الفهرس 
Pathophysiology of cirrhosisOnly 14 pages are availabe for public view
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Abstract
The current study was conducted in the Department of Tropical Medicine, Mansura university Hospital from June 2010- December 2012. It included (80) patients suffering from post-hepatitis C virus cirrhosis with large esophageal varices with no history of bleeding or prophylactic treatment. They were prospectively evaluated and randomized into three groups:Group I: 20 patients post hepatitis C virus cirrhosis with large esophageal variceswho underwent prophylactic endoscopic band ligation.Group II: 40 post hepatitis C virus cirrhosis with large esophageal varicesand hepatocellular carcinoma who underwent prophylactic endoscopic band ligation and PEI for HCC.Group III:20 post hepatitis C virus cirrhosis with large esophageal varices and hepatocellular carcinoma who underwent prophylactic endoscopic band ligation but not candidate for PEI. They were 49 males and 31 females, all groups were in Child A and B class. The mean age of the first group was 55.8±7.14 years , the second group was 57.9±5.9 years, while the third group was 58.1±5.32years. In our study, no significant differences were observed between both groups with respect to the following baseline characteristics: patient age and sex; Child-Pugh class, liver function tests including :(AST,ALT,bilirubin,albumin) ,I.N.R , platelets and AFP. In group II, 32 patients (80%) had one focal lesion and 8had multiple focal lesions. In group III, 5 patients (25%)had single focal lesion and 15patients(75%) had multiple focal lesions.After performing triphasic abdominal CT before the procedures, the enhancement of the focal lesions was homogenous in 36 patients (90%) in groupII and17 patients (85%) in group III.While it was heterogeneous in 4 patients (10%) of group II and 3 patients (15%) of group III who were confirmed with histopathology after percutaneous needle biopsy or MRI.In the current study the serum VEGF level in the studied group was 69.3±28.3pg/ml in group I(cirrhotic), 273.15± 114.82 pg/ml(HCC treated)and 356.65 ± 132.26 pg/ml in group III(HCC untreated).Vascular endothelial growth factor was significantly higher in the group III.And there was significant positive correlation was found between VEGF and tumour size (P= 0.047). Prophylactic band ligation was done for large esophageal varicesin all patients every 3 weeks till endoscopic recovery. Endoscopic recovery is achieved when varices were obliterated or were reduced to a size of grade 1.The incidence of endoscopic complications including chest pain and ulcer were non significant in all patients except for haematemesis and dysphagia which were significantly higher in HCC untreated patients compared to cirrhotic or HCC treated patients.Five patients (25%) of HCC untreated group developed PVT. The endoscopic recovery was significantly higher in the cirrhotic patients (gp I) 95% compared to both HCC treated (gpII) and HCC (gpIII) untreated with mean number of sessions needed to eradicate the varices was 4.45±1.15.In HCC treated group the mean number of sessions needed to eradicate the varices was 5.35±1.4 with endoscopic recovery in 85% of patients. While in HCC untreated patients the endoscopic recovery occurred only in 5% of patients with mean number of sessions 6.2±1.28. The mortality rate in HCC treated patients was 2.5% due haematemesis. While,in HCC untreated patients the mortality rate was 45% .The cause of mortality was due to haematemesis in 25% of patients and in 20% due to liver cell failure complications.