in people with portal hypertension. […] Weight loss/control of associated conditions â Many people with cirrhosis have steatotic liver disease due to obesity. Obesity may be the sole cause of liver damage, or may be a contributing factor. Losing weight can remove fat from the liver and may reduce further injury. […] Beta blockers â Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside the varices, which can reduce the risk of bleeding. […] Variceal band ligation â Variceal band ligation is a procedure that is done during endoscopy. A physician places small rubber bands around esophageal varices to prevent them from bleeding or stop active bleeding.
#83 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
If no esophageal varices are detected, experts usually recommend repeating the upper endoscopy in one to three years. […] If large varices are detected, a medication is prescribed to reduce the risk of bleeding, and the endoscopy does not usually need to be repeated. […] If small esophageal varices are detected, although the risk of bleeding is much lower than with large varices, medication is frequently recommended because it may prevent the development of other complications of portal hypertension. […] The timing of repeat endoscopy depends upon the appearance of the varices, the cause of the liver disease, and the person’s overall health. […] STRATEGIES TO PREVENT BLEEDING FROM VARICES […] Avoid alcohol â One of the most important ways to reduce the risk of bleeding from varices is to stop drinking alcohol. Alcohol can worsen cirrhosis, increase the risk of bleeding, and significantly increase the risk of dying.
#84 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Avoid NSAIDs â Nonsteroidal antiinflammatory drugs, or „NSAIDs,” include aspirin, ibuprofen, and naproxen. These drugs do not cause variceal bleeding but may cause upper gastrointestinal (GI) bleeding in people with portal hypertension. […] Weight loss/control of associated conditions â Many people with cirrhosis have steatotic liver disease due to obesity. Obesity may be the sole cause of liver damage, or may be a contributing factor. Losing weight can remove fat from the liver and may reduce further injury. […] Beta blockers â Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside the varices, which can reduce the risk of bleeding. […] Variceal band ligation â Variceal band ligation is a procedure that is done during endoscopy. A physician places small rubber bands around esophageal varices to prevent them from bleeding or stop active bleeding.
#85 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Avoid NSAIDs â Nonsteroidal antiinflammatory drugs, or „NSAIDs,” include aspirin, ibuprofen, and naproxen. These drugs do not cause variceal bleeding but may cause upper gastrointestinal (GI) bleeding in people with portal hypertension. […] Weight loss/control of associated conditions â Many people with cirrhosis have steatotic liver disease due to obesity. Obesity may be the sole cause of liver damage, or may be a contributing factor. Losing weight can remove fat from the liver and may reduce further injury. […] Beta blockers â Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside the varices, which can reduce the risk of bleeding. […] Variceal band ligation â Variceal band ligation is a procedure that is done during endoscopy. A physician places small rubber bands around esophageal varices to prevent them from bleeding or stop active bleeding.
#86 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Regular visits with your healthcare provider are needed to check for bleeding of the varices. If bleeding occurs, it’s likely to occur again. More treatments will then be needed in the future. Once endoscopic therapy (banding) is done, regular follow-up endoscopic scans with banding are done to completely get rid of the varices. If you’re given medicines to take by mouth, take them as directed. Work closely with your provider to manage your condition. Know when to get emergency care.
#87 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Regular visits with your healthcare provider are needed to check for bleeding of the varices. If bleeding occurs, it’s likely to occur again. More treatments will then be needed in the future. Once endoscopic therapy (banding) is done, regular follow-up endoscopic scans with banding are done to completely get rid of the varices. If you’re given medicines to take by mouth, take them as directed. Work closely with your provider to manage your condition. Know when to get emergency care.
#88 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Regular visits with your healthcare provider are needed to check for bleeding of the varices. If bleeding occurs, it’s likely to occur again. More treatments will then be needed in the future. Once endoscopic therapy (banding) is done, regular follow-up endoscopic scans with banding are done to completely get rid of the varices. If you’re given medicines to take by mouth, take them as directed. Work closely with your provider to manage your condition. Know when to get emergency care.
#89 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Patients should have routine surveillance gastroscopies to monitor status and progression of varices. […] Seek urgent medical/ ICU review/ MET (ext. 2222). […] Protect airway, support breathing as required (see Resuscitation guidelines). […] Secure large bore IV access. […] Correct hypovolaemia, remembering the potential for harm with excessive fluid administration. […] Maintain strict fluid balance. […] Continuous cardiorespiratory monitoring (see Clinical Guidelines (Nursing): Observation and Continuous Monitoring). […] If NGT in situ, place on free drainage. […] Consider treating coagulopathies (vitamin K, platelets, cryoprecipitate and FFP). […] Patient should be kept nil by mouth (NBM) until bleeding controlled and medically cleared for oral intake. […] Patients should remain nil by mouth (NBM) post variceal bleeding or banding and grade up diet as directed by treating gastroenterologist.
