Correlation between Serum-Ascites Albumin Gradient and Esophageal Varices in Portal Hypertension due to Cirrhosis of Liver

Introduction: Cirrhosis of the liver is a major health problem in our country. Patients with cirrhosis are at risk of developing esophageal varices and variceal bleeding with high mortality. They must undergo routine upper gastrointestinal endoscopy to screen for the presence of varices. This poses an economic, social, and medical burden. Thus, this warrants a non-invasive predictor of esophageal varices in a cirrhotic patient. The aim of this study was to find the correlation between SAAG and esophageal varices in portal hypertension due to cirrhosis of liver. Methods: Patients (45 males and 35 females) above 18 years of age and with cirrhosis of the liver underwent cross sectional observational study at Nepal Medical College Teaching hospital between October 2015 and December 2017 AD. Serum albumin and ascitic fluid albumin were analyzed on the same day and serum-ascites albumin gradient (SAAG) was calculated. Upper GI endoscopy was done to evaluate for the presence of esophageal and gastric varices. Pearson's chi-square test was applied to see the relation between SAAG and esophageal varices. Results: Among the 80 patients studied, 56.2% were male and 93.75% had varices. Majority of the patients who had esophageal varices had SAAG of more than 1.1 g/dL. A positive correlation was found between serum-ascites-albumin gradient and esophageal varices but was statistically not significant. A cut-off of >1.6 for SAAG to discriminate between presence and absence of varices yielded a sensitivity of 78.66% and a positive predictive value of 92.18%. Conclusion: This study highlighted that SAAG has a positive correlation with esophageal varices with high sensitivity and positive predictive value in estimating the presence of varices but without statistical significance. It has a low specificity. Due to statistically insignificant correlation and low specificity, SAAG cannot be used in place of upper GI endoscopy in diagnosing gastroesophageal varices

P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS

Aim To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites. Material and Methods Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices. Results In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain. Conclusions TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.

Experimental portal hypertension and portocaval anastomosis

The problem of the pathogenesis and treatment of portal hypertension and cirrhosis of the liver is one of the most complex and difficult chapters of modern medicine. The difficulty lies both in the variety of etiological and pathogenetic features of this syndrome, and in the low effectiveness of conservative and surgical methods of treatment.

Secondary biliary cirrhosis of the liver: case from clinical practice

Presents a clinical case of a patient developing secondary biliary cirrhosis due to prolonged extrahepatic cholestasis caused by cholelithiasis and the presence of choledocholithiasis, which is rare. The article describes the characteristics of secondary biliary cirrhosis of the liver. The course of the disease is considered, the data of laboratory and instrumental studies carried out on the patient in various clinics are analyzed.

Effect of lisinopril on indicators of electrocardiographic and echocardiographic studies in patients with liver cirrosis

Chronic diffuse liver diseases (CDLD) of various etiologies remain a serious socio-economic and clinical-epidemiological health problem. Every year more than 1 million people die from cirrhosis of the liver of various etiology all over the world. According to the results of a study by a group of authors, it was found that in the Siberian Federal District there is an unfavorable situation in terms of gastroenterological mortality, in particular, hepatological mortality. CCM is characterized by lengthening of the QT interval, electromechanical dyssynchronization, and chronotropic insufficiency. The duration of the QTc interval in the subgroup of patients with liver cirrhosis who received basic therapy and the drug lisinopril (Diroton) was (418.21 ± 2.74 ms) and was significantly lower than in the subgroup of patients receiving only basic therapy. Evaluating the parameters of transthoracic echocardiography among patients with liver cirrhosis, it was noted that during treatment with basic drugs in combination with lisinopril (Diroton), the volume of LV EDV significantly decreased (p < 0.05). The appointment of an ACE inhibitor lisinopril to patients with cirrhosis of the liver as part of complex therapy leads to an improvement in general well-being, a decrease in shortness of breath, an increase in exercise tolerance, an improvement in basic laboratory parameters, as well as an improvement in some morphometric parameters (EDV) and cardiac electrical systole.

Clinical and morphological case of developing liver cirrhosis associated with viral hepatitis in a young patient

The significance of chronic hepatitis is determined not only by the disease per se, but also by the increased risk of the formation of long-term adverse effects such as liver cirrhosis. Viral cirrhosis of the liver (as the outcome of chronic hepatitis B, C, B + D) comprise from 10% to 24.5% of all liver cirrhosis cases. Cirrhosis of the liver is considered as an irreversible stage of chronic hepatitis, more often observed in men above 40 years, but recently more and more its cases are found in young, working ones leading to disability. Due to the high liver regenerative potential, a prognosis for liver lesions of different etiologies may be rather favorable. As a result, early diagnostics, dynamic monitoring and the use of promising methods for treating liver pathology to stimulate its regeneration that compensates for lost liver functions are necessary. In the clinical and morphological case, pathomorphological changes in organs with liver cirrhosis, which developed as a result of viral hepatitis are described. The aim of the study was to describe pathomorphological changes in organs during liver cirrhosis, which developed due to viral hepatitis, which led to multiple organ failure in a young patient. Materials and methods. The analysis of the obtained accompanying medical documentation (outpatient card, medical history) was performed. The standard methodology of autopsy was used. To process histological sections of autopsy material, hematoxylin-eosin staining was used. Results. Histological examination in the liver shows development of portal tract fibrosis with lymphohistio cytic infiltration, formation of monolobular regenerated nodes, signs of edema, areas of demyelination, dystrophic changes in neurocytes, signs of acute renal failure, a combined profound change in the kidneys detected in the lungs and brain, which resulted in multiple organ failure and subsequent lethal outcome in a young patient. The early formation of portal hypertension with liver cirrhosis, esophageal and gastric varicose veins dilatation lead to fatal bleeding in half of patients. Therefore, timely diagnosed cirrhosis and hepatitis as their predecessors is one of the most relevant issues in medicine.