Causes Gastrointestinal Bleeding in Cirrhotic Liver Disease?
In 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
following is a general list:
1. Rupture of varices in the esophagus and stomach -
When this happens, the level of bleeding can be quite severe and ensue in
large quantities. The physical sign that often occurs is a sudden vomiting
of blood and stools becomes a shiny black color. The patient may
experience hypotensive shock and hepatic encephalopathy. Without immediate
medical attention, the condition can turn fatal. Some preventive measures
for a patient with varices are to eat soft foods, eat slowly, and chew
very thoroughly before swallowing.
In addition, avoid excessive coughing, sudden increases of pressure in the
stomach, and keep regular bowel movements.
2. Refluxing esophagitis -
The sphincters in the lower end of the esophagus can become loose during
ascitic cirrhotic disease. As a result, refluxing esophagitis is a common
complication of cirrhotic liver disease and inflammation of the esophagus
can trigger varices bleeding. To prevent this condition, ascites and acid
reflux must be actively treated.
3. Acute stomach membrane lesion (AGML) -
AGML is an acute erosive inflammation of the stomach membrane and
cirrhotic liver disease can often cause this condition. When there is
hypertension in the portal vein, there are excessive H+ ions that diffuse
to the lower end of esophagus that can cause rupture of the varices. It is
very important to actively treat AGML to prevent the possibility of
4. Peptic ulceration -
Portal hypertension changes the microcirculation and dynamics of blood
circulation in the stomach membrane. These changes cause blood stagnancy
in the stomach membrane as the inflow of blood from the arteries become
greater than the outflow through veins in the stomach membrane. This
stagnancy of blood can cause thrombosis, swelling, and ischemia. Stomach
acids and infectious agents can then attack and erode the membrane,
causing ulceration and bleeding.
5. Reduction in
blood coagulation factors -
functions can interfere with the synthesis of blood coagulation factors.
As a result, blood coagulation factors such as factor VII and VIII will
drop in number and prolong the PT and PTT. An enlarged spleen
causes a decrease in platelet count and even minor bleeds can lead to
severe bleeding, as the coagulation mechanism cannot function properly.
bleeding is a serious condition, the patient should be rushed to the
nearest hospital for emergency care.
For preventative care, we use Yunan Paiyao Capsule for general gum and
nose bleeds. For bleeds in the esophagus and stomach, we use Rhubarba (Rhei
Rhizoma) and Bletilla (Bletillae Rhzoma).