Principles of primary prophylaxis of bleeding from oesophagealvaricies in patients with liver cirrhosis

2016 ◽  
Vol 94 (7) ◽  
pp. 503-509
Author(s):  
Dmitry V. Garbuzenko
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Retrieval System ◽  
Primary Prophylaxis ◽  
Inclusion Criteria ◽  
Cochrane Reviews ◽  
Pubmed Database ◽  
Endoscopic Ligation

The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed database, Google Scholar retrieval system, Cochrane reviews, and lists of references from relevant publications for 1980-2015 using the key words «bleeding from esophageal varices», «prophylaxis», «portal hypertension». Inclusion criteria were confined to primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis. The analysis showed that the drugs of choice for primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis are non-selective beta-adrenoblockers, but their application is indicated only in case of clinicallyl significant portal hypertension in patients with large and mediumsize esophageal varices. When the use of these drugs is contraindicated, endoscopic ligation of esophageal varices can be recommended.

scholarly journals “SPLEEN STIFFNESS MEASUREMENT IN LIVER CIRRHOSIS PATIENTS FOR NONINVASIVE ASSESSMENT OF ESOPHAGEAL VARICES USING FIBROSCAN”

2020 ◽  
pp. 1-2
Author(s):  
Revathy Marimuthu Shanmugam ◽  
Vinay C ◽  
Sathya Gopalasamy ◽  
Chitra Shanmugam
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Esophageal Varix ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Surrogate Marker ◽  
Stiffness Measurement ◽  
Spleen Stiffness ◽  
Cirrhotic Patients

BACKGROUND: Many noninvasive surrogate marker for Portal hypertension or for the presence or grade of esophageal varices were studied..Splenomegaly along with splenic congestion secondary to splenic hyperdynamic circulation is seen secondary to Portal hypertension in cirrhotic patients that can be quantified by elastography. AIM:The aim of this study was to investigate whether spleen stiffness, assessed by TE, useful tool for grading chronic liver diseases and to compare its performance in predicting the presence and size of esophageal varices in liver cirrhosis patients. METHODOLOGY:86 patients with cirrhosis and 80 controls underwent transient elastography of liver and spleen for the assessment of liver stiffness (LSM) and spleen stiffness (SSM) . Upper GI endoscopy done in all Cirrhotic patients. RESULTS: Spleen stiffness showed higher values in liver cirrhosis patients as compared with controls: 58.2 kpa vs14.8 kpa (P < 0.0001) and also found to be significantly higher in cirrhotic patients compared with varices and those without varices (69.01 vs 42.05 kpa, P < 0.0001). Liver stiffness was also found to be higher in cirrhotic patients with varices when compared to patients without varices (38.5vs 21.2 kpa). Using both liver and spleen stiffness measurement we can predicted the presence of esophageal varices correctly. CONCLUSION: Spleen stiffness can be assessed using transient elastography, higher value correlated well with liver cirrhosis and presence of esophageal varices although it couldn’t correlate with grade of Esophageal Varix. Combined assessment of spleen and liver stiffness had better prediction of presence of Esophageal Varix.

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

Esophageal Varices in Chronic Intestinal Insufficiency in Absence of Portal Hypertension or Liver Cirrhosis: Case Report

2010 ◽  
Vol 42 (1) ◽  
pp. 103-105
Author(s):  
T. Yandza ◽  
S.M. Schneider ◽  
S. Novellas ◽  
L. Badan ◽  
M.C. Saint-Paul ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Case Report ◽  
Portal Hypertension ◽  
Esophageal Varices

scholarly journals THE RELATIONSHIP OF APRI SCORE (ASPARTATE AMINOTRANS FERASE-TO-PLATELET RATIO INDEX) AND PUGH CHILD SCORE

2020 ◽  
Vol 7 (2) ◽  
pp. 122-129
Author(s):  
Adelia Muhlifa Saputri ◽  
Magdaleni Agustina Rahayu ◽  
Sinta Murti
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Function ◽  
Esophageal Varices ◽  
Aspartate Aminotransferase ◽  
Secondary Source ◽  
Cross Sectional ◽  
Prognosis Of Liver Cirrhosis ◽  
Apri Score ◽  
Relationship Of

