What is the cause of esophageal varices?

UPRVUNL - 2021

Medical & Surgical Nursing

Easy

Appeared in: UPRVUNL - 2021

Explanation

Esophageal varices are abnormally enlarged veins in the lower part of the esophagus.
They are a direct consequence of portal hypertension, which is defined as elevated pressure in the portal venous system (the system that drains blood from the GI tract to the liver).
Portal hypertension is most commonly caused by liver cirrhosis, where scar tissue obstructs normal blood flow through the liver.
This blockage forces blood to find alternative pathways (collateral circulation) to return to the heart. The small veins of the esophagus are a key collateral pathway, and they swell under the increased pressure, forming varices.

Option A: Gastritis is the inflammation of the stomach's lining. While it can cause upper gastrointestinal bleeding, it does not involve the portal venous system and does not cause the formation of esophageal varices.
Option B: Hypotension, or low blood pressure, is a potential consequence or sign of a massive bleed from ruptured esophageal varices. It is a result of hemorrhage, not the cause of the varices themselves.
Option C: Peritonitis is the inflammation of the peritoneum, the tissue lining the inner wall of the abdomen. It is typically caused by a bacterial or fungal infection and is unrelated to the vascular changes of portal hypertension.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of Esophageal Varices as background academic context rather than a clinical decision trigger.
Recognizing that a patient with a history of chronic liver disease (e.g., cirrhosis, chronic hepatitis) is at high risk for developing esophageal varices is a critical nursing assessment.
Bleeding from esophageal varices is a life-threatening medical emergency. The nurse's priority is to rapidly assess and manage the patient's airway, breathing, and circulation (ABCs) and anticipate massive hemorrhage.
Nursing care for a patient with a variceal bleed includes establishing large-bore IV access for rapid fluid and blood product resuscitation, administering medications like octreotide to reduce portal pressure, and preparing the patient for emergency endoscopy.

How to Approach the Question

This is a factual recall question that asks for the direct cause of a specific medical condition.
First, identify the key term in the question: 'esophageal varices'. Recall or deduce its meaning: swollen veins in the esophagus.
Next, consider the underlying anatomy. The esophagus is part of the gastrointestinal tract, and its blood supply is connected to the portal system, which flows through the liver.
Evaluate each option based on this physiological context.
Gastritis (stomach inflammation), Hypotension (low blood pressure), and Peritonitis (abdominal lining inflammation) do not directly explain a pressure-related swelling of veins in the esophagus.
Consider 'Portal hypertension'. This term means high pressure in the portal vein. Logically, high pressure in this system would cause blood to back up and swell weaker, connected veins, which directly explains the formation of varices.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 617-619

E6 Medicine Davidson Principles Practice 24e p. 889-891

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) p. 121-123