Bleeding Esophageal Varices

Question 1

High BP in the liver (portal HTN) forces what type of circulation to form?

Answer 1

Collateral

Question 2

Where does collateral circulation form?

Answer 2

3 places:

• stomach
• esophagus
• rectum

Question 3

When you see an alcoholic client that is GI bleeding, it is usually caused by what?

Answer 3

esophageal varices

Question 4

Esophageal varices is usually not a problem until it ___ (vomit bright red blood).

Answer 4

ruptures

Question 5

What is the treatment for esophageal varices?

Answer 5

• Replace blood
• Monitor VS
• Monitor CVP
• Oxygen (anytime someone is anemic, O2 is needed)
• Octreocide (lowers BP in the liver)
• Endoscopic Sclerotherapy
• Esophageal Variceal Ligation
• Ballon tamponade
• Enemas (to get rid of blood)
• Lactulose (to decrease ammonia)
• Saline lavage to get blood out of stomach

Question 6

What does octreocide (sandostatin) do?

Answer 6

Lowers bp in liver

Question 7

What is a Sengstaken-Blakemore Tube?

Answer 7

• Type of balloon tamponade tube that holds pressure on bleeding esophageal varices.
• Infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage.
• Should not be used for more than 12 hours.
• Many safety implications can be applied to other oropharynx or nasopharynx tubes.

Question 8

Explain the pathophysiology of esophageal varices.

Answer 8

↑ BP in the liver (portal circulation) ➜ collateral circulation is formed (in the stomach, esophagus, rectum)

Question 9

Two most common procedures used for esophageal varices.

Answer 9

• Esophageal Variceal Ligation (EVL) : banding procedure

- Endoscopic Sclerotherapy : HCP injects a sclerosing agent into the varices via an endoscope

Question 10

Sengstaken-Blakemore Tube should not be used more than ___ hours.

Answer 10

12