In the advanced stage of cirrhotic liver disease, upper gastrointestinal bleeding is the most serious and life threatening complication and must be treated immediately. For those patients already found to have varices in the esophagus and stomach, prevention of bleeding is very important. In order to prevent this serious complication, we must know what the major causes are
The following is a general list:
1. Rupture of varices in the esophagus and stomach -
When this happens, the level of bleeding can be quite severeand ensue in large quantities. The physical sign that often occurs is a suddenvomiting of blood and stools becomes a shiny black color. The patient mayexperience hypotensive shock and hepatic encephalopathy. Without immediatemedical attention, the condition can turn fatal. Some preventive measures for apatient with varices are to eat soft foods, eat slowly, and chew verythoroughly before swallowing.
In addition, avoid excessive coughing, sudden increases ofpressure in the stomach, and keep regular bowel movements.
2. Refluxing esophagitis -
The sphincters in the lower end of the esophagus can becomeloose during ascitic cirrhotic disease. As a result, refluxing esophagitis is acommon complication of cirrhotic liver disease and inflammation of theesophagus can trigger varices bleeding. To prevent this condition, ascites andacid reflux must be actively treated.
3. Acute stomach membrane lesion (AGML) -
AGML is an acute erosive inflammation of the stomachmembrane and cirrhotic liver disease can often cause this condition. When thereis hypertension in the portal vein, there are excessive H+ ions that diffuse tothe lower end of esophagus that can cause rupture of the varices. It is very importantto actively treat AGML to prevent the possibility of bleeding.
4. Peptic ulceration -
Portal hypertension changes the microcirculation anddynamics of blood circulation in the stomach membrane. These changes causeblood stagnancy in the stomach membrane as the inflow of blood from thearteries become greater than the outflow through veins in the stomach membrane.This stagnancy of blood can cause thrombosis, swelling, and ischemia. Stomachacids and infectious agents can then attack and erode the membrane, causingulceration and bleeding.
5. Reduction in blood coagulation factors -
Damaged liver functions can interfere with the synthesis ofblood coagulation factors. As a result, blood coagulation factors such asfactor VII and VIII will drop in number and prolong the PT and PTT. An enlargedspleen causes a decrease in platelet count and even minor bleeds can lead tosevere bleeding, as the coagulation mechanism cannot function properly.
Since bleeding is a serious condition, the patient should berushed to the nearest hospital for emergency care.
For preventative care, we use Yunan Paiyao Capsule forgeneral gum and nose bleeds. For bleeds in the esophagus and stomach, we useRhubarba (Rhei Rhizoma) and Bletilla (Bletillae Rhzoma).
