الفهرس 
PORTAL HYPERTENSION
Other Imaging ModalitiesOnly 14 pages are availabe for public view
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Abstract
Background: Portal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices (EV) is one of its major complications. The prevalence of esophageal varices in cirrhotic patients ranges between 24% and 69% according to the degree of liver dysfunction (De Franchis and Primignani, 2001). The incidence of EV development is approximately 5% per year in patients with cirrhosis and the progression from small to large varices occur in 10% to 20% of cases after 1 year (De Franchis, 2003). In Egypt, it was found that the incidence of varices among portal hypertension patients was 77% (Hunter et al., 1998).
Objective: He aim of this study is to evaluate the usefulness of PAPAS index (Platelet/Age/ Phosphatase/AFP/AST) to predict for the presence of EV in HCV related cirrhotic patients
Patients And Methods
Study design: Cross-sectional study.
Sampling:
a- Sample size: one hundred (100) patients.
b- Sampling method: Patients with HCV related chronic liver disease admitted to Ain Shams University Hospitals, Tropical Medicine Department or attending the outpatient clinics during the period from Jan 2016 to December 2017 were enrolled in this study.
Tools of the study:
All patients were subjected to:
A. Complete history taking.
B. Thorough clinical examination: for manifestations of chronic liver disease and/ or liver cell failure including organomegaly and ascites.
C. Laboratory investigations: including CBC (including platelet count), ALT, AST, serum albumin, serum bilirubin, prothrombin time and INR, antibilharzial Ab, HBsAg, HCV-Ab and kidney function test.
D. Abdominal ultrasonography: This was done using Toshiba ”Just vision” real-time scanner instrument with a 3.5 MHz convex transducer
E. Upper Gastrointestinal Endoscopy:
F. To evaluate the presence and degree of varices in addition to any relevant upper GIT lesions. Pentax EG-3440 videoscope system was used. The endoscopic study was performed by the same examiner in all patients to avoid interobserver variability.
Esophageal varices (EV) were classified according into small or large varices (small; the varices can be depressed by endoscope, large; the varices cannot be depressed by endoscope and/or confluent around the circumferential).
Results: The present study was conducted on 100 consecutive patients with chronic liver disease admitted to Ain Shams University Hospitals, Tropical Medicine Department or attending the outpatient clinics with stigmata of chronic liver disease due to HCV based on clinical, laboratory and radiological data
Conclusion: APAS index had the best diagnostic performance to predict presence of EV in liver cirrhosis in comparison to the other studied models (with sensitivity 86%% and specificity was 93.33% with the best cut off point value >0.3, furthermore, the sensitivity of PAPAS index for prediction of large EV was 87%, specificity was 71.2% with the best cut off point value >0.3056) that may aid in further improvement of the quality of noninvasive screening of EVs and high risk EVs and in further reduction of endoscopic requirement.