الفهرس 
Portal HypertensionOnly 14 pages are availabe for public view
 |  | from | 228 |  |  |
| | | from | 228 | | |
Abstract
Portal hypertension is a common clinical syndrome, which is hemodynamically defined by a pathological increase of the portal pressure gradient and by the formation of portal–systemic collaterals that shunt part of the portal blood flow to the systemic circulation bypassing the liver, normal values of the portal pressure gradient are of 1-5 mmHg (Bosch et al., 2008). The development of esophageal varices in patients with cirrhosis occurs when the hepatic venous pressure gradient is greater than 10 mmHg (Groszmann et al., 2005) and the clinical relevance of esophageal varices is linked to the risk of bleeding that occurs when hepatic venous pressure gradient is greater than 12 mmHg (De Franchis, 2003). Esophagogastroduodenoscopy, though invasive, remained the gold standard for screening of esophageal varices in cirrhotic patients over many years. EGD directly visualizes esophageal varices and signs of impending rupture. (González-Ojeda et al., 2014) Many studies have been carried out to evaluate several non invasive methods for screening of esophageal varices.
Our study was carried out on 200 patients with post hepatitis C virus chronic liver disease, admitted at Ain Shams University Hospitals.
The aim of this work was to study the value of insulin resistance, portal congestion index, Right liver lobe diameter/INR ratio, Right liver lobe diameter/Serum Albumin ratio and platelet count/Splenic bipolar diameter ratio as noninvasive predictors of presence of esophageal varices and their risk of bleeding. The patients were divided into four groups: group I included 50 patients of Child A liver cirrhosis with no history of bleeding esophageal varices, group II included 50 patients of Child B liver cirrhosis with no history of bleeding esophageal varices, group III included 50 patients of Child C liver cirrhosis with no history of bleeding esophageal while group IV included 50 patients with history of bleeding esophageal varices of various Child scores. A fifth group (group V) was defined following upper gastrointestinal endoscopy including 105 patients with esophageal varices with no bleeding history out of groups I, II, and III. All the patients were subjected to full history taking, physical examination, routine laboratory investigations including liver function tests, renal function tests, coagulation profile, complete blood count, fasting blood sugar, fasting blood insulin, HCV antibody, HBsAg, and HOMA-IR calculation, as well as abdominal ultrasonography and measurement of right liver lobe diameter and spleen bipolar diameter, Doppler ultrasound measurement of the portal vein and PCI and upper gastrointestinal endoscopy and calculation of right liver lobe diameter/albumin ratio and right liver lobe diameter/INR ratio.
Our results revealed insulin resistance, portal congestion index, Right liver lobe diameter/ INR ratio, Right liver lobe
diameter/ Serum Albumin ratio and platelet count/ Splenic bipolar diameter ratio were able to differentiate between patients with no esophageal varices and patients with non bleeding esophageal varices in Child A patients with sensitivity 95.8% 100%, 83.3% , 91.7% and 95.8% respectively, specificity 50.8%, 68.5%, 63.8 %, 67.7% and 66.2% respectively While in Child B patients, insulin resistance, portal congestion index, Right liver lobe diameter/ INR ratio, Right liver lobe diameter/ Serum Albumin ratio and platelet count/ Splenic bipolar diameter ratio were able to differentiate between patients with no esophageal varices and patients with non bleeding esophageal varices in Child B patients with sensitivity 93.3% 96.3%, 80% , 100% and 95.3% respectively, specificity 50 %, 54.3%, 77.1 %, 48.6% and 75.7% respectively In Child C patients platelet count/ splenic bipolar diameter ratio was able to differentiate between patients with no esophageal varices and patients with non bleeding esophageal varices with sensitivity 100% and specificity 68.2% Our results revealed insulin resistance, portal congestion index, and platelet count/ Splenic bipolar diameter ratio were able to differentiate between patients with esophageal varices with no bleeding history and patients with history of bleeding esophageal varices with sensitivity 98%, 90.5%, and 96% respectively and specificity 42.9%, 78%, and 74.8% respectively.