How terrible is vomiting blood and black stool?
As a patient with liver disease, most people vomit blood caused by rupture of esophagogastric fundic varices, and this kind of bleeding is usually very urgent and violent, often up to 500-1000ml, basically “every vomit will be shock”, only the degree of severity, but all life-threatening, aggravating liver damage, mortality is very high. All of them cause heavy psychological and financial burden; repeated bleeding reduces the quality of life and survival time.
What kind of patients should have surgery?
In most cases, patients with cirrhosis should undergo medical treatment, effectively administering liver protection, antiviral, portal pressure lowering, immune enhancement, and Chinese herbal medicine. In the event of variceal rupture and bleeding, prompt treatment by endoscopic hemostasis should be effective. However, when the disease has progressed to a more advanced stage, especially when splenomegaly, marked hypersplenism (marked decrease in white blood cells and platelets, anemia) and severe varices of the esophagogastric fundus are seen by gastroscopy, regardless of the history of vomiting blood, it is time for surgical treatment.
What surgery should be done?
There are many surgical options, but there is a consensus in China that the basic approach is “flow dissection”, splenectomy with peripancreatic vascular dissection. The two main problems are (1) recurrent vomiting of blood in the stool and (2) hypersplenism, low platelets and white blood cells, and easy bleeding.
What are the benefits of surgery?
Although there are some risks associated with surgical treatment, timely surgical treatment may provide additional benefits to the patient by.
(1) Significant reduction in the likelihood of rebleeding, prolonged survival time, and improved quality of life.
(2) Stabilization and improvement of liver function, which facilitates the prevention and treatment of ascites.
(3) Laying the foundation and creating conditions for internal medicine treatment. Reduce abdominal distension, loss of appetite, etc., and improve nutrition.
(4) Simultaneous splenectomy to elevate platelets, white blood cells, and red blood cells: improve frequent nosebleeds, gum bleeding, etc.; correct anemia and prevent long-term anemia from damaging the function of the heart, lungs, brain, and other organs.
(5) Improve immunity, facilitate long-term liver protection, anti-virus, immunotherapy, and reduce the chance of liver cancer.
(6) In some patients, the spleen will reach the lower edge of the rib cage, or even the umbilicus or pelvis, etc. Due to the weakness of the abdominal wall, it is easy to cause spleen rupture and endanger life when trauma is sustained.
When to operate?
1.Severe esophagogastric fundic varices (gastroscopy suggests positive RC sign, the veins are tumor-like, bead-like and other changes), severe splenomegaly or severe hypersplenism, but there is no bleeding from ruptured esophagogastric fundic varices yet.
2, ever vomiting blood (upper gastrointestinal bleeding due to ruptured esophagogastric fundic varices shown by gastroscopy)
3, ever black stool (gastroscopy shows clear upper gastrointestinal bleeding caused by ruptured esophagogastric fundic varices)
4.No thrombosis in the portal vein; cirrhotic patients who have been sick for a long time are prone to portal vein thrombosis.
The danger of missing the time of surgery
Missing the best time for surgery, repeated vomiting of blood and black stool makes liver function seriously impaired, ascites in large amounts, reduced efficacy, increased anemia, decreased resistance, serious loss of quality of life, greater psychological and economic burden on individuals and families, reoperation to bear greater surgical risks, and even the timing of surgical treatment will be lost. Endoscopic hemostasis can be done, but it cannot solve splenomegaly and hypersplenism! Especially great limitations.