What 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 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 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 bleeding.

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 -
Damaged liver 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.

Since 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).