A patient with advanced liver disease may develop acute gastrointestinal bleeding after scuba diving. This may occur even after a relatively shallow dive.
Bleeding results from a sudden increase in portal pressure secondary to:
(1) increased shunting of blood to the viscera
(2) accumulation of nitrogen gas bubbles in the portal circulation during the ascent
A patient should not dive if they have cirrhosis with:
(1) portal hypertension with esophageal varices (the higher the grade of varices the more serious the bleeding)
(2) a history of gastrointestinal bleeding associated with portal hypertension
A patient with cirrhosis should be evaluated prior to diving to determine if the patient is at risk for bleeding.
Risk factors for bleeding:
(1) the presence of a coagulopathy
(2) deep water dive
(3) rapid ascent
(4) erosive disease of the esophagus, stomach or duodenum
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