b. All blood returning to the heart from the spleen, stomach, pancreas, and
intestines is detoured through the liver by the portal vein. Branches of the portal vein
carry the blood into the functional units (lobules) of the liver. Here, poisons are
extracted by the hepatic cells to be stored or detoxified. Nutrients just absorbed from
the intestines are extracted and stored or utilized in anabolism.
c. As portal pressure increases, blood backs up into the spleen and bypasses
the liver, returning to the right atrium via collateral circulation. The result is
splenomegaly, ascites, and varicosities of the collateral veins (esophageal and gastric
d. Esophageal and gastric varices are dilated, tortuous veins in the submucosa
of the esophagus and stomach. Prone to rupture, esophageal varices may require
immediate emergency treatment to control hemorrhage and prevent shock and death
e. Nursing Implications. A patient with bleeding esophageal varices is to be
considered in critical condition. Nursing management is aimed at assisting the
physician in controlling bleeding and preventing shock and death.
Monitor V.S. closely and assess level of consciousness frequently.
Observe for signs of hypovolemic shock.
Measure and record I&O.
Administer IVF's and blood, as ordered.
(5) Initiate balloon tamponade, as ordered. (Refer to figure 1-7 and
para 1-26f, Sengstaken-Blakemore Tube.)
Administer iced saline lavage, as ordered. (Refer to para 1-38, Lavage.)
Offer reassurance and moral support to the patient and his family.
(a) Assess the patient's mental status and coping mechanisms.
(b) Reinforce teaching and explanations.
(c) Report to the professional nurse any observations about the needs
of the patient and his family.