Can you recognize gastroesophageal varices?
Michael Caleb Gulley BSN, RN

Nursing Made Incredibly Easy!
June 2014 
Volume 12  Number 3
Pages 16 - 20
  PDF Version Available!

One of the most common complications associated with chronic liver failure is the formation of gastroesophageal varices-abnormally enlarged veins in the lower part of the esophagus. Their formation is the result of collateral circulation of splanchnic blood flow due to an increase in portal hypertension. When the portal venous pressure increases, blood flow is diverted into low-pressure veins, commonly in the esophagus and upper parts of the stomach. These low-pressure veins aren't accustomed to maintaining the additional volume and the subsequent pressure that increases with this volume, often becoming engorged, enlarged, and fragile (see How it happens).Due to a lack of tolerance for the high-pressure flow in these veins and an increasing portal venous pressure, gastroesophageal varices have a tendency to rupture and bleed. These acute bleeds can result in massive amounts of blood loss, leading to hypovolemic shock and, if not immediately treated, death. Fortunately, great strides have been made in the area of treatment in the last 30 years that have resulted in a 50% reduction in mortality.A: The primary cause of gastroesophageal varices is portal hypertension, which results in pooling of blood back into smaller vessels, including those in the esophagus. Several medical conditions can cause portal hypertension, including: * cirrhosis of the liver * clots in the splenic, portal, or hepatic veins * hepatic arterioportal fistula (an uncommon vessel blockage, usually a result of hepatic artery aneurysm or penetrating trauma, most notably transhepatic surgical procedures) * infection * heart failure * pancreatic tumor * Hodgkin disease * sarcoidosis (inflammation of the lymph nodes, lungs, liver, eyes, skin, or other tissues).In addition, several risk factors increase the chance of variceal rupture and bleeding, such as chronic alcoholism, chronic hepatitis, nonsteroidal anti-inflammatory drug (NSAID) use, clotting abnormalities, and certain parasitic infections.A: Signs

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