Upper GI Bleed – Blood Vomitus or Black Stools

 



Upper GI Bleed – Blood Vomitus or Black Stools

Cirrhosis is diffuse permanent damage to the liver. Once somebody develops cirrhosis, they are likely to face some or the other complications in upcoming 3-5 years. It is good to keep oneself aware about possible complications. One of the complications is gastrointestinal bleeding.

Hematemesis means vomiting of blood. Whenever a person has blood in his vomit, we call it as hematemesis. It is major and life-threatening complication of cirrhosis of the liver.

Reason for Blood in Vomit in cirrhosis

  1. Esophageal Varices
  2. Gastric Varices

Under normal circumstances, the blood that flows from spleen and the intestines enters a vessel known as portal vein and it in turn enters the liver for filtration. The blood from the liver enters the hepatic veins and from where it enters the heart and goes into the systemic circulation. However, when there is cirrhosis of the liver, this liver does not allow the blood to pass smoothly and it provides a resistance to the blood flow because of, which the pressure in the portal vein increases. The blood must reach the heart by an alternative route. In this circumstance as a result, few vessels around your food pipe, what we call as oesophagus, carries the blood from the portal vein into the heart. Now, the calibre of this vessel is quite small as compared to the portal vein.So, the blood, which is supposed to. pass from a large vessel when it passes through a small vessel, the pressure increases significantly. As a result, this starts bulging into the food pipe. Now, whenever somebody has fever and the pressure increases suddenly, or somebody takes a painkiller or a corrosive agent or sometimes even without any intake of any substance, just spontaneously, the pressure increases and because of which there is a rupture of this vessel into the food pipe. The patients vomit this blood out. It is a life-threatening condition. Unless it is urgently treated a patient may lose his life.

Clinical presentation

  1. Hematemesis

  1. Malena

Not always does the blood enters, the food pipe and is brought out through the mouth. Sometimes a lot of blood enters the stomach, which passes through the intestine and with contact with the acid from the stomach. This blood is converted to dark black colour stools. And as a result, patient starts passing foul-smelling dark black, tarry stools. So, this is another manifestation of bleeding. Sometimes the vessels in the stomach may rupture and may present in a similar fashion.

Appearance of patient

On examination of this patients, they have rapid pulse rate. The blood pressure starts going down. They are in a State of Shock with profuse sweating and hands and limbs becomes cool and clammy. It is an emergency condition. The person should not wait for anything and directly rushed to the emergency department

Management

He would be resuscitated with blood products, as well as fluids. He would be given antibiotics to prevent other complications of liver disease.He would be planned for an upper GI endoscopy. On endoscopy, the doctor would apply the band (Variceal ligation). If bleeding is from the stomach, glue may be injected. The efficacy of stopping the bleeding is more than 90 percent in a single sitting.

However, he still needs to continue certain drugs, like terlipressin, somatostatin or octreotide to prevent rebleeding for a period of three to five days. The risk of rebleeding is highest in three to five days, and patients are monitored in the hospital for this period. Sometimes the endoscopist feels that the varices are very high risk, and even after adequately achieving haemostasis or being able to stop the bleeding, they still may be able to advise you to undergo shunting. This shunt is called as TIPSS Shunt. TIPSS is a shunt in the liver. As I have described in the pathophysiology that liver cirrhosis provides increased resistance to blood flow. If we pass a shunt between portal vein and hepatic vein, the pressure in food pipe veins decrease. Sometimes even when you are not able to stop the bleeding on an endoscopy, an emergency shunting – TIPSS, must be carried out.



Dr. Pathik Parikh  is the only hepatologist in gujarat to be trained Mumbai (India), London (UK), Florida (US) and Osaka (Japan)

He is the first and the only doctor to be awarded combined INASL-JSH fellowship for hepatologist

Comments

Post a Comment

Popular posts from this blog

fibroscan for liver inflammation - overview

  FibroScan is a non-invasive medical procedure used to assess liver health by measuring liver stiffness and determining the degree of liver fibrosis. While it's not specifically designed to detect liver inflammation, it can provide valuable information about overall liver health. Liver inflammation, also known as hepatitis, can result from various causes such as viral infections (like hepatitis B or C), alcohol consumption, fatty liver disease, autoimmune disorders, and other factors. It's a crucial aspect of liver health assessment as chronic inflammation can lead to liver damage and fibrosis over time. Although FibroScan primarily evaluates liver stiffness and fibrosis, it indirectly reflects liver inflammation. Inflammation can contribute to liver fibrosis, which in turn affects liver stiffness. Therefore, higher levels of liver stiffness detected by FibroScan may suggest the presence of inflammation. However, FibroScan alone may not provide a complete picture of liver infl
Read more

Understanding Drug-induced Liver Injury (DILI): Symptoms, Causes, and Treatment

  "Understanding Drug-induced Liver Injury (DILI): Symptoms, Causes, and Treatment" is a clear and informative title that covers the essential aspects of DILI. Here's an outline of what each section might include: Symptoms of Drug-induced Liver Injury (DILI): Overview of common symptoms such as fatigue, jaundice (yellowing of the skin and eyes), abdominal pain, nausea, vomiting, and loss of appetite. Discussion on the variability of symptoms depending on the severity and type of liver injury caused by different drugs. Causes of Drug-induced Liver Injury (DILI): Explanation of how certain medications and drugs can lead to liver injury. Classification of DILI based on mechanisms, such as direct hepatotoxicity, idiosyncratic reactions, and immune-mediated responses. Risk Factors for Drug-induced Liver Injury (DILI) : Identification of factors that increase the likelihood of developing DILI, including specific drug characteristics, patient-related factors (e.g., age, genetics
Read more

Liver Disease

Image
Liver is a complex organ with more than 500 functions. Liver diseases are not just limited to alcohol. Over the last two decades, liver diseases besides alcohol have been considered as a cause for liver failure. The list below is just to name a few. Non-Alcoholic Fatty Liver Disease Alcoholic Fatty Liver disease Viral Hepatitis Metabolic liver disease Autoimmune hepatitis Drug induced liver injury Vascular liver disease Congenital liver disease Primary biliary cholangitis Primary sclerosing cholangitis Infectious liver disease Granulomatous liver disease Fatty Liver disease is the most common cause of liver disease in India and worldwide. Alcohol related liver disease is constant through these years while viral hepatitis thanks to good treatment availability is decreasing. These liver diseases can present as any of the following manner. Asymptomatic – Incidental finding on investigations Acute hepatitis with or without jaundice Acute Liver failure Chronic hepatitis Cirrhosis of liver A
Read more