Liver cirrhosis is the last stage of chronic liver disease that is in the path of the disease can cause damage of liver function and/or portal hypertension. The prognosis of liver cirrhosis can be assessed by manifestations of liver function disorders with Child Pugh score that include the presence or absence of ascites, encephalopathy, bilirubin serum, albumin serum, and prothrombin time or INR, while portal hypertension also occurs in patient of cirrhosis can lead the formation of esophageal varices. APRI score has platelet count and AST serum as its variable is suspected to be related to the Child Pugh score in assessing prognosis of cirrhosis patients. This study purposed to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score. Purpose of this research is to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score and degree of esophageal varices in patients with cirrhosis. Method used is a retrospective analytic study with cross sectional approach. The data source is secondary source. The sample in this study were patients with liver cirrhosis who were diagnosed by a doctor and had complied the inclusion criteria. The data obtained was analyzed using ANOVA. The result of this study is include 48 cirrhosis patients, male 81,3%, with a mean age 49,98 years. The most common cause of cirrhosis is hepatitis B obtained from reactive HBsAg examination in 33 patients (68,8%). The APRI score was found to have a weak correlation (r = 0.044) and not significant (p = 0.868) with the Child Pugh score. The APRI score do not able to assess the prognosis in advanced cirrhotic patients.

scholarly journals The possibility of introducing a normal pregnancy and delivery in patients with established liver cirrhosis

2021 ◽  
Vol 12 (2) ◽  
pp. 621-625
Author(s):  
N. Ghukasyan ◽  
A. Zohrabyan ◽  
A. Poghosyan ◽  
He. Khachatryan
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Esophageal Varices ◽  
Varicose Veins ◽  
Mode Of Delivery ◽  
Normal Pregnancy ◽  
Infectious Complications ◽  
Vacuum Extraction

The management of pregnant women with portal hypertension is challenging. In the second trimester, examinations are performed to identify esophageal varices. There are no clear recommendations regarding the primary prevention of bleeding in case of esophageal varices in pregnant women and management in case of bleeding. There are no recommendations on the preferred mode of delivery (vaginal or caesarean section) for portal hypertension. Since the persistent period is undesirable in the presence of varicose veins, it is recommended, if necessary, to shorten the second stage of labor by applying obstetric forceps or performing vacuum extraction of the fetus. In the presence of obstetric indications, a caesarean section is performed, which is also associated with certain risk; since cirrhosis often has varicose veins of the abdominal wall. In addition there is a tendency to bleed during childbirth, infectious complications, and slow wound healing. Because of possible medical contraindications and difficulty of prenatal management and delivery of patients with established liver cirrhosis, there are many cases of patients concealing their diagnosis when planning pregnancy and visiting a gynecologist, which, undoubtedly, can lead to concomitant complications and serious consequences that threaten the lives of patients. The clearest example of the above is the following patient case.

scholarly journals Elastography in the diagnosis of portal hypertension in patients with liver cirrhosis

2017 ◽  
Vol 89 (2) ◽  
pp. 33-37
Author(s):  
E O Liusina ◽  
Ch S Pavlov ◽  
V T Ivashkin
Keyword(s):  
Liver Cirrhosis ◽  
Hepatitis C Virus ◽  
Portal Hypertension ◽  
Hepatitis C ◽  
Diagnostic Accuracy ◽  
Esophageal Varices ◽  
Alcoholic Liver Cirrhosis ◽  
Abdominal Ultrasonography ◽  
Blood Indices ◽  
Viral Hepatitis C

Aim. To establish the diagnostic accuracy of liver and spleen density (LD and SD) measurements in patients with compensated alcoholic liver cirrhosis (LC) in the diagnosis of portal hypertension. Subjects and methods. The investigation enrolled 83 patients with compensated alcoholic and viral (hepatitis C virus) LC. All the patients underwent LD and SD determinations, abdominal ultrasonography, and endoscopy to detect esophageal varices (EV), as well as examination of blood indices. Results. In viral LC, there were substantial LD differences in patients with and without EV. The patients with EV were ascertained to have higher LD [27.9 (21—45) kPa] than those without EV [19.5 (16—26.2) kPa]. SD was also significantly higher than that in the EV group than in the non-EV group (p

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