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If an esophageal varix bursts, massive hemorrhage occurs, and the patient may die within minutes.
Medical treatment includes administration of a beta blocker, such as nadolol, with a nitrate, such as isosorbide, to lower portal pressures and decrease the likelihood of variceal bleeding. Invasive therapies include the injection of sclerosing agents or rubber banding of the dilated vein.
Bleeding esophageal varices constitute a medical emergency, requiring immediate treatment to control hemorrhage and prevent hypovolemic shock. The patient’s vital signs, SaO2, ABGs, electrolyte and fluid volume balance, and level of consciousness are closely monitored. Intravenous access must be established promptly and fluid resuscitation, followed by transfusion and the administration of plasma are critical to early stabilization of the patient. Medical therapies also include the use of vasoconstricting drugs, such as vasopression. Endoscopy is used to identify the site of the ruptured vessels which may then be treated with sclerotherapy, ligation, or banding.
Surgical procedures to prevent rebleeding include portocaval or mesocaval shunts, portosystemic anastomosis, splenorenal shunting or liver transplantation. All procedures are explained, sensation messages provided, and reassurance and emotional support offered.