[A method for identification of liver cirrhosis of alcoholic etiology]. / Metodo di identificazione della etiologia alcoolica della cirrosi epatica.

There is a significant association between the pro capita alcohol consumption and cirrhosis mortality rate. Cirrhosis usually develops after years of excessive drinking, although in many alcoholic men it never develops, even after decades of drinking. The admission of large amounts of alcohol beverages is very difficult for many patients. This is a serious problem. In order to make easier the diagnosis in those patients, the authors have studied a composed, arbitrary score for alcoholism risk. The diagnosis with only laboratory findings was worse than that with an additional alcoholism risk score, in 48 cirrhotic patients with doubtful history of alcoholic etiology. The alcoholic risk score was based on presence/absence of: 1) car driving or working accidents; 2) familiar or love problems; 3) alcoholic relatives; 4) other alcohol-correlate disease; 5) job type.

[Serum concentration of bile acids and portal hypertension in cirrhotic patients. Possible correlations]. / Concentrazione sierica degli acidi biliari e ipertensione portale di pazienti cirrotici. Possibile correlazione.

For the detection of mild liver disease (acute viral hepatitis, chronic persistent hepatitis, fatty liver) serum bile acids levels have not proved to be superior to transaminases or other common liver tests with almost similar sensitivity and/or specificity. Indeed it has been possible to show in patients with compensated cirrhosis of the liver that the serum bile acids concentration is related to the degree of intrahepatic shunts and that there was a significant relationship between the fasting serum bile acids and the intrinsic clearance of ICG. Measurement of serum bile acids appear to be more sensitive for detection of cirrhosis than commonly used tests. The elevation of bile acids concentration in cirrhotic patients is thought to result from a reduced hepatic clearance and/or from portosystemic shunting. In order to determine the role of serum bile acid estimation in the indirect assessment of portal hypertension, fasting and two-hour postprandial serum bile acids concentration were measured in 36 patients with liver cirrhosis, classified according to Child-Pugh's criteria. Real time ultrasonography, esophagogastroscopy and static liver scintigraphy of the liver were carried out in all patients. The size of esophageal varices, the portal vein and its related structure, the nuclear criteria were graded according to the common methods. Between the clinical findings, splenomegaly, was noted and graded, though the size of spleen does not correlate well with the level of portal pressure. In our patients a good correlation (p less than 0.001) existed between the two hour postprandial bile acids concentration and ultrasonographic findings of portal hypertension. Fasting serum bile acids (SBA) were significantly higher in severe than in mild liver cirrhosis according to Pugh's criteria (p less than 0.001). In conclusion we think that SBA concentrations have a great prognostic value in assessment of major complications (upper gastrointestinal hemorrhage particularly). The reduced liver blood flow, for intra-and extrahepatic porto-systemic shuntings, is probably the main cause of reduced hepatic clearance of bile acids.