Esophageal Varices-II: Clinical Features and Management

Esophageal varices manifest with gastrointestinal bleeding symptoms including hematemesis (vomiting blood), hematochezia (passing fresh blood rectally), and melena (black, tarry stools). Additional signs include abdominal pain, jaundice, pruritus, weight loss, anorexia, altered mental status, and muscle cramps. These symptoms indicate active or recent bleeding requiring immediate medical evaluation.

Initial assessment involves collecting detailed medical history to identify risk factors like liver disease, alcohol abuse, or viral hepatitis. Physical examination includes liver palpation, checking for splenomegaly and ascites, and observing visible abdominal collateral circulation. Hemodynamic stability assessment detects active bleeding through signs like hypotension and tachycardia, essential for determining treatment urgency.

Upper endoscopy (EGD) directly visualizes and grades varices, serving as the primary diagnostic tool. CT or MRI scans evaluate liver and portal vein abnormalities. Portal hypertension measurement uses hepatic venous pressure gradient (HVPG) assessment via catheter insertion into a hepatic vein; an HVPG exceeding 10 mmHg indicates significant portal hypertension.

Vasoactive drugs like octreotide or vasopressin are administered as soon as possible and before endoscopy to reduce portal pressure and control bleeding. Beta-blockers provide ongoing pressure reduction. These medications work alongside endoscopic therapies to stabilize patients and prevent rebleeding episodes.

Endoscopic variceal ligation ties off varices using an endoscope, placing rubber bands around them to stop bleeding and reduce rebleeding risk. This minimally invasive procedure is performed during upper endoscopy and effectively controls acute hemorrhage while promoting variceal closure through tissue necrosis.

Nurses administer IV fluids, electrolytes, and volume expanders to stabilize fluid volume and electrolytes. Blood transfusions address anemia, while proton pump inhibitors reduce gastric acid production. Continuous monitoring of vital signs and mental status, along with antibiotic prophylaxis to prevent infections, ensures comprehensive care during acute bleeding episodes.

Balloon tamponade applies direct pressure to control bleeding when endoscopic methods are unsuccessful. Transjugular intrahepatic portosystemic shunt (TIPS) creates a shunt to divert blood flow and reduce portal vein pressure. Surgical bypass procedures create alternative blood pathways to bypass the liver, reserved for refractory cases or when other interventions fail.