2021年1月22日星期五

hemorrhoids cancer,Infectious disease knowledge answer sequence 5 (manifestation and prevention of hemorrhage in liver cirrhosis)

    9. What are the manifestations of patients with liver cirrhosis and gastrointestinal bleeding?

    Gastrointestinal bleeding in patients with liver cirrhosis often manifests as:

    (1) The bleeding site from top to bottom is as follows: rupture of esophagus and gastric fundus vein bleeding, gastric mucosal spot-like bleeding caused by gastric mucosal erosion, duodenal ulcer bleeding and internal hemorrhoid bleeding.

    (2) Forms of bleeding: Except for internal hemorrhoid blood, which is manifested as a large amount of blood after defecation, the rest are all upper gastrointestinal bleeding; and can be manifested as hematemesis or hematemesis plus melena or melena.

    (3) Causes of bleeding: some have no obvious incentives, some are due to eating rough foods or due to mood swings, anger, etc.

    (4) Pre-bleeding symptoms: When there is bleeding but still has not vomited, it may manifest as chest tightness, heart palpitations, sweating, followed by nausea and vomiting, from coffee-like vomit to fresh blood or direct vomiting of fresh blood; finally tar-like black discharge Poop.

    (5) Bleeding volume: There is a big difference in the amount of bleeding. The severely damaged patients can vomit blood from 1,000 to 2000 mL at a time, or continuously vomit blood; the bleeding volume is small without vomiting blood, mainly melena and tarry stools.

    (6) Post-bleeding manifestations: The manifestations vary according to the amount of bleeding. Those with a large amount of bleeding will immediately show signs of shock such as pale complexion, decreased blood pressure, pulse speed, cold limbs, and disturbance of consciousness. It may be life-threatening if not rescued in time.

    10. How to prevent massive upper gastrointestinal bleeding caused by cirrhosis?

    The prevention of massive upper gastrointestinal bleeding starts from two aspects: (1) Various methods including surgery to reduce portal pressure, or inject sclerosing agent into varicose veins to block the lumen. Surgery can use portal-systemic venous shunt, so that the portal vein blood flow directly into the human veins, thereby reducing the pressure on the portal system and reducing the blood flow of the collateral circulation. Intravenous injection of sclerosing agent is also a common method in recent years. Commonly used hardeners are: sodium morrhuate, ethanolamine oil vinegar salt, sodium tetradecanoate, and ethoxylated hardener. After the sclerosing agent is injected into the varicose vein, the endothelium of the blood vessel falls off, thrombosis is formed, and the blood vessel is blocked, and then it hardens to form a permanent blockage. (2) Reduce and prevent various causes that can cause the portal vein pressure to suddenly increase or cause varicose veins to rupture. When the blood transfusion, the transfusion is too much or too fast, the portal pressure can increase and cause varicose veins to rupture and bleeding. When coughing and vomiting, the intra-abdominal pressure can suddenly rise, and the blood rushes into the varicose veins to make it suddenly expand and rupture. In chronic gastritis and reflux esophagitis, gastric acid reflux can cause erosion of the esophagus and gastric mucosa, corrosion of varicose veins and bleeding. Eating coarse food can also puncture the varicose veins in the esophagus or stomach and cause bleeding. Therefore, to prevent bleeding, it is necessary to avoid the occurrence of the above reasons. Such as active treatment of upper respiratory tract infection, avoid severe cough, treat gastritis and esophagitis, and avoid vomiting. The diet should be thin and soft, avoid dry hard foods, etc. Bleeding caused by hemorrhoidal veins is rare. Keeping the stool smooth can reduce hemorrhoidal vein bleeding.

    Sometimes upper gastrointestinal bleeding is manifested as a small amount of bleeding, which is mainly discharged from the feces, so it is not easy to be found. Therefore, patients with liver cirrhosis should pay attention to the color change of stool. If there is black stool or tarry stool, the possibility of upper gastrointestinal bleeding should be considered. Strong fecal occult blood is helpful for diagnosis. Finding a small amount of bleeding in time, and immediately giving hemostatic treatment to help prevent heavy bleeding.

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