Presented by: Ariane Joy Magnaye Karla Mejia & Sarah Jane Petalio

Varices > are varicosities that develop from elevated pressure in the veins that drain into the portal system

are dilated, tortuous veins that are usually found in the submucosa of the lower esophagus but many develop higher in the esophagus or extend into the stomach this condition is almost always caused by portal hypertension

Portal Hypertension- is the increased pressure throughout the portal venous system that result from obstruction of blood flow through the damaged liver

 Hematemesis
Melena General

detorioration in mental or physical status S/S Shock(cool clammy skin,hypotension, tachycardia)

 Endoscopy,

barium swallow ultrsosography CT, and angiography - to identify the cause and the site of bleeding Portal Hypertension Measurement
1. Indirect measurement
The measurement requires insertion of a catheter with a balloon into the antecubital or femoral vein.

2. Direct measurement
a. During the laparotomy, a needle may be introduced into the spleen; a manometer reading of more that 20 ml saline is abnormal b. Insertion of a catheter into the portal vein or one of its branches

 Laboratory

Test Liver function test Splenoportography Hepatoportography Celiac angigraphy

Pharmacologic

Therapy

- Vasopressin It produce constriction of the splanchnic arterial bed and decrease portal pressure - Somatostatin Cause selective splanchnic vasoconstriction and are used mainly in the management of active hemorrhage

- Propranolol & Nadolol

Beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in patient with known varices and to prevent rebleeding

- Nitrates Lower portal pressure by venodilation and decreased cardiac output and may be used in combination with beta-blockers

 Balloon

Tamponade - In this procedure, pressure is exerted on the cardia(upper orifice of the stomach) and against the bleeding varices by a double ballon tamponade.

 Endoscopic

Therapies

Endoscopic Sclerotherapy - also referred to as injection sclerotheraphy - a sclerosing agent is injected through a fiberoptic endoscope into the bleeding esophageal varices to promote thrombosis and eventual sclerosis.

 Esophageal

Banding Therapy - also referred to as esophageal variceal ligation (EVL) - a modified endoscope loaded with an elastic rubber band is passed through an overtube directly onto the varix (or varices) to the banded Transjugular Intrahepatic Portosystemic Shunting - Is indicated for the treatment of an acute episode of variceal bleeding refractory to pharmacologic or endoscopic therapy.

 Surgical

Bypass Procedures - can prevent variceal bleeding if the shunt remains patent Distal Splenorenal shunt Is made between the splenic vein and the left renal vein after splenectomy. and Transection - Is a procedure to separate the bleeding site from the high-pressure portal system to have been used in the emergency management of variceal bleeding

Devascularization

Monitoring the patients physical condition

and evaluating emotional responses and cognitive status Monitors and record vital signs and assesses the patients nutritional and neurologic status Monitor blood pressure Provide support and explanations about medical and nursing intervention Close monitoring of the patient helps in directing and managing complications.