الفهرس 
Introduction&Aim of the workOnly 14 pages are availabe for public view
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Abstract
Acute bleeding from esophageal varices is a major complication of cirrhosis, despite the large number of published studies, no predictive factors of bleeding have been identified (Ingrand eta, 1998). So, prevention of variceal bleeding, a major cause of morbidity and mortality is an important goal in the management of patients with portal hypertension (De BK et aI., 1999) Our study is conducted on:- 1- Forty patients with chronic liver disease whom were diagnosed by upper GIT endoscopy as first variceal bleeders with mean age 48.5±14 years 27 male and 13 females (group I). 2- Twenty patients with chronic liver disease whom were diagnosed as variceal patients by upper GIT endoscopy but did not experience hematemsis and/or melena before with mean age 50± 13 years 14 male and 6 female (group II). • Our study is aiming at detection of risk factors that affect occurrence of first variceal bleeding. To varify different parameters for prediction of first variceal bleeding in cirrhotic patients clinically, biochemically, endoscopically and hemodynamically. • To evaluate the efficiency of these parameters in predicting first variceal bleeding. • Our study found that first variceal bleeding is related to old age group which can be explained by impaired nutrition, poor healing with poor hepatic reserve and high morbidity and mortality of elderly patients that put them at high risk. • Erosive and eruptive mechanisms are potential explanation for variceal bleeding by detecting significant increase of non-steroidal anti-inflammatory drugs intake in group I than group II with increase incidence of significant physical exercise in group I compared to group II. • Clinical predictors for first variceal bleeding as significant increase in splenic size, ascites, bleeding tendency, anterior abdominal wall dilated veins and telangiectasia were all proved. • Also our study shows more worsening of liver condition with advanced Child Pugh scoring in group I compared to group II which could be a good predictor for first variceal bleeding and help also in evaluation of its prognosis and recurrence. • Thrombocytopenia and impaired coagulation status are good predictors for first variceal bleeding where thrombocytopenia and prolongation of prothrombin time show significant difference in group I compared to group II.