A study of 49 patients with Laennec's cirrhosis and hemorrhage from esophageal varices during a 5-year period revealed:
Massive hemorrhage was usually the underlying cause of death with initial or recurrent hemorrhage.
Current therapy with tamponade, massive transfusions, and supportive therapy has not affected the high mortality associated with initial hemorrhage from such lesions.
When available, such therapy appears to alter the mode of death, hepatic coma following hemorrhage being more common than exsanguination as the cause of death.
Ascites, plasma protein level below 7.0 Gm., or a hemoglobin below 7.0 Gm. on admission were usually associated in those patients that died.
Hemorrhage was the cause of death in 38 per cent of the 102 autopsied cases revealing Laennec's cirrhosis.
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Blakemore, A. H. Portacaval shunting for portal hypertension.Surg. Gynec. & Obst. 94:443, 1952.
Linton, R. R. Emergency treatment of bleeding esophageal varices and the results of portacaval shunts in 90 patients.N. Y. State J. Med. 538:2192, 1953.
Brick, I. B., Palmer, E. D., Hufnagel, C. A., andJahnke, E. J. Panel discussion on esophageal varices.Am. J. Gastroenterol. 23:505, 1955.
Hughes, C. W., andJahnke, E. J. Surgical aspects of portal decompression.Am. J. Gastroenterol. 24:372, 1955.
Ratnoff, O. D., andPatek, A. J., Jr. The natural history of Laennec's cirrhosis of the liver: An analysis of 386 cases.Medicine 21:207, 1942.
Douglas, B. E., andSnell, A. M. Portal cirrhosis: An analysis of 444 cases with notes on the modern methods of treatment.Gastroenterology 15:407, 1950.
Shull, H. G. Cited by Linton, R. R. The surgical treatment of bleeding esophageal varices by portal systemic venous shunts with a report of 34 cases.Ann. Int. Med. 31:794, 1949.
Snell, A. M. Clinical aspects of portal cirrhosis.Ann. Int. Med. 5:338, 1931.
Palmer, E. D., andBrick, I. B. Esophageal varices without hemorrhage in cirrhosis.New England J. Med. 250:863, 1954.
Hall, E. M., Olsen, A. Y., andDavic, F. E. Portal cirrhosis: Clinical and pathological review of 782 cases from 16,000 necropsies.Am. J. Path. 29:993, 1953.
Kozoll, D. C., Kane, J. M., andMeyer, K. A. Anatomical study of caused and associated pathology in 673 autopsied cases of massive gastrointestinal hemorrhage.Proc. Central Soc. Clin. Research 26:60, 1953.
Higgins, W. H. The esophageal varix.Am. J. Med. Sc. 214:436, 1947.
Merindino, K. A., andVolwiler, W. Medical and Surgical Aspects of portal hypertension: Report of 12 cases.52:724, 1953.
Linton, R. R., andEllis, D. C. Emergency and definitive treatment of bleeding esophageal varices.J.A.M.A. 160:1017, 1956.
Nachlas, M. M., O'Neil, J. E., andCampbell, A. J. A. The life history of patients with cirrhosis of the liver and bleeding esophageal varices.Ann. Surg. 141:10, 1955.
Chalmers, T. C.,et al. Fatal gastrointestinal hemorrhage: Clinicopathological correlations in 101 patients.Am. J. Clin. Path. 22:634, 1952.
Kinney, T. D., andMallory, G. K. Cardiac failure associated with acute anemia.New England J. Med. 232:215, 1945.
Zamcheck, N. Management of massive gastrointestinal hemorrhage on the wards of Boston City Hospital.A.M.A. Arch. Int. Med. 96:78, 1955.
Zamcheck, N.,et al. The bromsulphalin test in early diagnosis of liver disease in gross upper intestinal hemorrhage.Gastroenterology 14:343, 1950.
Fellinger, K., andKlima, R. Untersuchunger, über Anämein bei Leberzirrhosen,Wien. klin. Wchnschr. 46:1191, 1933.
Fellinger, K., andKlima, R. Lebercirrhose and Anamien.Ztschr. klin. Med. 126:547, 1934.
Berman, L.,et al. The blood and bone marrow in patients with cirrhosis of the liver.Blood 4:511, 1949.
Wintrobe, M. W. Relation of disease of the liver to anemia.A.M.A. Arch. Int. Med. 57:289, 1936.
Whipple, G. H. Hemoglobin and plasma proteins: Their production, utilization and interrelation.Am. J. M. Sc. 203:477, 1942.
Woodruff, A. W. The natural history of anemia associated with protein malnutrition.Brit. M. J. 1:1297, 1955.
Jandl, J. H. The anemia of liver disease: Observations on its mechanism.J. Clin. Investigation 34:390, 1955.
Schiff, L., Rich, M. L., andSimon, S. D. The haematopoietic principle in the diseased human liver.Am. J. M. Sc. 196:313, 1938.
Perera, G. A. The plasma volume in Laennec's cirrhosis of the liver.Ann. Int. Med. 24:643, 1946.
Hiller, G. L., Guffman, E. R., andLevey, S. Studies in cirrhosis of the liver: I. Relationship between plasma volume, plasma protein concentrations and total circulatory proteins.J. Clin. Investigation 28:322, 1949.
Hyde, G. M.,et al. The blood volume in portal cirrhosis as determined by P32 labeled red blood cells.J. Lab. & Clin. Med. 39:347, 1952.
