Hematemesis with cirrhosis of the liver, though?

Bleeding caused by cirrhosis of the liver is extremely dangerous, in cirrhotic patients, 60% of patients will be bleeding bleeding, so patients with liver cirrhosis positive understanding of their knowledge, their prevention and treatment has a significant role.

According to statistics, in cirrhotic patients, about 2 / 3 of people may experience hematemesis or melena, which we call upper gastrointestinal bleeding, which mainly due to cirrhosis of the liver leading to esophageal variceal bleeding, accounting for all gastrointestinal bleeding 60% to 75%.

Why will cause bleeding

The process of development of cirrhosis, organizational structure, alteration, makes the liver blood circulation disorder, portal vein pressure was significantly increased, from the gastrointestinal tract, spleen and other organs in the portal vein at the venous obstruction was forced to find another way out, and the circulation of the built up a wealth of “extra traffic” in order to return to the heart. Clinically, the formation of a few of the more important traffic branch, of which the bottom of the esophagus and stomach, the formation of varicose veins of the most important and also most likely to rupture. Rough diet, eat too much, agitation, constipation, etc. are often the reason for induced bleeding.

In case of patients variceal bleeding often occur vomiting blood, can be a big mouth spit blood, often mixed with blood clots, suggesting that large amount of bleeding, bleeding speed; like coffee grounds can also vomit or black with red blood. Some patients Although there is no vomiting blood, but basically they have a black, tarry stools can be as black and sticky; also be increased with the number of times, showing dark red bloody, often prompts a larger amount of bleeding, when patients often appear dizziness , vertigo, palpitation, nausea, and even fainted; accompanied by pale, cold extremities, cold sweat dripping and other performance.

If the shock symptoms, even if it has not yet appeared vomiting blood and black, should also be suspected to have gastrointestinal bleeding, particularly the elderly, or that there are constipation patients.

Hematemesis how to do

The event of hematemesis, the patient should be supine to the pillow, head to one side, vomit blood spit as far as possible clean, do not swallow, to keep the airway clear, to avoid choking the blood and vomit into the trachea caused by suffocation of patients.

At the same time to remain calm patients and their families is also very important. Variceal bleeding due to portal vein blood flow increased, the pressure rise caused by a certain amount of bleeding after the intravenous pressure has eased, bleeding slowed down, bleeding decreased, many patients stop bleeding on their own.

Remember that just because a patient says, thirst, stomach discomfort while the patient drink water or eat anything. Family members to do is call and emergency contact as soon as possible, as soon as possible evacuated to a nearby hospital for emergency treatment conditions.

If you are in hospital, while giving a positive rescue

1, all-the-job staff put down the live, active part in the rescue of patients to the ranks, so that busy but orderly, acute but not chaos, such as the individual on duty may be requested.

2, the patient admitted to hospital emergency rooms immediately after placement to avoid unnecessary movement and physical examination, absolute bed rest, head to one side to maintain airway patency, immediately oxygen, the establishment of 1-3 road access quickly added that blood volume, cut-off food, keep quiet. Should be given to stop bleeding was prescribed drugs, blood products or whole blood.

3, to enhance emotional care, will urge the spirit of relaxation, eliminating fear, anxiety and emotional tension and actively cooperate with the treatment.

4, close observation of vital signs, looking, urine output, pay attention to whether the skin pale, cold sweat and so on.

5, observe the color of vomit and faeces and the nature of the amount of accurate recording of access.

6, observed urine, continuous 2h urine output <30ml / h, to report physicians.

7, to keep room clean, fresh air pollution products vomit should be dealt with immediately so as to avoid a bloody evoked re-bleeding.

8, not hot pack, hot ironing, moxibustion, prevent blood heat Wang Xing.

9, good oral care and clean mouth two times, hematemesis, after timely and saline mouthwash to maintain oral hygiene and tasteless.

10, absolute bed rest, and then 2-4 times stand up once, massage pressure parts of the skin.

11, to help patients living expenses and avoid unnecessary visits to reduce the surrounding interference.

12, was prescribed intravenous high nutrition.

13,24 h is not reduced by the amount of bleeding, report physicians to enhance treatment measures, if required, surgery should be transferred to surgery.

How to prevent rebleeding

After active treatment in patients with bleeding after the cessation of failure to take preventive measures, most patients will be re-bleeding. Generally through the following measures to prevent variceal rebleeding:

Oral drug is to prevent re-bleeding of a simple method. Present more effective is the β-adrenergic receptor blockers, such as propranolol, nadolol, are used for the prevention of initial and re-bleeding of patients. The use of propranolol should start small dose and gradually increase the amount of the heart rate or pulse (Morning wake up) down to no medication prior to 75%. If the original heart rate 80 beats / min, dose added to the heart rate dropped to 60 beats / min or so, at this time for the patient required dose propranolol dose, the need for life to take, not arbitrary withdrawal.

Overall efficacy of drugs to prevent further bleeding is not ideal, only 20% ~ 25% of the patients effectively. Endoscopic treatment has recently developed rapidly, according to the patient specific choice of endoscopic therapy, such as esophageal varicose vein ligation.

A number of repeated bleeding of liver function better, but those who choose the right time to consider surgery. While a number of critically ill or lose the chance of operation with advanced cirrhosis of the liver repeated variceal bleeding, can be involved in ways to guide catheter placed through the jugular vein support tube between the hepatic vein and portal vein bridge, this method less traumatic, safer, lower gate pulse pressure more significantly, generally within 24 hours to control bleeding, but the long-term efficacy is not clear.

The above-mentioned measures to prevent further bleeding, do not fundamentally solve the problem of portal hypertension. Therefore, the patient’s self-care becomes particularly important. Should pay attention to eating light and cut out rough, hot and sour to stimulate food; to maintain the smooth bowel movement, if necessary, supplemented by Runchang laxative drugs; avoid breath holding and lifting heavy loads, can only do some minor moderate outdoor activities or physical exercise, do not doing sit-ups, etc. in any of the campaigns leading to increased abdominal pressure.

This entry was posted on Friday, February 26th, 2010 at 9:09 pm and is filed under Cirrhosis. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.