#90 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Bleeding varices require emergency medical treatment. If not treated quickly, a large amount of blood can be lost, and there is a significant risk of dying. If one or more of these symptoms develop, the person needs to seek emergency care, available in the United States by calling 911. Patients who are bleeding should call 911. They should not try to drive to the hospital or have someone else drive them. […] People with cirrhosis who are at risk for having varices usually undergo a screening test to determine if varices are present. If varices are discovered, strategies to prevent bleeding may be recommended. […] HOW ARE VARICES DETECTED? […] Upper endoscopy â The most common way to detect varices is with a procedure known as upper endoscopy. During this procedure, the person is sedated, and a clinician inserts a thin, lighted, flexible tube with a camera through the person’s mouth to view the lining of the esophagus and stomach.
#91 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Esophageal varices are enlarged veins at the lower end of the esophagus. Varices most often occur because of problems with blood flow in the liver caused by chronic liver disease. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and deadly problem. Treatment is needed to prevent them from bursting (rupturing) and bleeding. If bleeding occurs, it can cause death. […] Symptoms don’t occur unless the varices are bleeding. This is an emergency problem. If you have any of the following symptoms, get medical care right away: Vomiting blood or vomit that looks like coffee grounds, Black, tarry, or bloody stools, Feeling lightheaded, or fainting (loss of consciousness).
#92 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Esophageal varices are enlarged veins at the lower end of the esophagus. Varices most often occur because of problems with blood flow in the liver caused by chronic liver disease. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and deadly problem. Treatment is needed to prevent them from bursting (rupturing) and bleeding. If bleeding occurs, it can cause death. […] Symptoms don’t occur unless the varices are bleeding. This is an emergency problem. If you have any of the following symptoms, get medical care right away: Vomiting blood or vomit that looks like coffee grounds, Black, tarry, or bloody stools, Feeling lightheaded, or fainting (loss of consciousness).
#93 Esophageal Varices
https://www.veteranshealthlibrary.va.gov/3,40442
Esophageal varices are enlarged veins at the lower end of the esophagus. Varices most often occur because of problems with blood flow in the liver caused by chronic liver disease. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and deadly problem. Treatment is needed to prevent them from bursting (rupturing) and bleeding. If bleeding occurs, it can cause death. […] Symptoms don’t occur unless the varices are bleeding. This is an emergency problem. If you have any of the following symptoms, get medical care right away: Vomiting blood or vomit that looks like coffee grounds, Black, tarry, or bloody stools, Feeling lightheaded, or fainting (loss of consciousness).
#94 Patient education: Esophageal varices (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print
Bleeding varices require emergency medical treatment. If not treated quickly, a large amount of blood can be lost, and there is a significant risk of dying. If one or more of these symptoms develop, the person needs to seek emergency care, available in the United States by calling 911. Patients who are bleeding should call 911. They should not try to drive to the hospital or have someone else drive them. […] People with cirrhosis who are at risk for having varices usually undergo a screening test to determine if varices are present. If varices are discovered, strategies to prevent bleeding may be recommended. […] HOW ARE VARICES DETECTED? […] Upper endoscopy â The most common way to detect varices is with a procedure known as upper endoscopy. During this procedure, the person is sedated, and a clinician inserts a thin, lighted, flexible tube with a camera through the person’s mouth to view the lining of the esophagus and stomach.
#95 Esophageal Varices: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
Esophageal varices are swollen veins in the lining of your esophagus. […] Most treatment is aimed at damage control. […] Esophageal varices are serious because they have weakened walls that can leak or break and bleed. Internal bleeding from a ruptured vein can be sudden, severe and life-threatening. […] Bleeding is the most serious risk of esophageal varices. […] But bleeding varices are the most common cause of hospitalization and death in people with cirrhosis. […] An episode of variceal bleeding has a mortality rate of around 20%, and bleeding often recurs (comes back). […] Healthcare providers have several ways of treating varices to prevent and control bleeding. Most treatment is aimed at damage control. […] The goals of treatment are to: Control active bleeding. Prevent future bleeding. Reduce portal hypertension or prevent it from worsening, if possible.
