Examination of gastroesophageal regurgitation in the chronic liver disease patient.

Background: Chronic liver disease (CLD) is commonly encountered by physicians in hospital practice. Hepatic encephalopathy is a serious complication of chronic liver disease, arising most commonly in those with advanced liver cirrhosis. In patients with otherwise stable cirrhosis, hepatic encephalopathy often follows clearly identifiable precipitating events. The aim of study is to find out the precipitating factors and their frequency in patients of CLD presenting with hepatic encephalopathy to prevent mortality and morbidity.Methods: This descriptive observational study was carried out to identify the precipitating factors and their frequency among 50 cases of diagnosed chronic liver disease presenting with hepatic encephalopathy at department of Medicine of Sir Salimullah Medical College & Mitford hospital, Dhaka from July 2012 to December 2012 for a period of 6 months.Results: Among 50 patients, 36 patients (72%) were male, 14 (28%) were female. Study showed that age frequency 14 (28%) were from 41-50 years and 08 (16%) were from 51-60 years, 12 (24%) >60 years of age. Out of 50 patients, the etiology of liver cirrhosis was hepatitis B virus in 28 (56%), hepatitis C virus in 4 (8%), both Hepatitis B & C in 02 (4%) Among 50 patients, 13 (26%)were in Grade-3 and 11 (22%) in Grade-2 Hepatic encephalopathy. According to Child-Pugh scoring 16 (32%) in Grade-C & 09 (18%) in Grade-B. The most common precipitating factors were identified as GI bleeding (28%), Infection (26%), mixed (16%) & unknown (20%). In this study, mortality rate was 32% most of the patients from Child-Pugh class-C.Conclusions: Commonest precipitating factors of hepatic encephalopathy in this study were upper G.I. bleeding, infection, mixed factor and electrolyte imbalance. To prevent hepatic encephalopathy caution must be exercised in putting chronic liver disease patient on diuretics. Early and effective infection control measures and better hygienic conditions in government hospitals are needed to be maintained.J MEDICINE Jan 2018; 19 (1) : 10-14

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Child Pugh Score as a Predictor of Large Oesophageal Varices in Chronic Liver Disease Patients

Nepal Medical Journal ◽

10.37080/nmj.83 ◽

2020 ◽

Vol 3 (1) ◽

pp. 37-41

Author(s):

Awasthi Girish ◽

Tirtha Man Shrestha

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Tertiary Care ◽

Disease Patient ◽

Chronic Liver ◽

University Teaching ◽

Oesophageal Varices ◽

Variceal Hemorrhage ◽

Abdominal Sonography

Introduction: Variceal hemorrhage is a major complication of chronic liver disease. If patients at low or high risk of having esophageal varices (EV) could be identified by the Child Pugh score in predicting the size of oesophageal varices in patients with chronic liver disease. The main objective of this study was to determine whether Child Pugh Score can be used as a predictor of large oesphageal varices in chronic liver disease patient. Methods: A prospective cross-sectional study was conducted in emergency and medicine ward of Tribhuvan University Teaching Hospital from August 2015 to December 2015 with diagnosed chronic liver disease without history of previous medication for varices and any surgical intervention were studied. Patients underwent physical examination, hematological and biochemical tests and abdominal sonography and upper gastrointestinal endoscopy. Presence and absence of esophageal varices size was noted and correlation with Child Pugh Score and it’s associated variables studied. Results: Alcoholic liver disease was the major cause for chronic liver disease with most common age group involved being 41-50 years and 72% prevalence of esophageal varices. A statistically significant association was found between oesophageal varices grade and Child-Pugh’s classification grades i.e., the higher grade of oesophageal varices is associated with advanced grade of Child’s classification. Conclusions: Child Pugh Score had a predictive value to diagnose esophageal varices in chronic liver disease patients. The predictive accuracy as compared to the gold standard test “UGI endoscopy” showed that these parameters cannot replace endoscopy as the diagnostic test but can be used as a screening tool especially in a country like Nepal where availability of endoscopy facilities and access to tertiary care hospitals is an issue.

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