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Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.
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Chronic liver disease develops when the functional capacity of the liver is deranged, and it is not able to maintain normal physiological conditions. This study was carried to find out the association of portal vein size with gastro-oesophageal varices in diagnosed cases of cirrhosis of liver, so that this parameters can be used in predicting propensity to oesophageal varices non-invasively, and thus help in starting prophylactic therapy earlier to prevent bleeding and other complications of varices.METHODS100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were included for the study. Ultrasonography was done in all cases to find out the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was performed to see the presence of oesophageal varices of different grades. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient. p Value of <0.05 was considered for significant.RESULTSAmong 100 patients studied, 90% patients were found to have oesophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 oesophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of splenic diameter with grades of oesophageal varices, it was found that patients with splenic diameter >13 cm had higher grades of oesophageal varices i.e. 32 patients were grade 2 and 18 patients were grade 3, with p<0.001 and was found highly significant.CONCLUSIONSIn this study, we found that with increasing spleen size there are chances of formation of higher grades of oesophageal varices and both are also having positive association.
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Background: Liver cirrhosis is the end result of chronic liver injury and is one of the most common cause of morbidity and mortality. Several scorings are available to predict the severity and prognosis of liver cirrhosis. This study aims to calculate APRI index, MELD score and child Pugh score in cirrhosis patients and to find the correlation between them.Methods: This is the Cross-sectional study on 100 patients confirmed with cirrhosis of liver. Cirrhosis due to alcohol, Hepatitis B and C, autoimmune, Cryptogenic, NAFLD, were included in the study. APRI Index, MELD Score and Child Pugh Score were calculated, and the correlation was obtained.Results: This study found out the relationship between APRI index, MELD Score and Child Pugh Score with significant p value. The study also showed that all the three scores were raised with patients who had complication of cirrhosis like encephalopathy, refractory ascites. Among those who had complication like grade 3 or 4 encephalopathy, APRI index had a mean value of 3.4, Child Pugh had a mean score of 13.2, and MELD had a mean score of 36.08 with standard deviation of 2.0, 1.5, 6.0 respectively.Conclusions: APRI index is an independent predictor of morbidity and mortality. The prognostic performance of all 3 was comparable, Hence APRI index can be used as an alternative scoring which is cost effective and objective method in predicting the severity and prognosis in cirrhosis of liver.
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Introduction: Cirrhosis of Liver is prevalent in Bangladesh.PUD can coexist with portal hypertension with cirrhosis.Objectives: To identify frequency of peptic ulcer diseaseincreases with severity of cirrhosis of liver.Materials & Methods: Consecutive 96 patients of cirrhosis ofliver had enrolled when found oesophageal varices at ourendoscopy unit during endoscopic evaluations in 4 monthsperiod (August 2017 to November 2017).Results: Total cirrhotic patients enrolled were 114 (M=75,F=39), mean age was 51.80 ± 14.20 yrs (18-86years). HBVwas the leading cause of cirrhosis in 54.18%, HCV 5.22 %,proven NASH were 12.24% and rest were from unknownaetiology. Their average CTP score were 8.6 (12-5), 37.6%associated with portal hypertensive gastropathy. Grade-IIIoesophageal varicose found in 52 patients, whereas grade-II in25 patients. Among this 114 patients 46 (40.62%) revealedpeptic ulcer disease more in the form of gastric ulcer (n=31)than duodenal ulcer (n=10) and both (n=5).Most of the ulcersbelonged to Forrest class III (76.92%).Conclusion: Variceal bleeding and portal hypertensivegastropathy in patients with liver cirrhosis are prevalent causesof bleeding and anaemia. One of the potential causes ofhaematemesis, melaena, and anaemia among these patientsin Bangladesh has been discovered to be peptic ulcer illness.To verify the findings, large, multicenter-controlled trials arerequired.
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Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(>13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p<0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.