#96 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#97 Acute management of an oesophageal variceal bleed
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/
Ensure patient has a valid group and hold in case requires transfusion. […] Maintain IV access. […] The initial management of variceal bleeding is stabilization of the patient. […] Conservative fluid resuscitation in the form of crystalloid initially, followed by red blood cell transfusion, is critical to avoid overfilling the intravascular space and increasing portal pressure. […] Intravenous antibiotic therapy should be considered for all patients with variceal bleeding in light of the high risk of potentially fatal infectious complications. […] The Sengstaken-Blackmore tube (SSBT) was designed to stop hemorrhage by mechanically compressing esophageal and gastric varices. […] Re-bleeding has been reported in 33%-60% of patients. […] When balloon tamponade is required, there should be a low threshold for intubation, and intubation is highly recommended.
#98 Esophageal Varices – Harvard Health
https://www.health.harvard.edu/a_to_z/esophageal-varices-a-to-z
If the bleeding is caused by ruptured esophageal varices, one of two endoscopic treatments are often used: Band ligation or Sclerotherapy. […] Bleeding from esophageal varices can be life-threatening. […] At least 50% of people who survive bleeding esophageal varices are at risk of more bleeding during the next one to two years. […] The risk can be reduced by endoscopic and drug treatments.
#99 Esophageal Varices – Harvard Health
https://www.health.harvard.edu/a_to_z/esophageal-varices-a-to-z
If the bleeding is caused by ruptured esophageal varices, one of two endoscopic treatments are often used: Band ligation or Sclerotherapy. […] Bleeding from esophageal varices can be life-threatening. […] At least 50% of people who survive bleeding esophageal varices are at risk of more bleeding during the next one to two years. […] The risk can be reduced by endoscopic and drug treatments.
#100 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#101 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#102 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#103 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#104 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#105 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#106 Esophageal Varices – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448078/
Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. the severity of liver disease correlates with the presence of varices and risk of bleeding. This activity reviews the evaluation of esophageal varices and the role of the interprofessional team in managing this condition. […] The management of esophageal varices is with an interprofessional team that consists of a gastroenterologist, internist, surgeon, invasive radiologist, and an intensivist. The treatment selected depends on the severity of the disease and patient status. this is a serious life-threatening disorder and all patients should be in a monitored setting. The role of the nurse in monitoring is crucial. Vitals and oxygenation should be continuously monitored. Blood work should be followed to ensure that the patient is not anemic and developing renal or liver dysfunction. The pharmacist should have the key medications to stop the variceal hemorrhage. In addition, all drugs that are liver toxic should be discontinued. Because patients tend to have other comorbidities, nurses should ensure that the patient has DVT and pressure ulcer prophylaxis. Several treatments to stop variceal bleeding have the potential to cause complications including perforation of the esophagus. Thus, close monitoring of the patient is critical; nurses should regularly check for emphysema. Close communication between the team is vital if outcomes are to be improved. […] Unless the primary cause of portal hypertension is controlled, recurrence is common with all treatments. The prognosis for patients with esophageal varices is guarded. Multiorgan failure, complications from procedures and infections often lead to premature death.
#107 Esophageal Varices: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
Esophageal varices are swollen veins in the lining of your esophagus. […] Most treatment is aimed at damage control. […] Esophageal varices are serious because they have weakened walls that can leak or break and bleed. Internal bleeding from a ruptured vein can be sudden, severe and life-threatening. […] Bleeding is the most serious risk of esophageal varices. […] But bleeding varices are the most common cause of hospitalization and death in people with cirrhosis. […] An episode of variceal bleeding has a mortality rate of around 20%, and bleeding often recurs (comes back). […] Healthcare providers have several ways of treating varices to prevent and control bleeding. Most treatment is aimed at damage control. […] The goals of treatment are to: Control active bleeding. Prevent future bleeding. Reduce portal hypertension or prevent it from worsening, if possible.
#108 Nursing Care Plan For Esophageal Varices – Made For Medical
https://www.madeformedical.com/nursing-care-plan-for-esophageal-varices/
These nursing interventions for esophageal varices aim to manage the condition effectively, reduce the risk of bleeding, and provide holistic care for patients. […] Patient and family education is central to this care plan, empowering individuals to actively participate in their care, understand the condition, and take preventive measures. […] Through the implementation of this plan, we aim to reduce the risk of bleeding, improve patient outcomes, and support individuals in managing this challenging condition effectively.