Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital

This prospective follow-up study was designed to analyze the causes and outcome of upper gastrointestinal bleeding among patients presenting by hematemesis and/or melena to Emergency Endoscopy Unit, Ain Shams University Hospitals. One thousand patients presented by upper GIT bleeding were subjected to complete clinical evaluation, emergency upper gastrointestinal endoscopy and therapeutic interventions as indicated. Follow up was done for occurrence of re-bleeding or mortality. Variceal causes of bleeding were the most common, representing 70.1% followed by non-variceal causes [26.1%] and obscure causes [3.8%]. Esophageal varices [EV] alone represented 17.8% of causes of variceal bleeding, while combined esophageal and gastric varices represented 39.5% and isolated gastric varices 12.8%. Gastric lesions were the most common causes of non variceal bleeding. Recurrence of bleeding occurred in 19.4% of variceal group in comparison to 6.1% of non variceal group, while mortality was found in 4.3% of variceal group in comparison to 1.5% of non variceal group with very highly significant difference [P <0.001]. Hypertension, ascites, EV columns, EV grade IV, presence of gastric varices and associated respiratory disorder were independent factors as-sociated with recurrence of bleeding in variceai group. In non variceal group, recurrence of bleeding was significantly related only to the presence of gastric ulcers [P=0.035]. Independent factors associated with mortality in studied patients were age, associated diabetes, presence of esophageal varices and associated duodenal ulcer

Sonographic study of gall bladder function in patients with chronic liver disease and its relation to gall stone formation

Gall stones occur in about 30% of patients with cirrhosis, gall stones are often asymptomatic in liver cirrhosis, and the hypothesis of diminished gall bladder contractility in chronic liver disease may explain the high frequency of asymptomatic gall bladder stones. The present study was designed to evaluate ultrasonographically the alteration of gall bladder contractility and whether there is a relation between this alteration and cholelithiasis in chronic liver disease. Twenty selected male patients with hepatosplenic involvement in addition to 20 healthy male control of age matched they were divided into 3 groups: Group 1: Chronic liver disease [CLD] with gall stones [10 patients]. Group 2: CLD without gall stones [10 patients]. Group 3: Healthy controls [20]. Ultrasonographic examination was performed, fasting and one hour after a standard fatty meal, G.B. volume was calculated as follow: Vol. = Lx Wx Hx TI/6 The results showed Significant increase in the fasting volume of the gall bladder when comparing group 1 and control P<0.01 Significant increase in post prandial volume comparing G1 and G2 P<0.05. Highly significant increase in postprandial volume comparing G1 and control P<0.01. Significant increase in post prandial volume comparing G2 and control P<0.05. It is concluded from this study that delayed emptying of the gall bladder is a risk factor for gall bladder stone formation in cirrhotic patients, together with other risk factors as increased age, severity of cirrhosis and increased levels of serum triglycerides, and that ultrasound is an easy, non-invasive tool for the evaluation of the gall bladder motor function