ESOPHAGEAL VARICES

Arranged by :
Group 6
1. Weni Dwi Cahyani 21117130
2. Widya 21117132
3. Windah Anisyah 21117134
4. Wisma Wardani 21117136
5. Yola Alfina 21117138
6. Yosa Nanda Fermata 21117140
7. Yuti Sartika 21117142

Supervisor :
Sukron, S.Kep., Ns., MNS

NURSING SCIENCE STUDY PROGRAM

STIKes MUHAMMADIYAH PALEMBANG
2018/2019
 PREFACE

We thank God for the presence of Allah SWT for His abundance of grace,
so that we can complete the writing of the paper and the title is Esophageal
Varices to complete the task of learning the surgical medical nursing II.
Building criticism and suggestions are needed to improve this paper. We have
made every effort to write this paper, in the hope that it will useful for all
readers. And finally we say thank you very much.

Palembang, March 16, 2019

Author

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 TABLE OF CONTENTS

TITLE ............................................................................................................... i
FOREWORD ................................................................................................... ii
TABLE OF CONTENTS ................................................................................. iii
CHAPTER I INTRODUCTION
A. Background .......................................................................................... 1
B. Problem Formulation ........................................................................... 1
C. Purpose ................................................................................................. 1
D. Benefits Research ................................................................................. 2
CHAPTER II DISCUSSION
A. Definition ............................................................................................. 3
B. Etiology ................................................................................................ 3
C. Anatomy ............................................................................................... 4
D. Pathophysiology ................................................................................... 5
E. Complocations ..................................................................................... 6
F. Signs and Symptoms ............................................................................ 7
G. Management ......................................................................................... 7
H. Phatway ................................................................................................ 8
I. Nursing Care ........................................................................................ 8
CHAPTER III CLOSING
A. Conclusion ........................................................................................... 12
B. Suggestions .......................................................................................... 12
BIBLIOGRAPHY ............................................................................................ 13

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 CHAPTER I
INTRODUCTION

A. Background
Varicose veins are experiencing widening. We could see the veins
under our skin. The shape is usually elongated and prominent, resembling
the shape of a rather long cable. The blood vessels are colored dark blue
and even tends to purple for a little oxygen levels. Esophageal varices is a
disease characterized by abnormal enlargement of the veins in the lower
esophagus. Esophageal varices occurs when blood flow to the heart is
blocked. Your stream will look the other way, namely kc veins in the
esophagus, stomach, or rectum are smaller and easier to break. Varicose
veins are not only arise in the legs but also in other parts such as the vulva
(vaginal lips), the testes in men, which led to the ambient anus and throat
area.

B. Problem Formulation
1. What sense esophageal varices?
2. What is the etiology of esophageal varices?
3. How pathophysiology of esophageal varices?
4. How to complications from esophageal varices?
5. How the signs and symptoms of esophageal varices?
6. How Management on esophageal varices?
7. Any investigation of esophageal varices?
8. How Nursing Critical on esophageal varices?

C. Purpose
1. To fulfill the tasks subjects of Medical Surgical Nursing.
2. To find out how your understanding and knowledge of esophageal
varices.

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D. Benefits Research
1. For Authors
Broaden the knowledge and science of esophageal varices.
2. For Readers
Gain insight into the knowledge and science of esophageal varices.

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 CHAPTER II
DISCUSSION

A. Definitions
Esophageal varices is a disease characterized by abnormal
enlargement of the veins in the lower esophagus. The esophagus is the
tube that connects between the esophagus and stomach (manual labor
STIK students Muhammadiyah Pontianak).
Konisi esophageal varices is usually associated with cirrhosis and
portal hypertension in which the small veins in the esophagus becomes
distended and ruptured as a result of increased pressure in the portal
system.
Esophageal varices is a disease characterized by abnormal
enlargement of the veins in the lower esophagus. Esophageal varices
occurs when blood flow to the heart is blocked. Your stream will look the
other way, ie to the blood vessels in the esophagus, stomach, or rectum are
smaller and easier to break.
According to the group of esophageal varices is an abnormal
enlargement of the veins. As a result of the imbalance between the
pressure of the blood flow and the ability of the blood vessels was
abnormal enlargement appear on the veins.

