Microcirculatory Manifestations of Post-Hepatitis Cirrhosis 1999.2.5

Microcirculatory Manifestations of Post-Hepatitis Cirrhosis 1999.2.5

Yang Zhiyong and colleagues at the Infectious Disease Hospital in Xiaogan City, Hubei Province, published a paper in the 12th issue of the Journal of Microcirculation in 1998, confirming the characteristic microcirculatory changes in post-hepatitis cirrhosis: slowed blood flow in the microcirculation, blurred capillary clarity, and increased exudation, bleeding, and red blood cell aggregation. This is related to liver dysfunction in cirrhosis, increased globulin levels, decreased albumin levels, and reduced prothrombin levels. Due to the loss of negative charge on red blood cell surfaces and a drop in surface potential, the repulsive forces between cells are lost, leading to increased blood viscosity and slower flow. Based on these factors, patients with cirrhosis experience heaviness in the limbs, a dark purple tongue, and edema and congestion in the gastrointestinal mucosa. Combined with portal hypertension, the edema in the gastrointestinal mucosa becomes more severe, further hindering digestion. Swelling, nausea, diarrhea, and intestinal rumbling occur continuously, while appetite decreases and fatigue increases! Traditional Chinese medicine treats this condition by promoting blood circulation and removing blood stasis, with Salvia miltiorrhiza 30g as the first choice. Yang Shude’s formula often pairs oyster shell with safflower, and the Jin Gui Yao Lue’s turtle shell pill also follows this principle. Professor He Zesheng from the Fourth Military Medical University of the People’s Liberation Army and his team, in their study on regulating gastric microcirculation under chronic portal hypertension, pointed out: ① the gastric microcirculatory system generally expands and becomes congested, a chronic progressive process closely related to portal hypertension, liver function status, and the body’s ability to regulate its own microcirculation; ② congestion and expansion of the mucosal veins are the most severe and obvious, appearing earliest—in the mid- or early stages of cirrhosis—and characterized by increased opening of arteriovenous shunts; ③ the opening of arteriovenous shunts serves as a hallmark of gastric microcirculatory regulation.

In summary, the microcirculatory characteristics of the stomach and intestines under portal hypertension are: ① expansion and congestion of submucosal veins; ② slowed blood flow; ③ increased blood viscosity; ④ extensive opening of arteriovenous shunts. This leads to congestion, edema, and exudation in the gastrointestinal mucosa, resulting in poor absorption, abdominal distension, abdominal pain, diarrhea, increased intestinal rumbling, and loss of appetite. At this point, minor bleeding may occur, with positive fecal occult blood. Careless dietary choices—acidic, spicy, cold, meat-heavy, or hard-to-digest foods—can all lead to massive gastrointestinal bleeding. Therefore, proper care of the gastrointestinal tract is the most important means of ensuring survival for patients with cirrhosis.