Cirrhosis is a familiar and unfamiliar disease, familiar because we all know that it is a progressive and irreversible disease evolving from long-term chronic lesions of various types of hepatitis, but unfamiliar because many people, including some medical workers, patients and their families, do not really understand and grasp the knowledge about the treatment, complications and some serious consequences of cirrhosis.
Cirrhosis is often classified by the compensated and decompensated stages, and liver coma, upper gastrointestinal bleeding and liver cancer often occur in the decompensated stage of cirrhosis. Usually, patients and their families will give the treatment of cirrhosis to professional medical institutions, but we should know that cirrhosis does not only occur in hospital beds, but most of the prevention, care and general treatment of complications related to cirrhosis should be done at home, and these home-based treatments are based on the patient’s compliance and professionalism to determine how effective the treatment is. If a problem occurs, the patient may not seek medical attention in time, and the consequences are often unacceptable. Liver cancer is a chronic growth process that requires regular checkups, while liver coma and upper gastrointestinal bleeding are acute complications that often catch patients’ families off guard and can be life-threatening if not handled properly.
If the acute complications of cirrhosis can be detected in time and handled correctly and appropriately before the hospital, it is likely to reduce the damage or save lives! Today we will explain the home treatment process of upper gastrointestinal bleeding after cirrhosis, although not perfect, but at least repeatedly smooth the thinking to avoid confusion when it happens!
Upper gastrointestinal bleeding after cirrhosis generally refers to the increased pressure of portal blood flow into the liver after cirrhosis, and then the opening of the portal vein collateral circulation, resulting in heavy varices in the esophagus and gastric fundus, which cause the varices to rupture and bleed under the action of external factors such as continuous increase in pressure and feeding. The bleeding volume can be more than 1000 ml in a few minutes in massive cases, and the death rate can be about 10%.
First, how can we know that bleeding may be about to occur or has already occurred?
1.Medical signal: Gastroscopy suggesting severe varices of esophageal or fundic veins is a medical signal indicating the possibility of upper gastrointestinal bleeding in the near future, especially if the severe varices are accompanied by “red signs”, which suggests that we may have gastrointestinal bleeding in the last few days or weeks.
2.Signal symptoms: In addition to gastroscopy, the upper gastrointestinal bleeding caused by cirrhosis is not without other signs to follow. Many patients have further aggravation of cirrhosis before bleeding occurs, some of the original symptoms can be further aggravated, such as weakness, abdominal distension, anorexia, etc. have become more obvious; the face is gray or even yellowish, some patients will also have panic, shortness of breath, sweating, thirst, etc.; especially when eating heartburn, stomach heat, choking sensation when swallowing food, etc.; there are some signals should also be noted, such as Recently, the amount of gum bleeding increases when brushing teeth, coughing with blood in the sputum, a small amount of blood clots in the first mouthful of sputum after waking up in the morning, etc. These are all signs that upper gastrointestinal bleeding may occur in the near future.
3, bleeding signal: vomiting blood or black stool is evidence of the presence of upper gastrointestinal bleeding, but not all upper gastrointestinal bleeding will occur vomiting blood, this mainly determines the speed and amount of bleeding. High and rapid bleeding usually occurs with vomiting of blood, which can be bright red or coffee-colored because the blood mixes with gastric acid in the stomach to turn the blood coffee-colored. When the blood enters the intestine from the stomach, it is digested and decomposed in the intestine, and is usually excreted in a “tar-like” stool.
Second, there is clear bleeding, what should we do at home?
1, once the bleeding is clear should immediately call the 120 emergency number, while calling around relatives to help. It is not recommended to use private cars or non-ambulance special vehicles to escort patients, and the following rescue is feasible while waiting for help.
2.No vomiting of blood, only clear black stool, prohibited to get out of bed activities.
3.If vomiting of blood occurs, do not move the patient indiscriminately first, keep the patient in an elevated position with the upper body and lower limbs, while keeping the head to the side to avoid asphyxiation due to vomitus entering the airway, elevate the upper body at about 30° to 45° and the lower limbs at about 15° to 25° to ensure blood supply to vital organs.
4.Ice water or ice saline containing hemagglutinase can be given orally, it is not easy to take it too fast during the process, it is appropriate to take it slowly in small mouths, it can be repeated several times, and the dose of hemagglutinase can also be increased.
5.Give sublingual nitroglycerin or quick-acting heart pills, etc.
6.Ask the doctor of the nearest clinic to assist in opening intravenous access, and give oxytetracycline, omeprazole and dobutamine etc. to be administered quietly. This will help control bleeding, maintain blood volume and facilitate further treatment.
7.Prepare items related to hospitalization, such as ID card, medical insurance card, agricultural cooperative card, bank card and previous medical records or recent examination results.
8.Contact with the doctor in charge of the previous specialist hospital to prepare for emergency treatment.
Thirdly, what should we do if bleeding occurs frequently?
1, must strictly control the diet, to semi-liquid, easy to digest, light diet, do not eat peanuts, dried fruit, animal offal and raw food, etc..
2, discuss with the doctor for further treatment options, usually gastroscopic esophageal vein ligation, tissue glue injection, interventional vascular embolization, splenic embolization, intrahepatic portal vein stent shunt via jugular vein, flow disconnection surgery, liver transplantation, etc.
3. Gastroscopy is reviewed every six months or so.
In short, the upper gastrointestinal bleeding after cirrhosis is a dangerous condition, do not take the initiative to avoid delaying treatment, upper gastrointestinal bleeding from improving the quality of survival of patients in terms of prevention of upper gastrointestinal bleeding is more important than treatment, in the near future it is clear that the possibility of upper gastrointestinal bleeding to take effective treatment to effectively prevent the occurrence of upper gastrointestinal bleeding in cirrhosis.