ESOPHAGEAL VARICES Flashcards
where does hepatic vein drain blood from?
drains blood from liver to IVC 4 cm before it enters RA
what is the portal vein formed by?
formed by junction of splenic vein and SMA
what does the portal vein divide into?
L and R vein at hilum of liver
where does the portal venous system drain blood from?
drains blood from lower esophagus, stomach, intestines, spleen, and pancreas to the liver
what does obstruction d/t liver damage lead to?
leads to portal HTN and formation of collateral vessels connecting portal vein and systemic circulation
what does portal venous pressure compared to systemic venous circulation cause? check this out in the notes
reversal of blood flow and engorgement in collateral vessels
what is portal HTN?
increase in pressure within portal vein
what are the 2 common causes of portal HTN?
- cirrhosis d/t chronic viral hepatitis C
- alcohol-induced liver disease
what are the manifestations of portal HTN?
- ESOPHAGEAL VARICES
- caput medusae
- hypersplenism= over active spleen
- anemia
- neutropenia
- thrombocytopenia
- marked ascites
- hemorrhoids
what is a varix?
abnormally dilated vessel with tortuous course
where does a varix usually occur?
occurs in venous system, but may also occur in arterial or lymphatic vessels
what are the 2 big sites of varix formation?
- distal esophagus
- proximal stomach
what are the other sites of varix formation?
- umbilicus
- rectum
- retroperitoneum
what are esophageal varices?
dilated submucosal veins in distal esophagus connecting to portal and systemic circulation
what are the most dangerous varices and why?
esophageal varices are the most dangerous d/t risk of rupture -> massive upper gastrointestinal bleeding
what are risk factors for bleeding in regards to esophageal varices?
- size of varices
- presence of red whale markings (Longitudinal dilated venules on the varix surface)
- severity of liver disease
- active alcohol abuse
what is s/sx of variceal bleeding?
painless, upper GI bleed that can be acute, subacute, or chronic
what is the site of bleeding most often and least often in regards to s/sx of variceal bleeding?
most often- distal esophagus
least often- gastric fundusw
what are the s/sx of an acute massive bleed?
- systolic BP <100
- pulse rate >100 bpm, weak.
- pale
- diaphoretic
- restless
- thirsty
what does an acute massive bleed leas to?
shock
what is the test of choice for esophageal and gastric varices?
endoscopy
what testing has to be done d/t the fact that there is a high association of varices and hepatic disease?
must evaluate for coagulopathy via PT/INR and PTT
what additional tests must be done for dx of esophageal varices?
cbc- anemia and thrombocytopenia
liver tests- ast, alt, alk phos, bilirubin
(renal fxn too)
how many variceal bleeds stop spontaneously?
40%
what is bleeding varices?
an EMERGENCY
what is the treatment options of esophageal varices?
- airway mgmt- intubation
- 2 large bore IV’s
- correction of coagulopathy
- abx
- IV octreotide
- endoscopic banding or sclerotherapy
what is involved in 2-large bore IV therapy in esophageal varices?
- fluid resuscitation
- blood transfusion
> type and cross-match 6 units of packed red
blood cells
what is involved in correction of coagulopathy for tx of esophageal varices?
1-2 units FFP
platelet transfusion (>50k mcL)
what abx is given for esophageal varices?
3rd gen cephalosporins (rocephin) IV to prevent bacteremia and sepsis
what is IV octreotide?
synthetic analog of somatostatin that reduces portal pressure = less pressure in varices
when is endoscopic banding or sclerotherapy done?
when the pt is hemodynamically stable
what is the prognosis of esophageal varices?
- mortality depends primarily on the severity of assoc. liver dz
> 20% mortality at 6 weeks - recurrence rate of variceal bleeding is 50-75% within 1-2 years
> BB’s to decrease recurrent bleeding but NOT
during acute/active bleed because you want the
heart to pump faster during a bleed
