Treatment of gastrointestinal bleeding associated with Cirrhosis

Cirrhosis with esophageal and gastric bleeding occurred in middle-aged men, the majority of patients with chronic liver diseases, jaundice, schistosomiasis or history of chronic alcoholism. Incidence ago, the majority of patients with no obvious sign of discomfort or, in some patients with abdominal bleeding before back between the flu. The disease induced bleeding volume of more sustained bright red, Chung spit out, in some cases projectile was bleeding. In case of bleeding, and the family should immediately be taken to the hospital with first-aid measures to stare at the same time to bolster recumbent patients, cut-hot dishes and other protein food. Upper gastrointestinal bleeding where principles are : supportive therapy, infusion, blood transfusion to prevent and correct shock, bleeding drug use accordingly. Blood transfusion in the rescue process, the most important use of coagulation factor with rich new blood. The rescue is another important measure hemostasis. Methods include drug bleeding, mechanical pressure (3-Blakemore tube oppression) bleeding, blood clots endoscopic hemostasis and surgical hemostasis. ① drug hemostasis : cirrhosis with portal hypertension caused esophagus and stomach bleeding, to lower portal pressure, propranolol can be oral or intravenous infusion of vasopressin, 8 peptide vasopressin and somatostatin. While the use of hemostatic agents such as vitamin K, adrenochromazone, 6-amino-acid, anti-fibrinolytic blood and acid-fang Baiji powder Luohuazizhu grasslands. ② mechanical hemostasis : Major for three-Blakemore tube oppression bleeding. If the use of these drugs still hemostatic effect, but not immediately surgical treatment should immediately adopt the law. If the balloon placed at appropriate, to meet the hemostatic effect. Applications, inflatable something more general charge 200-400 ml; Esophageal capsule inflatable relatively small (80 ml), because esophageal varices more from gastric vein, as long as the gastric vein oppressed live, can only hemorrhage. If the bleeding is still unable to effectively stop, should continue to increase esophageal capsule inflatable volume. It was also advocated by gavage injected saline increases norepinephrine 8 mg to gastric vascular contraction, so right after the balloon oppression continue to have an effect bleeding. To avoid pressure mucosal injury, should be oppressed 12 hour Gassing 1-2 hours. Oppression hemostatic measures are generally not more than three days, three days later there is still bleeding should consider taking other measures. ③ endoscopic hemostasis : conservative medical treatment for patients who have failed to use endoscopic sclerotherapy hemostasis. Acute hemorrhage bleeding rate of 95%, for the bleeding site of vascular embolization of bleeding, such as bleeding site is not easy to judge, the endoscopic hemostasis spray thrombin. ④ surgical treatment : Application of this method is the treatment of heavy bleeding or repeated bleeding, surgical treatment should be considered, methods : gastric and ligation of esophageal varices; The cross-section of stomach, another stomach-anastomosis; If the patient whole situation is stable, can be considered for portal venous anastomosis or splenorenal shunt surgery.