Esophageal Varices

In the esophagus, the tube that joins the neck and stomach, there are swollen veins called esophageal varices. Those with severe liver problems are more susceptible to developing esophageal varices.

When a clot or scar tissue in the liver blocks normal blood flow to the liver, esophageal varices form. Blood enters smaller blood arteries, which are not intended to carry high amounts of blood, to circumvent the obstructions. The blood arteries have the potential to rupture and release life-threatening amounts of blood.

There are a few medications and medical treatments that can be used to lessen or halt esophageal variceal bleeding.

Esophageal Varices: Causes

When the blood supply to your liver is restricted, esophageal varices can occasionally develop. The most common cause of this, also known as cirrhosis of the liver, is scar tissue in the liver brought on by liver disease. Blood starts to back up in the flow. This causes the portal vein, a big vein that delivers blood to your liver, to become more pressurized. Portal hypertension is the name given to this disorder.

Smaller veins, such as those in the lowest section of the esophagus, are forced to seek alternative routes by portal hypertension. The additional blood causes these thin-walled veins to enlarge. They sometimes hemorrhage and burst.

Esophageal varices can be brought on by −

• Cirrhosis is severe scarring of the liver. Cirrhosis can be brought on by several liver conditions, such as hepatitis infection, alcoholic liver disease, fatty liver disease, and primary biliary cholangitis.

• Thrombus, also known as thrombosis. Esophageal varices can be brought on by a blood clot in the portal vein or in a vein called the splenic vein that feeds into the portal vein.

• Parasitic disease. A parasite ailment called schistosomiasis can be present in several regions of Africa, South America, the Caribbean, the Middle East, and East Asia. In addition to the liver, the parasite can harm the lungs, gut, bladder, and other organs.

Esophageal Varices: Symptoms

The patient with esophageal varices mainly presents with the following symptoms −

• Huge quantities of blood in your vomit.

• Red, dark, or tarry stools.

• Blood loss-related light-headedness.

• In extreme circumstances, unconsciousness.

If you exhibit any of the following symptoms of liver disease or have been told you have liver cirrhosis −

• Jaundice is characterized by the skin and eyes had a yellow tint.

• Bruising or bleeding easily.

• Ascites are an accumulation of fluid in the abdomen.

Esophageal Varices: Risk Factors

Several factors play an important role in the development of esophageal varices which includes −

• An elevated portal vein pressure. When the pressure in the portal vein rises, the risk of bleeding increases.

• Broad varies. The likelihood that esophageal varices will bleed increases with size.

• The varices have red markings. Long, crimson streaks or red patches can be seen in certain esophageal varices. Using a small, flexible tube called an endoscope that is inserted down your throat, your doctor may view them. These scars point to a significant risk of bleeding.

• Severe liver damage or cirrhosis. Esophageal varices are most frequently more prone to bleed the worse your liver illness is.

Esophageal Varices: Diagnosis

The diagnosis of the esophageal varices is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes −

• Endoscopic examination. The primary technique for detecting esophageal varices is a procedure known as upper gastrointestinal endoscopy. A flexible, illuminated tube called an endoscope is inserted down the mouth and into the esophagus during an endoscopy. Your doctor can inspect your esophagus, stomach, and duodenum, which is the first section of your small intestine, using a tiny camera on the end of an endoscope.

• The doctor checks for enlarged veins. When larger veins are discovered, they are measured and examined for red streaks and patches, which often signify a high risk of bleeding. The examination might be used to administer treatment.

• Image-based exams. Esophageal varices can be detected by abdominal CT scans and Doppler ultrasounds of the splenic and portal veins.

Esophageal Varices: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Conservative treatment includes −

• Tying up bleeding veins using elastic bands. During an endoscopy, your doctor could bandage the esophageal varices.

• Using drugs to reduce portal vein blood flow. Blood flow to the portal vein is slowed by medications such as vasopressin and octreotide. Following a bleeding event, medicine is often given for up to five days.

Surgical Treatment

Blood flow is being changed to avoid the portal vein. Your doctor could advise a surgery called a transjugular intrahepatic portosystemic shunt if medication and endoscopic therapies don't stop the bleeding (TIPS).

Procedure to stop bleeding − Esophageal varices may bleed less frequently as a result of therapies that lower blood pressure in the portal vein. Treatments might consist of −

Medications that lower portal vein pressure. Your portal vein's blood pressure may be lowered with the use of a beta blocker, a class of blood pressure medication. This may reduce the risk of bleeding.

Esophageal Varices: Prevention

Some of the measures that can help to prevent esophageal varices include −

• Avoid consuming alcohol. As the liver processes alcohol, people with liver illness are frequently recommended to avoid drinking. Alcohol use may strain the liver, which is already delicate.

• Adopt a balanced diet. Choose a diet high in fruits and vegetables. Choose lean protein sources and healthy carbohydrates. Limit your intake of fried and fatty meals.

• Keep a healthy weight. Having too much body fat might harm your liver. Obesity is linked to a higher risk of cirrhosis problems. If you are fat or overweight, lose weight.

Conclusion

An inter professional team composed of a gastroenterologist, internist, surgeon, invasive radiologist, and intensivist manages esophageal varices. The chosen course of therapy is determined by the disease's severity and the patient's condition. All patients should be in a supervised setting because this is a severe condition that poses a risk to their lives. The nurse's involvement in monitoring is essential. Continuous monitoring of vital signs and oxygenation is recommended.

To make sure the patient is not anemic and developing renal or hepatic disease, blood testing should be monitored. The essential drugs to halt variceal bleeding should be in the pharmacist's possession. Moreover, any liver-toxic medications must be stopped using.

Nurses should make sure the patient is receiving DVT and pressure ulcer prevention because patients frequently have additional comorbidities. The risk of consequences from various variceal bleeding therapies, such as esophageal perforation, is present. As a result, it's crucial to keep a close eye on the patient, and nurses should regularly check for emphysema. If results are to be improved, the team must maintain close communication.

All therapies for portal hypertension often result in recurrence unless the fundamental cause is managed. Esophageal varices patients have a guarded prognosis. Premature mortality is frequently caused by infections, multiorgan failure, and complications from surgeries.