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Clinical and laboratory predictors of outcome after acute variceal bleeding

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Internal Medicine

Advisors

Mugawer, Muhammad S. , Yousuf, Heba M.

Authors

Aly, Attef Abdel-Aziz Aly

Accessioned

2017-04-26 12:34:23

Available

2017-04-26 12:34:23

type

M.Sc. Thesis

Abstract

Background: Chronic liver diseases and cirrhosis have a 10-year mortality of 34-66%. Acute variceal hemorrhage (AVH) secondary to cirrhosis is the most important cause of mortality in cirrhosis. The prediction and evaluation of adequate hemostasis by non-endoscopic methods are desired by treating physicians.Objective: The aim of this study was to asses the validity of both Baveno II/III and Baveno IV criteria as well as to assess many other laboratory, endoscopic and ultrasonographic variables as predictors of variceal haemorrage.Methods: This study included 50 cirrhotic patients (27 males, 23 females, mean age 43.8 ± 8 yrs) presented with their 1st attack of acute variceal bleeding. All patients were treated with injection sclerotherapy. The patients were divided into two groups: group I included 44 patients with successful treatment and group II which included only 6 patients with failed treatment. Full clinical examination was done for all these patients, as well as biochemical investigations in the form of CBC, liver function tests, kidney function tests and blood sugar level. Abdominal ultrasound and at least two upper GIT endoscopies were done for every patient. Results: Comparison between the two groups showed that the mean haemoglobin and haematocrit as well as the number of blood units transfused correlate significantly with the incidence of treatment failure with a P value of 0.02, 0.02 and 0.0001 respectively. On the other hand, there was no significant difference in the platelets count or the coagulation profile between the two groups. We also found that the degree of ascites and the portal vein diameter were directly related to treatment failure with a P value of 0.04 and 0.02 respectively. In this study, the incidence of treatment failure was rising with increasing the grade of varices. As regarding the Baveno criteria, the overall accuracy of both Baveno II/III and Baveno IV criteria was nearly the same reaching about 82% and 83% respectively.Conclusion: There is no significant difference in accuracy between Baveno II/III and Baveno IV criteria.There are many variables like the mean haemoglobin and haematocrit, the number of blood units transfused, the degree of ascites, the portal vein diameter, the site and the grade of varices that can be taken as predictors of treatment failure in patients with variceal bleeding.

Issued

1 Jan 2009

DOI

http://dx.doi.org/10.21473/iknito-space/33148

Details

Type

Thesis

Created At

28 Jan 2023