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Background: In many studies Serum ascitic albumin gradient (SAAG) was found to be an independent predictor of PHTN and EV especially in alcoholic cirrhosis. Objectives of this study was to study correlation of level of 揝erum-Ascites Albumin Concentration Gradient� (SAAG) and complications of 揚ortal hypertension� (PHTN), manifested by 揈sophageal Varices� (EV).Methods: Present study was hospital based cross sectional study. The sample (100) was of patients with ascites. SAAG was measured in all subjects. EV was assessed by endoscopy in all. Data was analyzed using proportions and appropriate statistical tests.Results: High SAAG value was seen in 79% of the patients. EV incidence was 84.5%. 揷hild-pugh score� and size of the portal vein was found to be associated with EV. The incidence of EV among patients with high 揝AAG value of 1.1 to 1.44 g/dl� was 50%. The size of the EV was found to be significantly associated with SAAG level.Conclusions: Patients having ascites with EV were also having high levels of SAAG. Thus, we conclude that value of SAAG more than or equal to 1.2�05 g/dl can be used as a predictor of EV presence among ascites patients
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Objective To investigate the changes of plasma miR-29a level in patients with hepatocellular carcinoma(HCC) and its clinical significance.Methods Case-control study,30 patients with HCC,30 patients with cirrhosis of liver (LC) and 30 healthy controls (HC) were recruited from Shiyan Taihe Hospital,2016 January to June.The level of microRNA-29a (miR-29a) in plasma was detected by real time quantitative PCR,and the sensitivity and specificity of plasma miR-29a expression in the diagnosis of HCC were analyzed by receiver operating characteristic curve (ROC),and to analyze the correlation between the miR-29a and the alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma,the combination of miR-29a and AFP could improve the diagnostic efficiency of HCC.Results The relative expression of miR-29a was significantly different between HCC group (3.38±8.37),LC group (8.79±3.80) and HC group (11.98±6.64),the expression level of miR-29a in HCC group was significantly lower than that in LC group (P=0.046) and HC group (P=0.001),and that in LC group was significantly lower than that in HC group (P=0.026).The area under the ROC curve of miR-29a was 0.816 (95％ CI 0.695 to 0.938) less than AFP 0.918 (95％ CI 0.853 to 0.982),and the diagnostic efficiency of miR-29a was not as good as that of AFP.The levels of miR-29a and AFP in plasma of patients with hepatocellular carcinoma were significantly correlated (P=0.002).Conclusion The level of miR 29a in plasma of patients with HCC decreased,which may become the reference index of HCC diagnosis.
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To diagnose the cause of ascitis in cirrhosis of liver is difficult clinically as fluid is also present in cirrhosis with portal hypertension. The other diseases causing ascitis can also occur in cirrhosis of liver with portal hypertension. In tropical countries like India tuberculous ascitis is very common, hence tuberculous ascitis can occur even in presence of cirrhosis of liver with portal hypertension. In this case report, 45 years old male presented with tuberculous ascitis in cirrhosis of liver. This points out that tuberculous ascitis should be thought of even in presence of cirrhosis of liver or cirrhosis of liver with portal hypertension. The patient recovered completely with anti-tubercular treatment without any complications or toxicity. The role of anti-tubercular treatment and its toxicity in the presence of liver cirrhosis is also discussed.
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Background: Portal hypertension commonly accompanies cirrhosis of liver and is a consequence of an increase in splanchnic blood flow secondary to vasodilatation and increased resistance to the passage of blood through the cirrhotic liver. Development of oesophageal varices (OV) is one of the major complications of portal hypertension. In present study we attempted to compare different surgical modalities in case of Portal Hypertension (PHT) by their indications, contraindications, complications and outcomes in a group of 50 patients. Aim and objectives: To study the indications, contraindications, complications and outcomes in different decompressive shunt procedure and devascularisation procedure, to discuss the advantages and disadvantages of different surgical procedures in case of portal hypertension, to discuss role of shunt surgery in modern era of liver transplantation. Materials and methods: During our work period from June 2008 to November 2010, all patient admitted in our institution were considered for study. Detailed history was elicited in each case. Various symptoms were noted and a detailed general, systemic and local examination was done in cases. Various operative surgery was done in the form of Distal Spleenorenal Shunt, Spleenectomy with Devascularisation, Side to Side Mesocaval Shunt, side to side lineorenal Shunt. All the patients were observed for post operative complications and managed accordingly. Regular follow up of patient was conducted till date. All the case was studied on the basis of following proforma. Results: All patients were advised surgery. Out of this only 1 (2.56%) mortality were found which was with the DSRS. All patients with Child’s Criteria B were selected for side to side portocaval Baria B, Parmar N, Kumar S, Parmar H. Surgical management in portal hypertension. IAIM, 2016; 3(9): 194-199. Page 195 shunt of which there was no mortality, in all patients with Child’s Criteria A in whom different surgical modalities were conducted have 3.12% mortality with DSRS and associated morbidity variceal bleeding, total rebleeding and shunt occlusion in both groups. Variceal bleeding was found in 2 cases of which 50% was with Grade A and 50% was with Grade B of Child’s Criteria. Total rebleeding was found in only 1 (3.12%) patient with Child’s Criteria Grade A. Shunt occlusion was found in only 1 (3.12%) patient with Child’s Criteria Grade A. Encephalopathy was found in 5 (12.82%) patients out of which 4 (57.14%) patients were with Child’s Criteria Grade B, and only 1 (3.12%) patient with Child’s Criteria Grade A. Conclusion: More studies are needed to established any conclusion as there are some shortcomings like; patients are lost in follow up, liver transplantation is yet in developmental stage and scarcity of grafts in government setup.