B. Etiology
Various diseases involved in the portal vein blood flow and result in
an increase in portal vein pressure forming esophageal varices. The cause
of the increase in the portal vein can be classified by prehepatik,
intrahepatic and posthepatic.
Oesophageal varices is usually a complication of liver cirrhosis.
Cirrhosis is a disease characterized by the formation of scar tissue in gati.
Causes include hepatitis B and C or large amounts of alcohol
consumption. Other diseases that can lead to cirrhosis is a blockage of the
bile ducts.

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 Several other conditions can also cause varicose veins esofaghus
among others:
1. Thrombosis
Blood clot in the portal vein or vein splenikus. A blood clot in the
portal vein or splenic vein that feeds into the portal vein, can cause
esophageal varices.
2. Sarcoidosis
These inflammatory disease begins in the lungs - lungs, but can affect
almost every organ in the body including the liver. It rarely causes
cirrhosis.
3. Schistomiasis
This parasitic infection affects millions of people in developing
countries, especially in parts of Africa, South America, the Caribbean,
the Middle East and Southeast Asia. It can damage the liver and lungs,
intestines and bladder.
4. Syndrome Budd – Chiari
In rare circumstances, blood clots block blood vessels that carry blood
away from your heart.
5. Severe congestive heart failure
It occurs when the heart can not pump enough blood to meet the body's
needs. In congestive heart failure, blood backs up into the veins
between the heart and the right side of your heart, increases blood
pressure in the portal vein.

C. Anatomy
The esophagus is a hollow
cylindrical organ with a length of about
18-26 cm. The esophagus connects
between the pharynx and stomach. The
esophageal proximal boundary is the
upper esophageal sphincter, which
travels distally to the posterior

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 mediastinum like a hollow tubular tube to the lower esophageal sphincter.
Esophagus is a functional part that is anatomically related to the
meeting between the muscular pharyngeal constructor and the
cricopharynx. The esophagus is the center of the tonic contraction, thick-
walled, with circular smooth muscles 2-4 cm long, up to the diaphragm
hiatus.
The esophageal wall consists of 4 layers, namely: mucosa, submucosa,
muscularis propria and adventisia. The esophagus does not have a serous
layer so it is a unique digestive tract. The normal mucosa consists of a flat
layered epithelium, between the propria and mucous muscularis, there is a
lymphatic flow that originates from the muscularis propria. Muskularis
propria consists of striped muscles and smooth muscles, namely in the
proximal part of the striped muscle, the middle part of the muscle is
striped and plain and in the distal part of smooth muscle.

D. Pathophysiology
Esophageal varices occurs when blood flow to the heart is blocked.
Your stream will look the other way is to veins in the esophagus, stomach
or rectal smaller and more easily broken. Not imbangnya between the
pressure of blood flow to the ability of the blood vessels resulting in
enlargement of the veins (varicose veins).
The majority of the dried blood from the esophagus through the
esophageal veins carry deoxygenated blood from the esophagus to the
azygos vein which in turn flows directly into the superior vena cava. These
veins do not have a part in the development of esophageal varices. The
remaining blood from flowing into the esophagus mucosal lining of the
esophagus surface veins, which drain into the coronary arteries (\ left
gastric vein), which in turn flows directly into the portal vein. Superficial
vein (usually only about 1mm in diameter) become distended up to 1-2 cm
in diameter in association with portal hypertension. Normal portal pressure
is approximately 9 mmHg compared to the inferior vena cava pressure of
2-6 mm Hg. This creates a normal pressure gradient of 3-7 mmHg. If the

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 portal pressure rises above 12mmHg, This gradient increased to 7-10
mmHg. A gradient greater than 5 mmHg is considered portal hypertension.
At a gradient greater than 10 mmHg.
Blood flow though the hepatic portal system of liver directed to areas
with lower venous pressure. This means that collateral circulation
develops under the esophagus, the stomach wall, stomach and rectum.
Small blood vessels in this area becomes distended, becomes thinner
walled, and appear as varicosities. In addition, the ship is poorly supported
by other structures, because they are not designed for high pressure. In
situations where increased portal pressure, such as with cirrhosis, there is
dilation of blood vessels at the anastomosis, leading to esophageal varices.
Splenic vein thrombosis is a rare condition that causes esophageal varices
without a raised portal pressure. splenectomy can cure the variceal
bleeding due to splenic vein thrombosis. Varicose veins can also form in
other areas of the body, including the stomach (gastric varices), duodenum
(duodenal varices), and rectum (anal varicose veins). Treatment may be
different types of varicose veins.

