Sinrasu, P (2019) Study of Right Lobe of Liver Diameter to Albumin Ratio as a Non-Invasive Predictor of Oesophageal Varices in Patients with Liver Cirrhosis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: One of the most dreaded complications of liver cirrhosis is oesophageal varices which is a result of portal hypertension. It carries a very high risk of mortality (20 to 35%). The risk of developing oesophageal varices in cirrhotic patients over their life time amounts to about 5 to 15 percent per year and the rate of progression from small to large varices amounts to 8 percent per year. Therefore early identification and grading of varices remains the foremost step for risk assessment and thereby prevention of mortality. AIMS & OBJECTIVES: 1. To study the value of biochemical and ultra sonographic parameters in prediction of presence and size of oesophageal varices. 2. Right lobe of liver to albumin ratio can be used as a screening tool to suspect the presence of oesophageal varices. MATERIALS AND METHODS: Setting: The study was conducted on 100 patients admitted in Government Rajaji Hospital & Madurai Medical College during the study period from March 2018 to August 2018. Design of Study: Prospective analytical study. Participants: Patients of age > 18yrs, admitted as in-patients at Govt. Rajaji hospital, Madurai who are diagnosed as cirrohosis. Inclusion Criteria: All patients aged 18 years and above diagnosed to have cirrhosis of liver admitted in Medicine Department and Medical Gastroenterology department. Exclusion Criteria: 1. Previous history of portal hypertensive bleeding, hepatocellular carcinoma, portal vein thrombosis. 2. Previous or current treatment with β blockers, diuretics or other vasoactive drugs. 3. Budd Chiari Syndrome and other causes of non-cirrhotic portal hypertension. Anticipated Outcome: Increased right lobe of liver diameter to serum albumin ratio correlates with the severity of varices in cirrhosis patients. DISCUSSION: Among the study population of 100, about 42% belong to the age group of 40 to 50. Among 100, there were 90 male and 10 females. In this study, Alcoholism is the most common etiology contributing about 56% which is followed by viral 32%. The serum bilirubin values of most patients about 48% lie between 7-9 mg/dl. Serum albumin levels of most of the patients about 38% fall between 3-4 g/dl. About 38% fall under category B of Child Pugh classification. The right lobe liver diameter of about 44% of patients fall between 9-11cm. The F/H ratio of about 42% of patients falls within 5-7. About 40% of the study population have been found to have grade 2 varices. The standard deviation of the study population of 42% whose values fall with within F/H ratio of 5-7 is found to be 1.36. For those with grade 3 varices when compared with right lobe liver diameter the standard deviation obtained is 1.42 which corresponds to a p value of 0.033 which is significant. It proves that there is direct correlation between right lobe liver diameter and oesophageal varices. For those with grade 3 varices when compared to F/H ratio with a mean value of 7.96 the standard deviation obtained is 1.34 which corresponds to the p value of < 0.001which is significant. The correlation coefficient is found to be 0.86 which is a good correlation. The right lobe liver diameter is a very easy parameter that can be measured simply as a part of ultrasound abdomen and serum albumin levels are measured as routine biochemical investigation. Thus this method requires parameters which can be easily detected without any additional efforts and thereby carries increased compliance. CONCLUSION: Higher grades of oesophageal varices was noted with higher right lobe of liver diameter to albumin ratios. Thus the Right lobe of liver to albumin ratio can be used as a screening tool to diagnose the presence of oesophageal varices. Hence, this can identify subset of patients who require prophylactic endoscopic management. Therefore, this reduces the economic burden on the patients and reduces the cost of management.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Right Lobe of Liver Diameter, Albumin Ratio, Non-Invasive Predictor, Oesophageal Varices, Liver Cirrhosis. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Aug 2019 02:45 |
| Last Modified: | 31 Aug 2019 15:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11245 |
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