الفهرس 
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Abstract
Cirrhotic patients frequently undergo screening endoscopy for the presence of esophageal varices despite that, fewer than 50% of cirrhotic patients have varices at screening endoscopy and most have small sized varices with low risk of bleeding .This represents a medical burden due to increasing number of patients with liver cirrhosis.
The aim of the present study was to search for some and coagulation and/or fibrinolytic parameters that might non-invasively predict the presence of esophageal varices in patients with liver cirrhosis. Thesis was carried out on ninety-three patients with chronic liver disease, admitted to Suez Canal University Hospitals.
The patients were divided into 2 groups: CLD patients with bleeding esophageal varices and CLD patients with no bleeding esophageal varices.
All patients were subjected to full history taking, physical examination, laboratory investigations including complete blood count, liver function tests, coagulation and fibrinolytic profile and ultrasonography.
The aim of this work was to study the role of hematological, biochemical, coagulation and fibrinolytic parameters for prediction of the presence of esophageal varices as well as for prediction of bleeding from varies.
Patients with bleeding esophageal varices showed a significantly higher Child-Pugh score, Spleen Size Diameter, Total bilirubin, C-Reactive Protein (CRP), Prothrombin Time (PT), INR, PTT, serum AST and AST/ALT ratio and a significantly lower Thrombin Activitable Fibrinolysis Inhibitor (TAFI), Hemoglubin, WBC, platelets count, Albumin and Platelets count/Spleen size diameter ratio in comparison to patients without bleeding varices.
Patients with Child Puph C bleeding esophageal varices showed significant differences in all coagulation and fibrinlytic parameters (Platelets count, PT, INR, PTT and TAFI) in comparison to Child Puph A and B bleeding esophageal varices patients.
The results revealed that the platelet count/spleen size diameter at cut off value ≤1135.7 can differentiate between patients with bleeding esophageal varices and patients without bleeding with sensitivity of 95.2 % and specificity of 96.8%. While TAFI at cut off value ≤ 63%, can differentiate between bleeding esophageal varices and patients without bleeding where sensitivity 76.8 % and specificity 96.8%.
Regarding the AST/ALT ratio the results revealed that AST/ALT ratio at cut off value >1.3 had sensitivity 69.4% and specificity 96.8% for prediction of bleeding esophageal varices.