الفهرس 
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Abstract
Portal hypertension commonly accompanies the presence of liver cirrhosis, and the development of oesophageal varices (OV) is one of its major complications. The prevalence of OV in patients with liver cirrhosis may range from 60% to 80%, and the reported mortality from variceal bleeding ranges from 17% to 57%.
In the 1996 the American Association for the Study of Liver Disease single topic symposium stated that cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. The Baveno III Consensus Conference on portal hypertension recommended that all cirrhotic patients should be screened for the presence of OV when liver cirrhosis is diagnosed. Other authors have suggested repeating endoscopy at 2–3 year intervals in patients without varices and at 1–2 year intervals in patients with small varices so as to evaluate the development or progression of this feature.
In order to reduce the increasing burden that endoscopy units will have to bear, some studies have attempted to identify characteristics that non-invasively predict the presence of any OV or of large OV. These studies have shown that biochemical, clinical, and ultrasonographic parameters alone or together have good predictive power for non-invasively assessing the presence of OV.
Overall, the most common result of these studies was that parameters directly or indirectly linked to portal hypertension, such as splenomegaly and decreased platelet count were predictors of the presence of OV. However, in patients with chronic liver disease the presence of decreased platelet count may depend on several factors other than portal hypertension, such as shortened platelet mean lifetime, decreased thrombopoietin production, or myelotoxic effects of alcohol or hepatitis viruses. On the other hand, the presence of splenomegaly in cirrhotic patients is likely the result of vascular disturbances that are mainly related to portal hypertension.
It may be more cost-effective to routinely screen only cirrhotic patients at high risk for the presence of varices. Several studies have revealed factors that predict risk for first variceal haemorrhage, namely, high Child-Pugh score, variceal size, signs of variceal wall thinning, presence of gastric varices, presence of portal hypertensive gastropathy, and high hepatic vein pressure gradient. However, factors that predict the presence of varices are not as well defined.
The aim of the present study was to identify haematological , biochemical and ultrasonographic predicators of oesophageal varices in patients with liver cirrhosis. In this study four factors were evaluated including platelet count, seum albumin, portal vein diameter and spleen size as well as their correlation with presence of oesophageal varices and its grade.
This study was conducted on 50 patients with liver cirrhosis diagnosed by abdominal ultrasound and then further classified according to Child – Pugh scoring into three groups, the group I consisted of twenty patients, all of them were Child A. The group II compromised of twenty patients, all of them were Child B and the group III consisted of ten patients, all of them were Child C.
All patients were subjected to the following:
I- Clinical evaluation focusing on:
A- Proper and detailed history taking about the presenting symptoms (fatigue, dyspepsia, anorexia, yellowish discoloration of eye, abdominal distension and right hypochondrial pain)
B- Thorough clinical examination with particular stress on the size of the liver and spleen as well as the presence of ascites.
II-Routine laboratory investigations including:
A- Complete blood picture: Haemoglobin concentration, red blood cells count, white blood cells count and platelet count.
B- Liver function tests: serum alanine transferase (ALT), serum aspartate transferase (AST), serum bilirubin, serum albumin, Albumin/Globulin ratio (A/G ratio), prothrombin activity and serum alkaline phosphatase.
C- Renal function tests: blood urea and serum creatinine.
D- Erythrocyte sedimentation rate.
E – Serum sodium and potassium.
III- Doppler ultrasound examination of the abdomen focusing on:
Liver echopattern (normal, bright or coarse), presence of splenomegaly, ascites and portal vein diameter.
IV- Upper GIT endoscopy was done for all patients.
V - Liver biopsy was done for patients whenever possible and their informed consent was taken.
Statistical analysis of data obtained from the present study revealed the following results:
• Our results revealed that , the number of patients with oesophageal varices were 44 patients (88%) and those without varices were 6 patients (12%) , in group I ( eleven patients with grade I varices , four patients with grade II varices and five of them without varices ) , in group II ( nine patients with grade I varices , ten patients with grade II varices and one patient without varices ) and in group III ( eight patients with grade II varices and two patients with grade III varices ) .
• The mean of platelet count was significantly lower in patients with varices than those without varices, as well as the mean of platelet count in groups II and III were significantly lower than in group I. Moreover it was significantly lower in group III than in group II.
• There was a significant negative correlation between grading of O.V. and platelet count in the three studied groups. The sensitivity of low platelet count for prediction of O.V. was 75 % with specificity of 50 % and a positive predictive value of 83.3 %.
• The mean of platelet count / spleen diameter ratio was significantly lower in patients with varices than those without varices , as well as the mean of platelet count / spleen diameter ratio in groups II and III were significantly lower than in group I .
• There was a significant negative correlation between grading of O.V. and platelet count / spleen diameter ratio in the three studied groups. The sensitivity of low plaelet count / spleen diameter ratio for prediction of varices was 93% with specificity of 50% and a positive predictive value of 93%.
• The mean serum albumin was significantly lower in patients with varices than those without varices and the mean value of serum albumin in groups II and III was significantly lower than in groups I. Furthermore, there was significant negative correlation between grading of O.V. and serum albumin in groups I and II.
• The mean value of portal vein diameter was significantly higher in patients with varices than those without varices and the mean portal vein diameter was significantly higher in those with grade II than in grade I varices. Moreover, in group III the mean of portal vein diameter was significantly higher in those with grade III than in grade II varices.
• There was significant positive correlation between grading of O.V. and portal vein diameter in the three studied groups.The sensitivity of portal vein diameter for prediction of varices was 95 % with a specificity of 33.3 % and positive predictive value of 82.6 %.
• The mean of spleen size was significantly higher in those with varices than in those without varices and the mean of spleen size was significantly higher in those with grade II than in grade I varices. While in group III, the mean of spleen size was significantly higher in those with grade III than in grade II varices.
• There was significant positive correlation between grading of O.V. and size of spleen in the three studied groups.The sensitivity of splenomegaly for prediction of varices was 90 % with specificity of 33.3% and positive predictive value was 81.8%.