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Objective To study the clincial effectiveness and safety of endoscopic sphincteropapillotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis.Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD,the ESBD group) and 42 cases who underwent endoscopic papillary balloon dilation(EPBD,the EPBD group)were retrospectively analysed and compared for complete stone clearance rate,one-time stone clearance rate and complications.Results The rate of complete stone clearance and one-time stone clearance were 94.9％ (75/79) and 77.2％ (61/79)in ESBD group,and those were 88.1％ (37/42) and 59.5％ (25/42) in EPBD group respectively.The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group.In ESBD group,ERCP-related bleeding occurred in 3 patients (3.8％),post-ERCP hyperamylasemia in 3 (3.8％)and post-ERCP pancreatitis in 2 (2.5％) ; while in EPBD group,post-ERCP hyperamylasemia occurred in 8 patients(19.0％),post-ERCP pancreatitis in 6(14.3％) and ERCP-related bleeding did not occur.There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group (P =0.551).However,the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were significantly lower than those in EPBD group(P ＜ 0.05).Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis,with several advantages over EPBD in terms of higher one-time stone clearance rate,reduced risk of post-ERCP pancreatitis and hyperamylasemia,and without noticeable increase in the risk of bleeding related to ERCP.
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73 liver cirrhosis patients have been selected. Serum zinc and albumin levels were estimated in them in comparison to controls. Significant decrease in zinc and albumin levels were observed in liver cirrhosis patients. This work is an attempt to understand the important role that the zinc plays in the pathogenesis and therapy of liver cirrhosis and the role of albumin in zinc transport.
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Adult , Female , Humans , Liver Cirrhosis/pathology , Liver Cirrhosis/therapy , Male , Middle Aged , Serum Albumin/analysis , Serum Albumin/blood , Zinc/analysis , Zinc/bloodABSTRACT
Background: Child Turcotte Pugh (CTP) score and Model for End Stage Liver Disease (MELD) are used commonly to assess the prognosis of liver disease but the disadvantage of these static tests is their inability to identify the functional reserve of the liver. Among all quantitative liver function tests indocyanine green (ICG) clearance test is most widely used and has been used to determine operative risk before hepatectomy and to assess prognosis of patients with cirrhosis. Aim: To correlate indocyanine green (ICG) clearance test with MELD score in patients with cirrhosis of liver. Methods: Forty patients with cirrhosis of liver were included and divided into two groups according to their CTP scores. Group A had 20 patients with CTP class A and group B had 20 patients with CTP class B. After ICG injection, ICG retention at 15 minutes (ICGR15) and ICG clearance rate were calculated. Results: In group A, the mean ICGR15 was 32.86% + 6.4% while in group B it was 51.08% + 12.8% (p <0.001). ICG clearance rates were 4.3% + 2.8% and 3.5% + 3.8% per minute in group A and B respectively. MELD score had a strong positive correlation with ICGR15 but a negative correlation with ICG clearance rate. On ROC curve analysis, AUC for MELD was 0.805 vs. 0.88 for ICGR15 in assessing prognosis of patients with cirrhosis. The sensitivity and specificity of MELD score was 60% and 80% respectively while that of ICGR15 was 85% and 90% respectively. Conclusion: ICGR15 has a higher sensitivity and specificity than MELD score in assessing the prognosis of patients with cirrhosis of liver.
