Symptoms of gastric varicose veins, there are 3 clinical manifestations

The main cause of esophageal varices at the fundus of the stomach is liver cirrhosis, which can cause acute gastrointestinal bleeding and, in severe cases, pose a threat to the patient's life. Therefore, timely diagnosis and treatment are very important. Let us now understand the related symptoms of this disease.

1. Manifestations of the primary disease: 90% of portal hypertension is caused by cirrhosis, and patients with cirrhosis often experience fatigue, weakness, loss of appetite, and weight loss. 10% to 20% of patients have diarrhea. Dull or even dark skin or mild jaundice, subcutaneous or mucosal hemorrhages, spider nevi, liver palms, splenomegaly and manifestations of endocrine disorders such as sexual dysfunction, irregular menstruation (amenorrhea or excessive menstruation, etc.) and male breast development may be seen.

2. Manifestations of portal hypertension include ascites and edema, varicose veins of the abdominal wall and hemorrhoidal veins, and splenomegaly.

3. Bleeding and its secondary effects Bleeding from the gums, subcutaneous tissue and mucous membranes is a common symptom in patients with cirrhosis. If there is obvious gastrointestinal bleeding (hematemesis and black stools), the main sources of bleeding are varicose vein rupture and portal hypertensive gastropathy. Varicose veins are mainly esophageal varices, but can also occur in other parts of the stomach or any part of the intestine. Rapid blood loss of large amounts can immediately cause hemodynamic changes, including a rapid decrease in blood volume, a decrease in blood return, a decrease in cardiac output, a drop in blood pressure, a decrease in pulse pressure, an increase in heart rate, insufficient perfusion and hypoxia of organs and tissues in the body, leading to functional and morphological damage, making the condition more complicated. After blood loss, through autoregulation, sympathetic nerve excitement appears first, causing the capacitance vessels to contract, and the blood circulation does not immediately undergo obvious hemodynamic changes; if bleeding continues and the resistance vessels contract, the peripheral skin temperature will drop.

However, the contraction effect of sympathetic nerve excitement on the blood vessels of internal organs (heart, brain, etc.) is not obvious, which allows the circulating blood volume to supply more vital organs. When this compensatory effect cannot make the vascular bed adapt to the reduced blood volume, ventricular filling pressure decreases, cardiac output decreases, central venous pressure drops, heart rate accelerates, and blood perfusion to various organs and tissues is insufficient. Metabolic disorders follow, acidic metabolites accumulate, and resistance vessels cannot maintain their high tension and no longer respond to adrenergic stimulation, which increases capillary permeability and causes fluid leakage, further causing hemodynamic changes and leading to serious tissue damage. As a result, there may be arrhythmia, heart failure and further deterioration of liver function, and even jaundice, edema, increased ascites and hepatorenal syndrome. The patient may be irritable, apathetic or lose consciousness, which may be caused by reduced cerebral blood flow due to massive blood loss. These phenomena become evident when cerebral blood flow is reduced to 50%, and hepatic encephalopathy may also occur subsequently. For patients with blood loss, when they make a fist and then extend their palms, the wrinkles on their palms become pale, indicating a 50% loss of blood volume. If the patient goes into shock while lying flat, the blood volume loss is about 50%; if the patient only goes into shock while standing, the blood loss is about 20% to 30%. If the patient's head is raised 75 degrees and the blood pressure drops by 20 to 30 mmHg after 3 minutes, or if the patient's blood pressure and pulse rate are checked in the supine position and compared with the results in the upright position, if the blood pressure in the upright position decreases by 10 mmHg and the pulse rate increases by 20 times/min, then the amount of blood loss exceeds 1000 ml. Therefore, the approximate amount of blood loss can be estimated based on clinical symptoms. After massive blood loss, spider nevi and palmar erythema may disappear temporarily, and the spleen may also shrink. After blood volume is replenished, circulatory function can be restored.