A client with liver cirrhosis is at risk of developing esophageal varices. Which medication should the nurse expect to be prescribed to reduce the risk of bleeding from these varices?
A.
Lactulose
B.
Omeprazole
C.
Furosemide
D.
Propranolol
The Correct Answer and Explanation is:
Correct Answer: D. Propranolol
Explanation:
A client with liver cirrhosis is at significant risk of developing esophageal varices, which are enlarged veins in the lower part of the esophagus. These varices form due to increased pressure in the portal venous system, a condition known as portal hypertension, which is a common complication of cirrhosis. The increased pressure forces blood to find alternative pathways, resulting in dilated veins that are prone to rupture and cause life-threatening bleeding.
Propranolol, a non-selective beta-blocker, is often prescribed to reduce the risk of bleeding from esophageal varices. It works by decreasing the heart rate and reducing the force of contraction, which in turn lowers the blood pressure within the portal vein (portal pressure). By reducing portal hypertension, propranolol effectively decreases the likelihood of variceal bleeding.
The management of esophageal varices involves both primary and secondary prophylaxis. Primary prophylaxis aims to prevent the first bleeding episode in clients with diagnosed varices, while secondary prophylaxis is used to prevent recurrent bleeding in clients who have already experienced a variceal bleed. Propranolol is a key medication in both settings.
Lactulose (Option A) is primarily used to manage hepatic encephalopathy, a complication of liver cirrhosis, by reducing the absorption of ammonia in the gut. However, it does not directly affect portal hypertension or the risk of variceal bleeding.
Omeprazole (Option B) is a proton pump inhibitor that reduces stomach acid production and is used to treat gastroesophageal reflux disease (GERD) and peptic ulcers. It does not impact portal hypertension or esophageal varices.
Furosemide (Option C) is a diuretic used to manage fluid retention in conditions like cirrhosis-related ascites, but it does not reduce portal hypertension or protect against variceal bleeding.
In conclusion, propranolol is the medication of choice for reducing the risk of bleeding from esophageal varices in clients with liver cirrhosis due to its ability to lower portal pressure and prevent variceal rupture.