One of the most interesting diseases I have come across in nursing is esophageal varices.  These are swollen veins in the lining of the lower esophagus near the stomach.  They are usually caused by liver failure, cirrhosis or other conditions that result in reduced blood flow through the liver.  This reduced blood flow causes blood to back-up into veins in the esophagus and stomach forming varices.  Swollen veins in the esophagus or stomach resemble the varicose veins that some people have in their legs.  The enlargement causes the walls of the veins to stretch and become fragile.  Because the veins in the esophagus are so close to the surface of the esophagus, swollen veins in this location can rupture and cause dangerous bleeding. 

          Esophageal varices almost always occur in people who have cirrhosis of the liver. Experts say that 85% of cirrhosis patients have the disorder.  Cirrhosis causes scarring of the liver, which slows the flow of blood through the liver.  Scarring causes blood to back up in the portal vein, the main vein that delivers blood from the stomach and intestines to the liver.  This “back up” causes high blood pressure in the portal vein and other nearby veins, and this is called portal hypertension.  The backup of blood forces veins to enlarge in the vicinity of the stomach and esophagus.  Esophageal varices usually have enlarged, irregularly shaped bulbous regions that are referred to as varicosities and they are interrupted by narrower regions.  Because the blood pressure inside the varices is higher than inside normal blood vessels, and the walls of the vessels (and esophagus) are thin, the veins rupture easily and can bleed profusely.

          In order to understand the symptoms of this disorder, we need to look at symptoms from both esophageal varices and also the symptoms related to gastrointestinal bleeding.  Symptoms of esophageal varices may include difficulty swallowing, vomiting blood, vomiting material that looks like coffee grounds, blood in the stool (black stool, rectal bleeding, red or maroon stool) and anorexia.  Symptoms of gastrointestinal bleeding may include dizziness, rapid pulse, rapid breathing, low blood pressure, fainting, fatigue and pale skin.  The evaluation of esophageal varices begins with a medical history and physical examination.  Physical findings will include abnormally yellow skin or eyes, ascites (fluid in the abdomen), bruising of the skin, dark urine, pale skin from anemia, malnutrition, spider angiomas on the skin, varicose veins on the abdomen, severe hemorrhoids, liver enlargement, liver tenderness, blood in the stool, blood in the vomit, rapid pulse, low blood pressure, confusion, lethargy and signs of dehydration. 

          The diagnosis of esophageal varices is confirmed through testing.  Tests that may be used to evaluate esophageal varices include a liver profile, a complete blood count, a hepatitis panel, a coagulation profile, an espohagoscopy and an upper GI (gastrointestinal) endoscopy.  Treatment for esophageal varices involves reducing the risk of bleeding from the varices.  This includes avoidance of alcohol, medications to reduce the risk of bleeding and surgical procedures to stop variceal bleeding.  Bleeding from esophageal varices can be life threatening.  Patients can lose massive amounts of blood in a short time, causing extremely low blood pressure and shock.  If you vomit blood or notice blood in your stool, you should always seek immediate medical attention, especially if you have cirrhosis or a history of alcohol abuse or chronic hepatitis.  At least 50% of people who survive bleeding esophageal varices are at risk of more bleeding during the next one to two years.  The risk can be reduced by endoscopic and drug treatments.


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