Pathologic changes of the liver cause communication of blood vessels with bile ducts, so that blood passes into the intestines through bile ducts, presenting as upper digestive tract hemorrhage which is also called hepatogenic biliary tract hemorrhage. Hepatogenic biliary tract hemorrhage is one of the important causes of upper digestive tract hemorrhage; it amounts to 53-70% of biliary tract hemorrhage.
In hepatogenic biliary tract hemorrhage, the incidence in male is higher than female. There are various causes of this disease, namely, inflammation, stones, parasites, tumors and vascular pathologic changes. In the hepatic pathologic changes, inflammation, cirrhosis, tumors (including carcinoma of liver, adenoma, cavernous hemangioma) and venous varicosity of bile ducts, all are the pathologic basis of biliary tract hemorrhage and among those, the most common cause is intra-hepatic cholangitis.
The production of virus hepatitis by Hepatophilic virus causes not only intra-hepatic diffuse cholangitis but also portal hypertension and coagulative disorders. The latter conditions can also lead to hemorrhagic tendency of the bile duct mucosa and become the main causes of biliary tract hemorrhage.
Hepatogenic biliary tract hemorrhage often occurs in liver disease patients of comparatively late stage, so some patients may have history of liver disease, positive hepatitis antigens and antibodies and abnormal liver function test results. The clinical symptoms of these patients are usually rather typical: that is, tarry stools, abdominal pain and jaundice. The incidence of jaundice may reach 60% to 95%, and it may repeatedly occur following abdominal pain and hemorrhage. The severity of abdominal pain is variable: in mild cases there may be only upper abdominal discomfort, distensive pain and hypochondrial pain.
The more severe cases often belong to those with rapid and profuse bleeding associated with nausea, vomiting and comparatively typical biliary colic. Abdominal pain may be followed by cyclic vomiting of blood and hematochezia; if the amount of bleeding is large, there may be symptoms of collapse and hemorrhagic shock such as palpitation, lowering of blood pressure, paleness of face and profuse sweating. Physical signs associated are fever (complicated by infection) abnormality of area of liver dullness (enlarged or shrunk) and enlargement of gallbladder. Because of the seriousness of the disease and the amount and rapidity of hemorrhage may be fatal, the patient should be sent to hospital for treatment as early as possible.
It is clear that early effective TCM systemic treatment for acute or chronic hepatitis is the only competent preventive measure for hepatogenic biliary tract hemorrhage. Some liver disease patients with repeated upper digestive tract hemorrhage should be treated with effective systemic TCM therapy after control of the bleeding to prevent progression of the liver disease and relapse of the bleeding.
Introduction of cases
| Case 4
Shu (code number 0124), male, 43 years of age. His first visit was on Sept 1998, complaining of pruritus and pale yellowish color of skin. He had upper abdominal pain 9 years ago and was hospitalized in 1980, 1986 and 1989 three times, all because of profuse hemorrhage of upper digestive tract and every time, the bleeding was stopped by conservative treatment. Thereafter, he took gastric drugs for long periods and he also suffered from tiredness, abdominal distention after meal, frequent diarrhea, nausea, hypochondrial pain and repeated exogenous insults. In the previous week, he was given western medicine on account of common cold, but, contrarily, fatigue become worse and he had also sleepiness, hyperhidrosis, thirst of mouth and dryness of throat and occipital pain. Physical examination revealed well development, anemic looking, tongue pale and enlarged with teeth prints, tongue coating thin and white, lips pale, abdomen soft, liver enlarged to 3 cm. There was percussion tenderness over hepatic region and pain was marked when pressure was applied to right upper abdomen during deep breathing. The impression was hepatophilic virus disease complicated with biliary tract infection and hemorrhage. After 3 parcels of TCM drugs, the liver enlargement was 1.5 cm, and the common cold symptoms regressed. After 1 week of TCM treatment, the liver returned to normal, headache ceased, thirst of mouth lessened but he still felt tired and sleepy. The lips and tongue became somewhat reddish in color and tongue coating was absent. It was regretful that the patient stopped the TCM treatment by himself only after 4 weeks of treatment without completion of the course. |
| Case 5
Wong (code number 2127) male, age 38 years. His first visit was on May 7, 2000 when he complained of repeated abdominal distention and pain and had to call on the emergency department at the height of the pain. After the revelation of gallbladder stone, he was operated for this purpose and at the same time, he was detected to be a carrier of type B hepatitis virus. Postoperatively, he felt extreme tiredness, sleepiness and frequent loin pain which was hard to be cured. He also experienced repeated nasal hypersensitivity, common cold, fatigue, sleepiness poor appetite, abdominal distention and pain, constipation (about once in 2-5 days) with hard feces and hematochezia. Physical examination : skin dark and pale yellowish in color, puffy looking, increase in pigmentation of skin around the eyes, swelling of lower eye lips, significant enlargement of tongue with teeth prints, abdominal distended and full, liver enlarged to 3 cm, with percussion tenderness. The patient had nausea, vomiting and headache after taking one parcel of TCM drugs. He continued the therapy and although he still felt nausea but did not vomit. He had mild headache, vague abdominal pain, loose stools and burning sensation of the anus. After 3 parcels of TCM drugs, the above symptoms disappeared and the liver became normal. After 1 week of TCM drugs, the mental status was good and fatigue was not present. After 2 weeks of treatment, there was occasionally blood in the stools, and the amount of feces was large. The urine was yellowish and burning sensation of the anus was present but anal examination did not reveal fissure or hemorrhoid. TCM medication continued to 3 weeks and hematochezia stopped, but there was occasionally abdominal pain, diarrhea and the stools were copious, loose and of wetness-heat character. Nasal hypersensitivity and tiredness disappeared and he was in good spirits. The systemic TCM treatment totaled 6 weeks and at the end of which clinical sure was obtained. Medication was then stopped for observation. |
Written by WONG Kwok Hung
published on 22nd May 2001
(translated by Professor ZHENG Hua En in December 2002)