E. Complication
Compilation esofaghus primary varicose veins are bleeding. Varicose
veins are usually susceptible esofaghus rebleeding occurred, especially in
the first 48 hours. The possibility of re-bleeding was also increased in
patients with old age, liver or kidney failure and in alcohol.
Complication esofaghus varicose veins are:
1. Hypovolemic shock
Because of the resulting bleeding esophageal varices, so that the
patient will experience resulting in hypovolemic shock patients in
acute blood loss / loss of fluid.
2. Encephalopathy
Encephalopathy means the disease in anoxic encephalopathy otak,
contohnya generally refers to permanent brain damage.
3. The infection, such as pneumonia aspiration

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F. Signs And Symptoms
The signs and the symptoms of bleeding esophageal varices among
others (students working guide books STIK muhammadiyah pontianak):
1. Shock
2. Dizzy
3. Very thirsty
4. Vomiting blood
5. Tarry black stool
6. Urination becomes a bit

G. Management
Bleeding in esophageal varices should be addressed immediately,
otherwise death can occur. Things can be done to overcome the bleeding,
among others:
1. Ligation of varicose veins
Tying the blood vessels that are bloody with elastic bands. This is the
preferred treatment for bleeding esophageal varices. During this
procedure, the doctor uses an endoscope to ensnare varicose veins with
elastic bands, which basically strangles the veins. Variceal ligation
usually causes fewer serious complications than other treatments. It is
also less likely lead to recurrent bleeding.

2. Endoscopic injection therapy

Injecting veins with a particular solution so that the blood vessels to
stop bleeding. In this procedure, bleeding varicose veins are injected
with a solution that shrinks them. Bleeding is usually controlled after
one or two treatments, but complications can occur, including
perforation of the esophagus and scarring of the esophagus that can
lead to problems swallowing (dysphagia).
3. Drugs – drugs

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 A drug called octreotide (Sandostatin, Sandostatin LAR is often used
in combination with endoscopic therapy to treat bleeding from
esophageal varices, Octreotide works by reducing the pressure in the
veins. These drugs usually lasts for five days after the bleeding
episode.
4. The balloon tamponade
This procedure is sometimes used to stop severe bleeding while
waiting for a more permanent procedure. A tube is inserted through the
nose and into the stomach and then increased. The pressure on the
blood vessels can temporarily stop the bleeding.
5. Shortcuts intrahepatic portosystemic transjugularis.
Shunt In this procedure, called a transjugular intrahepatic
portosystemic shunt (TIPS), a small tube called a shunt is placed
between the portal vein and liver vein, which carries blood from the
heart back to the heart. This tube stays open with a metal stent. By
providing an artificial pathway for blood through the liver, shunt often
can control bleeding from esophageal varices. But TIPS can cause a
number of serious complications, including liver failure and
encephalopathy, which can develop when the toxins that would
normally be filtered out by the liver passed through a shunt directly
into the bloodstream. TIPS is mainly used when all other treatments
have failed or as a temporary measure in people waiting for a liver
transplant.

