Ramprasath, R (2020) A Study of Non-Invasive Prediction of Large Oesophageal Varices in Chronic Liver Disease patients in Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Portal hypertension is a major hallmark of cirrhosis which can be defined as a portal pressure gradient exceeding 5-10 mm Hg. In portal hypertension, portosystemic collaterals decompress the portal circulation and give rise to varices. In patients with cirrhosis and portal hypertension, esophageal varices and gastrointestinal bleeding represents a serious complications leading to mortality. 40% of the patients with compensated disease and 60% of the patients with decompensated disease had esophageal varices at diagnosis. AIMS AND OBJECTIVES: 1. To study the incidence of large and small esophageal varices in patients with liver disease. 2. To evaluate various clinical, biochemical and ultrasonographic parameters in predicting the presence of large esophageal varices. 3. To evaluate the sensitivity and specificity of each of the parameters in predicting large esophageal varices. MATERIALS AND METHODS: Patients: Consecutive newly diagnosed patients with liver disease (cirrhosis / portal hypertension) with or without history of gastrointestinal bleeding at our institution (Institute of Internal Medicine, Rajiv Gandhi Government General Hospital, Chennai) which serves as a tertiary referral center were included in this prospective study. Patients were asked to sign an informed consent prior to enrollment in the study. Inclusion criteria: ◈ Age: 18 years to 80 years. ◈ Liver disease with portal hypertension. Exclusion criteria: ◈ Hepatocellular carcinoma detected by USG. ◈ Primary hematologic disorders. ◈ Current treatment with beta blockers/ nitrate. ◈ Previous surgical intervention for portal hypertension. Clinical Evaluation: All patients underwent a detailed clinical evaluation at entry. Relevant history, etiology of liver disease (alcohol intake, blood transfusion etc.,), and signs of liver cell failure such as alopecia, anemia, jaundice, parotid swelling, gynaecomastia, testicular atrophy, palmar erythema, pedal edema, ascites, splenomegaly were recorded. By ultrasonography of abdomen, mild ascites were noted. Moderate and massive ascites were detected clinically by shifting dullness and fluid thrill. According to West Havens Criteria, encephalopathy were noted. CONCLUSION: 1. The prevalence of large esophageal varices in our study was found to be 49.15% 2. Our study shows that low platelet count, splenomegaly, portal vein and splenic vein size are independent predictors. 3. Use of these parameters help identify patients to perform endoscope for patients only with a high risk of large esophageal varices. 4. These parameters help in avoiding unnecessary endoscopies. 5. This may help reduce costs which will be economical. 6. If its efficacy is confirmed, it may permit institution of prophylactic measures like beta-adrenergic antagonists for preventing primary variceal bleeding in patients with liver cirrhosis, without the need for costly and invasive investigations like gastrointestinal endoscopy.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201711014 |
| Uncontrolled Keywords: | Non-Invasive Prediction, Large Oesophageal Varices, Chronic Liver Disease patients, Tertiary Care Hospital. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Jan 2021 07:54 |
| Last Modified: | 28 Jan 2021 07:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13213 |
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