NCLEX Review Guide: Esophageal Varices

Understanding Esophageal Varices

• Esophageal varices are enlarged, swollen veins in the lower esophagus that develop due to portal hypertension, most commonly from liver cirrhosis.
• Portal hypertension causes blood to back up and seek alternative routes, leading to collateral circulation through esophageal veins.
• Primary risk factors include chronic liver disease, cirrhosis, hepatitis B/C, alcohol abuse, and portal vein thrombosis.

Signs & Symptoms

• Hematemesis (vomiting blood) - may be bright red or coffee-ground appearance indicating upper GI bleeding.
• Melena (black, tarry stools) indicating digested blood from upper GI tract.
• Signs of hypovolemic shock: hypotension, tachycardia, altered mental status, decreased urine output.
• Abdominal pain, dysphagia, and signs of liver disease (jaundice, ascites, spider angiomata).

Acute Care Priorities

1. Establish IV access immediately - preferably two large-bore IVs for fluid resuscitation and blood product administration.
2. Monitor vital signs continuously and assess for signs of shock - hypotension, tachycardia, decreased consciousness.
3. Position patient in semi-Fowler's or side-lying position to prevent aspiration of blood.
4. Prepare for emergency endoscopy and possible balloon tamponade (Sengstaken-Blakemore tube).
5. Administer prescribed medications: vasopressin, octreotide, or beta-blockers to reduce portal pressure.

• Remember the ABC priority: Airway (prevent aspiration), Breathing, Circulation (IV access, fluid resuscitation).
• Look for keywords in questions: "cirrhosis," "portal hypertension," "vomiting blood" - these point to varices.
• Understand that prevention is key - beta-blockers reduce portal pressure and prevent initial bleeding.