Esophageal Varices

WHAT YOU SHOULD KNOW:

Esophageal varices are swollen veins in the lower part of your esophagus. They are caused by increased pressure in the blood vessels of your liver. As the pressure builds in your liver, the pressure also builds in the veins in your esophagus.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

You may have severe abdominal pain or see blood in your vomit or bowel movements if your varices bleed. Bleeding can also cause confusion, chest pain, and shortness of breath. You may need a blood transfusion if you lose too much blood. Blood loss can be life-threatening. You may need a liver transplant if your liver fails.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Central line:

This is a special IV catheter or tube. It is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. Other central lines, such as a PICC, may be put into your arm. You may need a central line to receive medicines or IV fluids that need to be given through a big vein. You may need a central line if it is hard for caregivers to insert a regular IV. Also, a central line may stay in longer than a regular IV can. Some central lines may also be used to take blood samples.

Ventilator:

A ventilator is a machine that gives you oxygen and breathes for you when you cannot breathe on your own. Blood from your esophagus may get into your lungs, if your bleeding is severe. The ventilator will be used to protect your lungs. An endotracheal tube (ET) may be put into your airway through your mouth or nose and attached to the ventilator. You will get oxygen through the ET.

Nasogastric tube:

A nasogastric (NG) tube may be put into your nose, and passed down your throat until it reaches your stomach. The tube will be attached to a suction machine. If your varices are bleeding, the blood will go to your stomach. The suction machine will pull the blood from your stomach and your caregiver will be able to decide the best treatment for you.

Medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Beta-blockers: These decrease the pressure in your liver.

Monitoring:

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • Cardiac and oxygen monitoring: A device is connected to your central line. The device records the blood flow activity in your heart. It also measures the amount of oxygen in your blood. Decreased blood flow and oxygen levels may mean you have internal bleeding.

  • Liver pressure monitoring: A small tube is put into a vein in your liver so caregivers can measure liver pressure. Your caregiver will know that your treatment is working if the pressure is lower.

Tests:

  • Blood tests: You will need blood tests to see if you have an infection, or if your body is responding to treatment.

  • Chest x-ray: You will need a chest x-ray to see if you have blood or an infection in your lungs.

  • EGD: Your caregiver uses an endoscope to see the walls of your esophagus and upper intestines. An endoscope is a bendable metal tube with a light and tiny camera on the end. It is placed down your throat, into your stomach and intestines. Your caregiver will be able to see where you are bleeding. This may be repeated while you are in the hospital.

  • MRI: This scan uses powerful magnets and a computer to take pictures of your chest and abdomen. An MRI may show a break in your varices. You may be given dye to help the varices show up better. Tell your caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell your caregiver if you have any metal in or on your body.

  • Barium swallow: This test is an x-ray of your throat and esophagus. It may also be called a barium esophagram. You will drink a thick liquid called barium. Barium helps your esophagus and stomach show up better on x-rays. A barium swallow can help your caregiver find where you are bleeding.

Treatment:

  • Balloon tamponade: A balloon is placed in the esophagus and blown up. The balloon puts pressure on the varices to control bleeding. This allows your caregiver to decide what treatment is best for you. The balloon is not permanent.

  • Endoscopic variceal band ligation: Bands are placed around the large varices in your esophagus. The pressure of the bands causes the varices to shrink. This is done to slow down or stop the bleeding.

  • Endoscopic sclerotherapy: Medicine is put in the varices to make them smaller and stop the bleeding.

  • Surgery:

    • Shunt placement: A shunt is a plastic tube placed in a vein in your liver and connected to a larger vein. A shunt is used to reduce pressure in the veins in your liver. This will help stop the bleeding.

    • Esophageal transection: This surgery is done by cutting away the part of the esophagus that is bleeding. This is done to control severe bleeding.

  • Blood transfusion: You may need a transfusion if you lose too much blood from burst varices. You may get whole or parts of blood, such as platelets or plasma, through an IV.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Esophageal Varices (Inpatient Care)

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