Not everyone with liver disease and upper gastrointestinal hemorrhage is bleeding from varices. Nearly half of such patients bleed from mucosal lesions including peptic ulcers, gastric erosions, or esophageal tears. Any patient with chronic disease of the liver is at great risk of becoming encephalopathic from an upper gastrointestinal hemorrhage at any site as a result of both circulatory compromise and the presence of intestinal contents high in protein. Because of this, efforts to provide circulatory support and reduce the amount of blood in the intestine should be undertaken promptly. The latter goal is best achieved by the use of mineral laxatives and by gastric lavage with ice water. Saline lavage should be avoided because of the danger of fluid retention and the initiation or aggravation of ascites.

Definitive diagnosis of the bleeding site can be made only by upper gastrointestinal endoscopy, after lavage of the stomach, and following efforts to restore circulatory homeostasis. Prior to endoscopy, vitamin K (phytomenadione) should be administered if the prothrombin time is prolonged, even though response to this vitamin may be poor because of hepatic damage. Fresh frozen plasma and platelet transfusions should also be given where indicated. Before endoscopy, bleeding patients with signs and symptoms of hepatic encephalopathy should be sedated very lightly, if at all, in order to avoid worsening that state.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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