# Esophageal Varices --- **Esophageal varices** (singular **varix**) Basically [[varicose veins]] in the esophagus a huge risk factor for [[GI bleed|upper GI bleeds]] and also death. • Esophageal varices-60% of patients with decompensated cirrhosis • Back pressure from [[hepatic portal system|portal hypertension]] from liver cause fragile varices on esophagus; fragile collateral veins more prone • Bleed very easily; can be deadly due to blood loss- 10-40% mortality - If the blood is swallowed, the breakdown of that hemoglobin produces [[ammonia]], which can be dangerous for [[hepatic encephalopathy]]. ## Ruptures This is the dangerous, but also they are very fragile and can rupture easily. - eating - especially anything hard or crunchy - straining - [[GERD]] [[antidiuretic hormone|vasopressin]] may be the initial therapy for ruptured esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. [[growth hormone|octreotide]] may also be the initial therapy as it lowers the portal hypertension, and it has less systemic effects than vasopressin. ## Signs & Symptoms often asymptomatic unless they rupture/bleed. in that case you might see: - hematemesis - melena - altered mental status - [[shock]] ## Diagnostic Tests - [[endoscopy|upper endoscopy]] - measuring for [[hepatic portal system|portal hypertension]] - liver function tests - AST/ALT/bilirubin/alkaline phosphate - x-ray/angiography ## Treatment Endoscopic Variceal Ligation (EVL), called "banding" ![[endoscopic variceal ligation.png]] ![[hepatic portal system#TIPS|TIPS]] ## Nursing Considerations Let people know they should be careful not to rupture the varices, like by avoiding straining, heavy lifting, ___