Diagnostic utility of venous ammonia, spleen size and platelet count as non invasive markers of porto systemic collaterals in cirrhotics.

Babu Kumar, S (2011) Diagnostic utility of venous ammonia, spleen size and platelet count as non invasive markers of porto systemic collaterals in cirrhotics. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Portal hypertension is defined as portal pressure gradient of more than 6 mm Hg. The hypertensive portal vein is decompressed by diverting up to 90% of the portal flow through portasystemic collaterals back to the heart resulting in enlargement of these vessels. These vessels are commonly located at the gastro esophageal junction where they lie subjacent to the mucosa and present as gastric and esophageal varices. Duodenum, rectum, retroperitoneum are the other important sites where significant collaterals form due to portal hypertension. However, due to their higher resistance and increased portal venous inflow, these collaterals are unable to decrease the hypertension. Demonstration of the existence and extent of portosystemic collaterals is important in the management of patients with portal hypertension. The reported prevalence of esophageal varices in cirrhotic patients is variable with figures ranging between 24% and 80%, with a mean of about 60% : The prevalence of varices seems to be related to the degree of liver dysfunction, 30% for compensated patients and of 60% for decompensated patients. Because of this variability, it has been recommended that all patients with cirrhosis should be evaluated by endoscopy to ascertain the presence of portal hypertension. Studies combining venous ammonia and other non invasive predictors on Indian patients are limited. Such predictive factors may be expected to vary in different populations because of differences in the etiologies of liver cirrhosis, severity of liver disease. Therefore this study was conducted to evaluate the utility of blood ammonia, spleen size and platelet count as a predictor of esophageal varices and large spontaneous porto systemic shunt presence. AIM AND OBJECTIVES : 1. To investigate the diagnostic utility of venous ammonia levels, spleen size and platelet count as non-invasive markers of esophageal varices. 2. To correlate these markers with endoscopy findings, ultra sound features and Child- Pugh classification as indices of shunt presence. 3. To evaluate non – invasive markers in predicting large esophageal varices. 4. To evaluate non – invasive markers in predicting Gastric varices and large porto systemic collaterals. CONCLUSION : Identifying high ammonia levels in cirrhotic patients is a good non invasive marker of esophageal varices. Among the non invasive markers studied, only platelet count predicts Gastric varices, portal hypertensive gastropathy and large spontaneous shunts. Spleen size & portal vein size are sonographic markers of large esophageal varices. Simple platelet / spleen ratio is a useful predictor of large esophageal varices. Non invasive predictors are safe, acceptable, patient friendly method of identifying esophageal varices. Non Invasive markers are helpful in selecting patients with low probability of esophageal varices in whom upper GI endoscopy may not be needed.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diagnostic utility ; venous ammonia ; spleen size ; platelet count ; non invasive markers ; porto systemic collaterals ; cirrhotics.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 02:47
Last Modified: 14 Jul 2017 02:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/1604

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