Chodos, R. B.,et al. The clinical significance of the blood volume in the anemia of portal cirrhosis:Clin. Res. Proc. L:111, 1953.
Eisenberg, S. Blood volume in patients with Laennec's cirrhosis of the liver as determined by radioactive chromium tagged red cells.Am. J. Med. 20:189, 1956.
Chaplin, H., andMollison, P. L. Red cells life-span in nephritis and in hepatic cirrhosis.Clin. Sc. 12:351, 1953.
Huang, K. W., andWang, H. W. Anemia associated with cirrhosis of the liver.A.M.A. Arch. Int. Med. 84:958, 1949.
Hall, C. A. The macrocytosis of liver disease.J. Lab. & Clin. Med. 48:345, 1956.
Wilhelmi, A. E., andLong, C. N. H. Metabolic changes associated with hemorrhage.Ann. New York Acad. Sc. 49:605, 1948.
Blalock, A., andLevy, S. E. The effect of hemorrhage, intestinal trauma and histamine on the partition of the blood stream.Am. J. Physiol. 118:734, 1937.
Engel, F. L., Harrison, H. C., andLong, C. N. H. Biochemical studies on shock. III. The role of the liver and hepatic circulation in the metabolic changes during hemorrhagic shock in the rat and cat.J. Exper. Med. 79:9, 1944.
Keys, H., andSnell, A. M. The combination of oxygen and hemoglobin in patients with liver disease.J. Clin. Invest. 16:684, 1937.
Wilson, R. H.,et al. The determination of blood volume flow through non-ventilated portions of the normal and diseased lung.Am. Rev. Tuberc. 68:177, 1953.
Wiggers, C. J., Opdyke, D. F., andJohnson, J. R. Portal pressure gradients under experimental conditions including hemorrhagic shock.Am. J. Physiol. 146:192, 1946.
LeVeen, H. E., Mulder, A. G., andProkop, A. The physiological mechanism for death in massively bleeding peptic ulcer.Surg. Gynec. & Obst. 94:433, 1952.
Johnson, D. H. Hemorrhage and liver flow.J. Physiol. 126:431, 1954.
Burton, A. C. “Law of Physics and Flow in Blood Vessels,” inVisceral Circulation. Ciba Foundation Symposium, London, Churchill, 1952.
Fine, J., Seligman, A. M., andFrank, H. A. On the specific role of the liver in hemorrhagic shock.Ann. Surg. 126:1002, 1947.
Webster, L. T. Ammonium metabolism.Am. J. Med. 21:130, 1956.
Phillips, G. B.,et al. The syndrome of impending hepatic coma in patients with cirrhosis of the liver given certain nitrogenous products.New England J. Med. 247:239, 1952.
Sherlock, S.,et al. Methione toxicity in liver diseases and prevention by chlortetracyclineAm. J. Med. 21:131, 1956.
Green, D. M., andMethegn, D. Estimation of acute blood loss by the tilt test.Surg. Gynec. & Obst. 84:1045, 1947.
Wechsler, R. L., Roth, J. L. A., andBockus, H. L. The use of serial blood volumes and head-up tilts as important indications of therapy in patients bleeding from the gastrointestinal tract.Gastroenterology 30:221, 1956.
Blakemore, A. The treatment of bleeding esophageal varices with balloon tamponade.New York J. Med. 54:2057, 1954.
Sengstaken, R. W., andBlakemore, A. H. Balloon tamponage for the control of hemorrhage from esophageal varices.Ann. Surg. 131:781, 1950.
Stefanini, M. The Hemorrhagic Diathesis of Liver Dysfunction and Obstructive Jaundice. International Society of Hematology (Proceedings of the Third International Congress). New York Grune, 1951, p. 486.
Durham, R. H. The results of splenectomy in Banti's syndrome.Ann. Int. Med. 34:1372, 1951.
Krevans, J. R., andJackson, D. P. Hemorrhage disorder following massive whole blood transfusions.J.A.M.A. 159:171, 1955.
Weiner, A. S., andWexler, J. B. The use of heparin when performing exchange transfusions in newborn infants.J. Lab. & Clin. Med. 31:1016, 1946.
Mallinson, P. L. Blood transfusion in clinical medicine. Oxford, Blackwell, 1951.
Howland, W. S., Boyan, C. P., andDatto, A. C. Physiologic alterations with massive blood replacement.Surg. Gynec. & Obst. 101:478, 1955.
Cookson, B. A., Costan-Durieux, J., andBailey, C. P. The toxic effects of citrated blood and the search for a suitable substitute for use in cardiac surgery.Ann. Surg. 139:430, 1954.
Spear, P. W., Sass, M., andCincotti, J. J. Ammonia levels in transfused blood.J. Lab. & Clin. Med. 48:702, 1956.
Fleming, R. G., andSnell, A. M. Portal cirrhosis with ascites: An analysis of 200 cases with special reference to prognosis and treatment.Am. J. Digest. Dis. 9:115, 1942.
The author wishes to express his gratitude to Col. B. H. Sullivan, Jr., and Lt. Col. W. H. Crosby for their help and guidance in the preparation of this paper.
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Sheehy, T.W. Relation of hemorrhage from varices to mortality in cirrhosis. Digest Dis Sci 2, 195–209 (1957). https://doi.org/10.1007/BF02231128
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