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H. Phatway
Attached

I. Nursing Care
1. Assessment
Assessment in patients with esophageal varices, including
assessment of history, physical examination and diagnostic
assessment. In the assessment of the history, the main complaints in
patients with esophageal varices varies according to the clinical
manifestations of loss resulting from esophageal varices that affect
organ systems. In the esophageal varices without bleeding usually still
a common complaint, but the usual get complaints abdominal
discomfort, nausea, vomiting, and anorexia or muscle cramps - the
abdominal muscles. In patients with bleeding esophageal varices, the
main complaints are common hematemesis and melena.
Health history assessment undertaken to explore peremasalahan in
patients with esophageal varices. In keshatan history obtained their
main complaint weakness, malaise, weight loss, change in urine
become jaundiced or become dark, itching - itching (usually
associated with obstruction of the gallbladder or liver cirrhosis),
edema or ascites, and impotence or sexual dysfunction.
It is important for nurses untunk past assess disease, history of liver
disease or treated with hematemeis or melena history and the history
of pengguanan drugs - drugs used unbelievable past. Nurses also
examines about their lifestyle habits of alcohol use. Family history
assessment is conducted to identify their relationship with the older
generation wilson disease (Azer, 2009). Psychosocial assessment
obtained their concerns about the conditions of disease and in some
patients should receive health pemenuhaninformasi.
On physical examination, the nurse started with an examination of
the general situation and the level of zerkesadaran, especially if there
is a history-melena massive hematemesis. TTV is an important

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 inspection checks that should be done at the time of the first
discovery. Hypotension and regular brakardia obtained. This is to
detect any signs of hypovolemic shock resulting from massive
bleeding. In chronic conditions are usually obtained patient looked
thin and weight loss.
Examination of esophageal varices is focused on:
a) Inspection
Patients usually pale (associated with extravasation of
intravascular progressive), jaundice (associated with liver
failure), cyanosis due to decreased oxygen saturation.
Increased respiratory rate and respiratory effort. Discomfort in
the abdomen, the expression of pain on light palpation of the
abdomen, edema, ascites, hematemesis, melena. Examine for
abdominal venous distension. Obtained the change of urine
becomes dark yellow (jaundice) or becomes dark and and
atrophy of the testes (Azer, 2009). On rectal examination, see
the change in color becomes darker stool indicates bleeding
above the channel gastroentestinal
b) Auscultation
Increased intestinal peristalsis
c) Percussion
Tap abdominal pain
d) Palpation
e) Hipokondrium region abdominal tenderness or below the right
and left ribs (Azer, 2009). Obtained enlarged parotid glands
(obtained in patients with alcoholism and malnutrition),
enlarged spleen (splenomegaly).
2. Nursing Diagnosis
a) Deficit fluid volume associated with acute blood loss,
b) Damage to gas exchange associated with decreased oxygen
transport capacity and factors of risk of aspiration,
c) High risk of infection associated with intravenous stream,

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 d) Fear (anxiety) / anxiety related to changes in health status,
e) Lack of knowledge about the disease process, prognosis, and
treatment needs b / d lack terpapr information.
3. Intervention
a) Monitor the volume of fluid each hour
b) Measure urine output per hour
c) Monitor S02 using oximetry or ABGs
d) Monitor breath sounds and onary symptoms
e) Use O2 supplement according to instruction
f) Monitor body temperature
g) Monitor for abdominal distension
h) Please note the behavior hint agitated example, easily aroused,
lack of eye contact, behavior against or attacking
i) Determine the patient's perception of the cause of bleeding

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 CHAPTER III
CLOSING

A. Conclusion
Esophageal varices is a disease characterized by abnormal
enlargement of the veins in the lower esophagus. Various diseases
involved in the portal vein blood flow and result in an increase in portal
vein pressure forming esophageal varices. Oesophageal varices is usually a
complication of liver cirrhosis. Cirrhosis is a disease characterized by the
formation of scar tissue in gati. Causes include hepatitis B and C or large
amounts of alcohol consumption. Esophageal varices occurs when blood
flow to the heart is blocked. Your stream will look the other way is to
veins in the esophagus, stomach or rectal smaller and more easily broken.
Compilation esofaghus primary varicose veins are bleeding. Varicose
veins are usually susceptible esofaghus rebleeding occurred, especially in
the first 48 hours.

B. Recommendation
Authors can only give a little knowledge about esophageal varices
authors hope readers can understand and apply the nursing alikasi
regarding esophageal varices.

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 BIBLIOGRAPHY

http://www.catatandokter.com/2008/02/varises-esofagus.html
Robins.2007. Textbook of Pathology, Volume 2. Jakarta: EGC.
Marilynn Doenges E, et al. 1999. Nursing care plan. Jakarta: EGC.

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