OESOPHAGEAL VARICES AND DIAGNOSTIC

INVESTIGATIONS
-BY VASU THAGARAM
M.SC. NURSING I YEAR
SIMS COLLEGE OF NURSING
 DEFINITIO
N
Oesophageal varices are dilated and tortuous
veins in the oesophageal wall, secondary to
increased venous pressure in the splanchnic
venous bed or in the superior vena cava.
They are prone to rupture and often are the
sources of massive haemorrhages from the
upper gastro-intestinal tract and rectum.
 DIAGNOSTIC EVALUATION
▶ Endoscopy- To identify the cause and bleeding site.
Portal hypertension measurements
▶Indirect
measurement-
▶ Ultrasonography
▶ Computed
tomography
▶Liver function tests- serum
aminotransferase, bilirubin, alkaline
phosphatase, etc. serum
(increased) proteins,
▶Splenoportography- To detect
extensive collateral circulation in
oesophageal vessels, which would indicate
varices.
▶Hepatic portography- X-ray
visualization of the hepatic portal system
made radiopaque by intravenous infusion of
a suitable medium.
Celiac
angiography
Balloon tamponade
Endoscopic variceal ligation
(oesophageal banding therapy)-
Trans jugular intrahepatic portosystemic
shunt (TIPS)
Additional therapies
Coated expandable stents
SURGICAL MANAGEMENT
▶ Surgical bypass procedure- Distal splenorenal shunt
Devascularization and transection (Sugiura procedure)-
 NURSING DIAGNOSIS

▶Fluid volume deficit related to active bleeding as

evidenced by decreased urine output (less than
30mL/hr).
▶Ineffective tissue perfusion related to hypovolemia
as evidenced by abnormal arterial blood gases.
▶Anxiety related to change in health status as
evidenced by irritability and nervousness due to
bleeding.