Annotations for Esophageal Varices Research Paper.
Atassi, K. A. (2002). Bleeding esophageal varices. Nursing, 32(4), 96. Retrieved from Ovid.
In this journal article of one page, Kathrine Atassi concisely explains a scenario where an adult male patient presents with complications from esophageal varices and how he will get treated. Since the entire article is written in a story-like format from starting with the signs and symptoms to ending with treatments, it is easy to follow the important aspects of esophageal varices and remember them.
The signs and symptoms this patient presented were vomitting large amount of bright red blood, low blood pressure, low hgb of 8.2gm/dl, tachycardia, cachexia, pale oral mucus membrane and history of alcohol abuse. 500ml bolus of NaCL 0.9% admistered to maintain blood pressure, and oxygen titrated to maintain SpO2 at 94%. The differential diagnosis rules out stomach ulcer since he has no abdominal pain, diarhea or rectal bleeding. This information helps nurse what signs to recognize for esophageal varices, so I would use this article the most.
Atassi also explains how alcohol abuse leads to portal hypertension creating obstruction of hepatic circulation eventually causing rupture of esophageal blood vessels. Endoscopy was done to reach the diagnosis, and sclerotherapy to prevent prevent further bleeding. Ranitidine (Zantac), Vitamin K and Librium given to decrease stomach acidity, bleeding and alcohol withdrawl symtoms, respectively. Later spironolactone and fursomide (Lasix) given to remove excess fluid. Therefore, this article is most helpful to me as it is not only easy to understand, but also helps remember some basic but very important points about patient who has esophageal varices.
Smith, M. M. (2010). Emergency: variceal hemorrhage from esophageal varices associated with alcoholic liver disease. American Journal of Nursing, 110(2), 32-39. Retrieved from Ovid.
This article also explains esophageal varices on a case-based scenario, but describes specifically how alcoholic cirhosis is present in half of all the patients with this disease. Smith uses over 28 reputable scholarly articles. At the end, Smith highlights a study done to investigate the relationship between gender, alcohol intake level and relative risk for liver disease. Although, it found that women had significantly higher risk of developing liver disease but doesn’t explain why, other than a theory that women generally has lower volume of body water than men and therefore a given number same alcohol level by both genders will make female counterpart’s blood alcohol level higher. Another theory was estrogen increases gut permeability and portal endotoxin level resulting in greater injury to the liver. However, Smith doesn’t add talk about any studies that was done to investigate why women has higher risk of liver injury from alcohol at any consumption level.
Uribe, L., & Schub, T. (2011). Esophageal Varices. CINAHL Nursing Guide, Retrieved from EBSCOhost.
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This article is written by two authors, edited by an editor, peer reviewed by two different entities and referenced to 6 reputable sources. Therefore, it is a well researched article. This article is different that other articles since it is written in a quick lesson format with everything from etiology, facts and figures, risk factors, clinical presentation, assessment, treatment goals, food for thoughts, red flags to watch out for, and things to tell the patient and family members. All these lessons are presented in either an outline or a short paragraph to guide the readers step by step. Therefore, it is useful for me as it is short but yet has most important information and some pertaining facts about esophageal varices that a nurse need to know along with the emphasis on patient teachings. All the information presented in this article are unto date as it was revised on Feb 25, 2011. Compare to the other sources, this article didn’t include research studies as it was strictly written as a guide.