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Objective To study the intestinal bacterial overgrowth(IBO)and bacterial translocation(BT)in cirrhotic rats,and the effect of microecologics on it.Methods In order to induce cirrhosis model the rats were given 40%CCl4 elaeo-solution by subcutaneous injection,then were treated by microecologics(prebiotics and probiotics).The rats were randomly divided into normal control group(13 rats),cirrhosis model group(10 rats),prebiotics therapy group(19 rats),probiotics therapy group(19 rats)and therapy control group(20 rats).To detect endotoxin,cultivate and count enteric bacilli.mesenteric lymph nodes,tissue of liver and spleen were taken to cultivate bacteria.Results ① the counts of small intestinal bacilli in cirrhosis rats were obviously higher than normal rats(P
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Objective To evaluate the efficacy of endoscopic variceal ligation and somatostatin for esophageal varices bleeding.Methods Eighty patients with hepatic cirrhotic esophageal varices bleeding were allocated into two groups,forty in endoscopic variceal ligation(EVL)group and the others in somatostatin(stilamin)group.Results Initial hemostasis rates(including emergency hemostasis and no bleeding for 72 hours)and one-month rebleeding rates in EVL group and somatostatin group were 97.5% vs 80%(P0.05).The hepatic encephalopathy rates were 2.5% vs 15%(P0.05).Conclusion Endoscopic variceal ligation is superior to somatostatin for hepatic cirrhotic esophageal varices bleeding.EVL can lower the rate of hepatic encephalopathy.
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Objective To discuss the clinical relationship between changes of the parameter of the peripheral blood cells and liver cirrhosis.Methods The parameter of the peripheral blood cells of 321 patients with cirrhosis of liver was analyzed.Results Changes of the parameter of the peripheral blood cells of patients with liver cirrhosis were abnormal obviously.Changes of Hb,RBC,HCT and RDW were well correlate to the degree of impairment of liver function.With the progression of impairment of liver function,Hb RBC and HCT decreased,RDW increased gradually in patients with liver cirrhosis(P
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Objectives:To investigate the effect of growth hormone(GH) and parenteral nutrition (PN) on protein metabolism in patients with cirrhosis of liver. Methods:The test group received GH and PN,and the control group received PN only.All the treatments were maintained for 7 days.The serum levels of Alb,TFN and PA were detected on the day before the treatment and the day 3,5 and 7 after the treatment. Results:As compared with the day before the treatment,the levels of Alb,TFN and PA on the day 3,5 and 7 in the two groups were all increased.However,the changes in the test group were greater than those in the control group.As compared with the control group,the level of Alb on the day 7 and the levels of TFN and PA on the day 5 and 7 in the test group were significantly higher. Conclusions:The therapeutic value of combined use of GH and PN is much better than that of single PN in patients with cirrhosis of liver.
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The distribution and number of dendritic cells (DC) were studied by ABC immunohistochemical method in specimens of hepatocellular carcinoma (HCC, n=24), cirrhosis of liver (CL, n=15), chronic active hepatitis B (CAH, n=9), chronic persistent hepatitis (CPH, n=14), acute hepatitis B(AH, n=9) and normal liver (NL, n=11). The results showed that 1) in HCC, DC was mainly distributed in the intercellular space of the tumor cells and the clustered lymphoid cell area, the tumor cells were surrounded by the dendrites of DC; 2) the number of DC cells/mm2 in HCC (12.8) was significantly higher than that in CL (8.4); which was again significantly higher than that in NL (6.1); 3) the number of DC in NL was higher than those in CAH (3.9), CPH (3.3) and AH (2.9); and 4, the number of DC in HBsAgpositive HCC was higher than that in HBsAgnegative HCC. The above results suggested that 1) DC might be involved in the host immune reaction against tumor by means of antigen presentation; 2) DC might play some protective role in the evolution of CAH→CL→HCC.
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This article is to report the results of the clinical assessment on the significance of 14 conventional liver function tests in the diagnosis of 161 cases of pathologically-confirmed liver cirrhosis. Out of the 14 tests, four, including quantitative determinations of serum ?-globulin (?-glo), total bilirubin (T bil), albumin (alb) and zinc, sulfate turbidity test (ZnT), proved more valuable than the oters.It was found that ?-glo increased in 91 cases out of 110 (82.73%), T bil in 60 cases out of 89(67.42%), and ZnT in 82 cases out of 161 (50.93%), but alb decreased in 77 cases out of 110(70.00%). The corresponding parameters between the compensated and decompensated cases differed significantly: ?-glo increased 68.29% in the former and 91.13% in the latter(PP 0.01), but alb decreased 52.28 in the former and 42.92 in the latter (P