Noninvasive prediction of large esophageal varices in chronic liver disease patients

Esophageal varices [EVs] are a serious consequence of portal hypertension in patients with liver diseases. Several studies have evaluated possible noninvasive markers of EVs to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. This prospective study was conducted to evaluate noninvasive predictors of large varices [LV]. The study analyzed 106 patients with liver diseases from January 2007 to March 2008. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Laboratory parameters like hemoglobin level, platelet count, prothrombin time, serum bilirubin, albumin and ultrasonographic characteristics like splenic size, splenic vein size, portal vein diameter were assessed. Univariate and multivariate analysis was done on the data for predictors of large EVs. Incidence of large varices was seen in 41%. On multivariate analysis, independent predictors for the presence of LV were palpable spleen, low platelet count, spleen size >13.8 mm, portal vein >13 mm, splenic vein >11.5 mm. The receiver operating characteristic [ROC] curve showed 0.883 area under curve. Platelet spleen diameter ratio 909 had a sensitivity and specificity of 88.5%, 83% respectively. Thrombocytopenia, large spleen size, portal vein size and platelet spleen diameter ratio strongly predicts large number of EVs

Chronic abdominal pain: imaging of bowel

A 70-year-old-man was evaluated as an outpatient for chronic abdominal pain for the last two years. The pain was intermittent and not severe enough for him to seek immediate medical attention. There was no history of vomiting, abdomen distension, or of similar episodes in the past. He gave no history of any change in his bowel habits. There was no significant past medical history. On examination, his vital signs were stable. Abdominal examination was normal. An upper gastrointestinal series with small-bowel follow-through and a double contrast barium enema was performed, which clinched the diagnosis [Figures 1 and 2]. What is your diagnosis?