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ESOPHAGEAL VARICES Flashcards

1
Q

where does hepatic vein drain blood from?

A

drains blood from liver to IVC 4 cm before it enters RA

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2
Q

what is the portal vein formed by?

A

formed by junction of splenic vein and SMA

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3
Q

what does the portal vein divide into?

A

L and R vein at hilum of liver

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4
Q

where does the portal venous system drain blood from?

A

drains blood from lower esophagus, stomach, intestines, spleen, and pancreas to the liver

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5
Q

what does obstruction d/t liver damage lead to?

A

leads to portal HTN and formation of collateral vessels connecting portal vein and systemic circulation

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6
Q

what does portal venous pressure compared to systemic venous circulation cause? check this out in the notes

A

reversal of blood flow and engorgement in collateral vessels

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7
Q

what is portal HTN?

A

increase in pressure within portal vein

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8
Q

what are the 2 common causes of portal HTN?

A
  1. cirrhosis d/t chronic viral hepatitis C
  2. alcohol-induced liver disease
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9
Q

what are the manifestations of portal HTN?

A
  1. ESOPHAGEAL VARICES
  2. caput medusae
  3. hypersplenism= over active spleen
    • anemia
    • neutropenia
    • thrombocytopenia
  4. marked ascites
  5. hemorrhoids
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10
Q

what is a varix?

A

abnormally dilated vessel with tortuous course

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11
Q

where does a varix usually occur?

A

occurs in venous system, but may also occur in arterial or lymphatic vessels

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12
Q

what are the 2 big sites of varix formation?

A
  1. distal esophagus
  2. proximal stomach
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13
Q

what are the other sites of varix formation?

A
  1. umbilicus
  2. rectum
  3. retroperitoneum
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14
Q

what are esophageal varices?

A

dilated submucosal veins in distal esophagus connecting to portal and systemic circulation

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15
Q

what are the most dangerous varices and why?

A

esophageal varices are the most dangerous d/t risk of rupture -> massive upper gastrointestinal bleeding

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16
Q

what are risk factors for bleeding in regards to esophageal varices?

A
  1. size of varices
  2. presence of red whale markings (Longitudinal dilated venules on the varix surface)
  3. severity of liver disease
  4. active alcohol abuse
17
Q

what is s/sx of variceal bleeding?

A

painless, upper GI bleed that can be acute, subacute, or chronic

18
Q

what is the site of bleeding most often and least often in regards to s/sx of variceal bleeding?

A

most often- distal esophagus
least often- gastric fundusw

19
Q

what are the s/sx of an acute massive bleed?

A
  • systolic BP <100
  • pulse rate >100 bpm, weak.
  • pale
  • diaphoretic
  • restless
  • thirsty
20
Q

what does an acute massive bleed leas to?

A

shock

21
Q

what is the test of choice for esophageal and gastric varices?

A

endoscopy

22
Q

what testing has to be done d/t the fact that there is a high association of varices and hepatic disease?

A

must evaluate for coagulopathy via PT/INR and PTT

23
Q

what additional tests must be done for dx of esophageal varices?

A

cbc- anemia and thrombocytopenia
liver tests- ast, alt, alk phos, bilirubin
(renal fxn too)

24
Q

how many variceal bleeds stop spontaneously?

A

40%

25
Q

what is bleeding varices?

A

an EMERGENCY

26
Q

what is the treatment options of esophageal varices?

A
  1. airway mgmt- intubation
  2. 2 large bore IV’s
  3. correction of coagulopathy
  4. abx
  5. IV octreotide
  6. endoscopic banding or sclerotherapy
27
Q

what is involved in 2-large bore IV therapy in esophageal varices?

A
  • fluid resuscitation
  • blood transfusion
    > type and cross-match 6 units of packed red
    blood cells
28
Q

what is involved in correction of coagulopathy for tx of esophageal varices?

A

1-2 units FFP
platelet transfusion (>50k mcL)

29
Q

what abx is given for esophageal varices?

A

3rd gen cephalosporins (rocephin) IV to prevent bacteremia and sepsis

30
Q

what is IV octreotide?

A

synthetic analog of somatostatin that reduces portal pressure = less pressure in varices

31
Q

when is endoscopic banding or sclerotherapy done?

A

when the pt is hemodynamically stable

32
Q

what is the prognosis of esophageal varices?

A
  • 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

GI (22 decks)

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