Dilated veins in the esophagus, often due to blocked flood flow through the portal vein, where blood flows from parts of the GIT to the liver. These have the risk of rupturing, leading to massive hemorrhaging.
Assessment Findings
- Signs of bleeding: Hematemesis, Melena, Hepatosplenomegaly, Jaundice, Ascites, Signs of Shock (tachycardia, hypotension, tachypnea, cold clammy skin, level of consciousness)
Diagnosis
- Upper GI Endoscopy for visualization
- Serum liver function test.
Nursing Interventions
- NPO
- Blood studies to determine extent of the effects of bleeding.
- O2 Therapy to maintain adequate blood oxygen.
- Blood Transfusion to replace lost blood.
- Vasopressin (Pitressin) to maintain blood pressure
- Assist in NGT and Sangstaken-Blakemore Tube insertion for a balloon tamponade.
- Monitor: VS q30min, lumen pressure, drainage, suction, respiratory distress. If respiratory distress occurs, pinch the tube at the patient’s nose and cut it with scissors, then remove the tube.
- Deflate the esophageal balloon for ~30 minutes every 8 to 12 hours.
- Frequent mouth and nose care.
Surgical Intervention
- Endoscopic Sclerotherapy, a sclerosing agent is injected into the varix to promote thrombosis and sclerosis.
- Endoscopic Variceal Ligation (variceal banding)
- Shunt Procedures