2021年2月7日星期日

preparation h hemorrhoids,Why do patients with liver cirrhosis have low blood pressure?

    As a common clinical disease, cirrhosis belongs to the scope of digestive system diseases. According to the etiology, it can be divided into post-hepatitis cirrhosis, alcoholic cirrhosis and schistosomiasis cirrhosis. Among them, post-hepatitis cirrhosis is infectious. disease. Although schistosomiasis is an infectious disease, it is mainly infected by contact with infected water, fecal pollution of water sources and oncomelania snails. Therefore, compared with post-hepatitis liver cirrhosis, the probability of "human-to-human transmission" is relatively low. Regarding the specific symptoms, signs, and laboratory examination characteristics of liver cirrhosis, I believe that friends of patients will have a certain understanding by browsing professional websites. I will not repeat them here. For the clinically common low blood pressure phenomenon, try The following analysis is conducted from a professional perspective.

    I mentioned in the article "Why patients with liver cirrhosis always feel hungry" written on 6/6: Portal hypertension is one of the main pathological changes of liver cirrhosis. Then, in order to relieve portal hypertension, there will be many collateral circulation establishment and opening, such as esophageal gastric varices, inferior vena cava, hemorrhoidal varices to relieve portal hypertension, if these collateral circulation can not be effectively established, and Allow the portal pressure to increase indefinitely, and the result can only be rupture of the venous blood vessels. Therefore, the opening of the collateral circulation is actually the body's "natural" compensation mechanism!

    The liver is not only the human body's largest digestive organ, but also an important immune organ. Therefore, when the liver is diseased, the patient's immune function is often relatively poor. Although simple alcoholic liver disease and fatty liver appear to have milder symptoms than hepatitis B and C and are easier to treat, in fact, alcoholic liver disease, fatty liver combined with hepatitis B and hepatitis C are not uncommon among domestic liver disease patients. For example, alcoholic liver disease is chronic damage to liver cells caused by long-term heavy drinking. Alcohol is ethanol. Drinking moderately can dredge the meridians, while excessive drinking is harmful! The clinical judgment of whether excessive drinking is based on the alcohol content is the standard, alcohol consumption (grams) = drinking ml × alcohol degree × 0.8, exceeding 80 grams per day is called excessive alcohol, according to this standard, if you drink 50° white wine every day More than 160ml is considered "excessive drinking". If you drink in this way for a long time (for 20-30 years), even if you do not have the underlying diseases of hepatitis B, hepatitis C, or fatty liver, it can still cause cirrhosis.

    In addition to the symptoms of hyperphagia, the more common clinical symptoms, patients are often found to have low blood pressure. Hypotension in patients with liver cirrhosis is usually seen in the following two conditions: 1. There is chronic blood loss in the body, such as melena, hematemesis or hemorrhoids bleeding, resulting in insufficient effective blood volume and hypotension; 2. Patients with liver cirrhosis with large amounts of ascites, due to Excessive accumulation of interstitial fluid in the abdominal cavity (Note: One of the causes of ascites is the dilation of the surrounding arteries), which leads to a decrease in the effective circulating blood volume, resulting in the inability to form effective pressure on the arteries when the blood flows, so it will appear as low blood pressure .

    In addition to low blood pressure caused by pathophysiological mechanisms, patients also need to pay attention to the following conditions:

    1. Due to poor liver function, the patient feels that he needs more bed rest. In the resting state, the arterial blood flow slows down, the heart rate slows down, and the cardiac output (that is, the amount of blood ejected from one ventricle per minute) decreases. As a result, the blood cannot form a kind of "pressure" on the blood vessels when the blood flows, so the blood pressure will be low. This situation is called "Orthostatic hypotension" in "Diagnosis".

    2. In liver cirrhosis, due to portal hypertension, pathological changes of esophageal and gastric varices often occur. Through gastrointestinal X-ray barium meal examination, the gastric mucosa sometimes shows "worm-eaten" changes. The explanation in the words of a professional doctor is: The gastric mucosa becomes "tofu" due to ischemia and hypoxia. If you eat a little carelessly, you may scratch the mucosa and induce gastrointestinal bleeding (including hematemesis, blood in the stool, occult blood in the stool, etc.), which can lead to blood pressure Low. For hematemesis and hematochezia, both patients and doctors can make timely judgments and treatments. However, if the stool occult blood test is positive (the daily bleeding volume is less than 5ml, and there is no visible bleeding), the patient and non-specialist It may be overlooked that if fecal occult blood persists, it will cause chronic blood loss in the body, which will also lead to low blood pressure.

    3. A large number of patients with ascites due to high intra-abdominal pressure, resulting in obstruction of lymphatic drainage, insufficient effective circulating blood volume in arteriovenous blood vessels, due to the reduction of effective circulating blood volume, a certain pressure cannot be formed on the blood vessel wall, so blood pressure will also Low. It is common in clinical practice that patients with large amounts of ascites, poor renal function, and ineffective diuretics have sudden hypotensive shock without inducement. This is mostly the cause.

    4. In the advanced stage of liver cirrhosis, due to poor liver function, the liver's ability to clear norepinephrine is reduced, and sympathetic nerve excitement will lead to faster heart contraction, but it cannot effectively release and return the blood stored in the ventricle. It flows into the arteriovenous blood vessels. Because the arterial vessels cannot receive the pressure caused by the rapid return of blood, the blood pressure will be low. Clinically, it is also common for people with a large amount of ascites because the diaphragm raises the pressure on the heart, and the "ineffective contraction" of the myocardium is caused by the reflex of the nervous system, which is unable to eject sufficient blood and participate in the blood circulation, thus leading to lower arterial blood pressure.

    Summary: Liver cirrhosis is a serious chronic liver disease caused by a variety of causes. Although the lesion is mainly in the liver, its pathological mechanism can simultaneously affect the normal function of multiple organs (such as gastrointestinal, kidney, etc.), which can lead to hormone metabolism ( For example, the renin angiotensin aldosterone system is abnormal, and because of the combined effects of factors such as long-term bed rest and hyponatremia, hypotension often occurs. Therefore, blood pressure monitoring for patients should also be highly valued by patients and doctors as well as liver function. For medical staff: daily blood pressure monitoring for patients is not only for patients with a history of hypertension, but does not pay attention or even gives up Blood pressure monitoring can often lead to fatal outcomes!

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