Relation between ascites, portal hemodynamics and risk of bleeding in patients with liver cirrhosis and portal hypertension

الملخص EN

Background:Portal hypertension is one of the main consequences of cirrhosis.

Development of gastro-oesophageal varices and ascites are the most important clinical manifestations of portal hypertension.

Aim of the work: The aim of the present work was to study the relation between ascites, portal hemodynamics and risk of bleeding in patients with liver cinhosis and portal hypertension.

Subjects and Methods:This study was carried out on thirty patients with liver cirrhosis and portal hypertension divided into two groups: Group I: included fifteen liver cirrhosis patients without ascites.

They were 10 males (66.67%) and 5 females (33.33%), their age ranged between 36-65 years (48.60±6.85 years) ; Group II: included fifteen liver cirrhosis patients with ascites.

They were 9 males (60.00%) and 6 females (40%), their age ranged between 36-70 years (54.53±8.54 years).

All subjects included in the study were subjected to: History taking, clinical examination and laboratory investigations including complete blood count, serum bilirubin, albumin, aspartate and alanine aminotrans ferases (AST, ALT) and prothromtoin activity.

The cirrhotic patients were scored according to modified Child-Pugh criteria.

Abdominal ultrasonography with duplex Doppler study of the portal vessels was performed with measurement of portal blood mean velocity (PMV), portal blood flow volume (PFV), congestion index (CI) and determination of direction of blood flow.

Upper gastrointestinal endoscopy was done using a video-endoscope Olympus XQ 240.

Esophageal varices (EV) were scored according to the North Italian Endoscopic Club (NIEC) classification, the NIEC index was calculated and risk of bleeding in the first and second years was derived from NIEC index for each patient from a table.

NIEC score for portal hypertensive gastropathy (PHG) was examined and designated mild or severe.

Results: Liver cirrhosis patients with ascites (group II), showed statistically significant higher NIEC index for EV, risk class and risk of bleeding than in group I without ascites , while NIEC index for (PHG) showed no statistical significant difference between both groups (p = 0.264).

Liver cirrhotic patients with ascites showed statistically significant lower PMV (cm/sec) and higher portal vein CI (cm2/cm/sec) than cirrhotic patients without ascites.

(p = 0.011, 0.004 respectively).

The portal vein flow direction showed no statistical significant difference between both groups (p = 0.264).

Conclusion:From this study we conclude that changes in portal hemodynamics that occur in patients with liver cirrhosis may be implicated in the development of ascites.

Also, the presence of ascites is associated with higher NIEC index for EV, risk class and risk of bleeding which signifies that liver cihrrosis patients with ascites are more susceptible to the development of (EV) and are at increased risk of gastroesophageal bleeding than liver cihrrosis patients without ascites.