ABSTRACT
Emergency fibroscopy revealed bleeding lesions in 84 cirrhotic patients. In patients with moderate or no hepatic failure, the commonest actively bleeding sources were oesophagogastric varices and acute mucosal ulcers associated with the ingestion of anti-inflammatory drugs. In patients with severe hepatic failure, acute mucosal ulcers unrelated to drugs predominated and there was evidence that these were stress-induced erosions.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/complications , Stress, Physiological/complications , Acute Disease , Adolescent , Adrenal Cortex Hormones/adverse effects , Adult , Aged , Aspirin/adverse effects , Chronic Disease , Esophageal and Gastric Varices/complications , Female , Humans , Male , Middle Aged , Peptic Ulcer/chemically induced , Peptic Ulcer/complications , Peptic Ulcer/etiology , Peptic Ulcer Hemorrhage/etiology , Rupture, SpontaneousABSTRACT
The cause of upper gastrointestinal bleeding was studied in 85 cirrhotic patients by emergency endoscopy. In every patient, one or several lesions were observed and the site of bleeding was ascertained in 59. The two main causes were oesophago-gastric varices (46 p.cent) and acute mucosal lesions(42 p.cent). The source of bleeding appeared to be related to the degree of liver function impairment. In patients with no or moderate liver function impariment, bleeding usually originated from varices or from drug-associated mucosal erosions. Patients with severe impairment of liver function most often bled from spontaneous acute oeso-gastro-duodenal ulcerations. These ulcerations resembled what has been described in "stress" hemorrhage. Because of the relationship between liver function and the cause of hemorrhage, mortality was lower in variceal bleeders (29 p.cent) than in patients with spontaneous ulcerations (83 p.cent). In patients with severely impaired liver function, portacaval shunt was rarely indicated since hemorrhage was generally due to acute mucosal ulcerations.
