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Abstract: Mr. Zheng, 45, presented with abdominal distension and loss of appetite with no apparent cause 1 month ago. He came to the clinic after poor symptomatic treatment at the local rural health center and developed tarry stools 4-5 times/day 1 day before admission. After examination, he was diagnosed with esophagogastric fundic varices, post-hepatitis cirrhosis, chronic viral hepatitis B, and hypersplenism. After a series of treatments, the patient’s condition was controlled and no more tarry stools occurred.
Basic information】Male, 45 years old
Disease Type】Esophagogastric varices, post-hepatitis cirrhosis, chronic viral hepatitis B, hypersplenism
Hospital】The 988th Hospital of the PLA Joint Services and Security Forces
Date of Consultation】April 2022
Treatment plan】Medication (sodium esomeprazole for injection + octreotide acetate for injection) + tissue gel injection + esophageal variceal ligation
Treatment period】Hospitalization for 5 days, followed up after 1 month
Results】The disease was controlled, anemia was corrected, and no more tarry stools appeared.
I. Initial consultation
Patient Zheng had a past history of hepatitis B for more than 10 years without systematic treatment and cirrhosis for 3 years, and underwent splenectomy for upper gastrointestinal bleeding and hypersplenism in 2019. This time, due to abdominal distension and loss of appetite for 1 month, abdominal ultrasound performed at the local township health center indicated: cirrhosis, portal hypertension, ascites, abnormal liver function after splenectomy (specific values not known), symptomatic treatment was given (specific medication not known) with poor results, and 1 day ago with tarry stools, 4-5 times a day, so he came to the hospital for consultation. After arriving at the hospital, routine blood tests showed: leukocytes 4.20×10^9/L, hemoglobin 45g/L; liver function showed: glutamate transaminase 32U/L, glutamic oxalacetic transaminase 24U/L, albumin 24.5g/L, globulin 37.2g/L; gastroscopy suggested: esophageal varices, fundic varices, chronic superficial gastritis. Preliminary diagnosis: esophagogastric varices, post-hepatitis cirrhosis, chronic type B viral hepatitis, hypersplenism.
II. Treatment history
The patient had a history of cirrhosis for many years, and his condition often recurred. He was under great stress, worried about his prognosis, depressed, and had a tendency to give up on himself, so he was encouraged to improve his self-imposed closed environment by exchanging treatment experience with his patients, and try to integrate into the surrounding society as much as possible to enhance his confidence in overcoming the disease. Through consultation with the family, the patient had undergone splenectomy three years ago due to upper gastrointestinal bleeding. This time, the patient was given acid suppression treatment (sodium esomeprazole for injection) and treatment to reduce portal hypertension (octreotide acetate for injection), as well as treatment with esophageal varices ligation and gastric fundic tissue glue injection, and the patient’s vital signs were observed and oral secretions were removed in a timely manner during the treatment.
III. Treatment effect
After the treatment, the patient did not have any further gastrointestinal bleeding and his general condition was improved. The patient was instructed to take absolute bed rest for 24 hours after the operation, and after 24 hours of fasting, if there was no bleeding, he could eat a little liquid, warm and cool food, such as rice soup, pure milk, etc. If abdominal pain of different degrees occurred after the operation, the general condition was tolerable, and if necessary, the symptoms could be reduced by performing side lying and body curling. After 5 days of hospitalization, the patient’s general condition was observed to be good, and the patient also indicated that there were no other uncomfortable symptoms, so he was discharged from the hospital, and was instructed to come back for a review after 1 month.
IV. Notes
We are glad that the patient’s condition was controlled and the anemia was corrected after treatment, and no more tarry stools appeared. After discharge from the hospital, the patient was advised to pay attention to dietary management, with high-calorie, high-protein (plant-based protein is the mainstay in advanced cirrhosis), vitamin-rich food, avoiding spicy and stimulating food, rough food, slag diet, smoking and alcohol to avoid inducing bleeding. Do not strain to defecate, bend excessively, minimize coughing, vomiting, frequent eructations, etc. to avoid elevated abdominal pressure. At the same time to maintain optimism, do a good job of self-psychological adjustment, not only paralyzed, lucky, and do not be afraid, which is not conducive to the recovery of the disease. If there is any discomfort, go to the hospital in time to avoid delaying the disease.
V. Personal insight
Varicose veins of the fundus are prone to rupture and bleeding of the varicose veins, which can be life-threatening in serious cases, and improper diet is a common cause of rupture and bleeding of varicose veins. The common symptoms are abdominal distension, black stool, vomiting blood and bloody stool when bleeding is large, accompanied by dizziness, weakness, nausea and other symptoms. The patient often has a poor diet, such as overeating, eating spicy and irritating foods from time to time, and irregular rest and rest, which leads to recurrent attacks, so in future life, the diet should be changed and the diet should be fine and soft without irritation. However, the disease is also a preventable and controllable disease, so patients should be encouraged to build confidence, actively cooperate, overcome bad eating habits, improve compliance, correct understanding, actively seek medical treatment, and not give up on themselves.