الفهرس 
PORTAL HYPERTENSIONOnly 14 pages are availabe for public view
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Abstract
C
irrhosis is the end stage of chronic damage to the liver. Portal hypertension commonly accompanies liver cirrhosis with the development of OV and PHG as major comolications.
Gastrooesophgeal variceal hemorrhage (GOV) is a major complication of portal hypertension resulting from liver cirrhosis. Oesophageal variceal bleeding is one of the most dreaded complications of cirrhosis because of its high mortality. The prevalence of varices in patients with cirrhosis is approximately 60-80%. The incidence of OV increases by nearly 5% per year, and the rate of progression from small to large varices is approximately 5 to 10 % per year.
The mortality rate from variceal bleeding is about 17-57 % but when patients are treated optimally in hospital it is found to be only 20%.
The American Association for the Study of Liver Disease and the Baveno V Consensus Conference on portal hypertension recommended that all cirrhotic patients should be screened for the presence of OV when liver cirrhosis is diagnosed.
Some authors have suggested repeating endoscopy at 2-3 year intervals in patients without varices and at 1-2 year intervals in patients with small varices so as to evaluate the development or progression of the OV. However, this approach has two major limitations. Endoscopy is an invasive procedure and secondly the cost effectiveness of this approach is also questionable. As only 9-36% patients with cirrhosis are found to have varices on screening endoscopy. It may be more cost-effective to routinely screen patients at high risk for the presence of varices so as to reduce the increasing burden and procedure cost of endoscopy units.
Identification of non-invasive predictors of OV and portal gastropathy will enable us to carry out UGE in selected group of patients thus avoiding unnecessary intervention and at the same time not missing the patients at risk of bleeding
The aim of this work is to assess the value of MELD score as a non-invasive predictor of OV in comparison to other predictors.
The current cross-sectional study was conducted on one hundred cases who presented with established liver cirrhosis of any cause the history, clinical examination, laboratory investigations, ultrasound examination and UGE was done for all cases, Child-Pugh score and MELD score were calculated from parameters obtained at time of admission.
Our patients were classified into 2 groups:
Group I: 75 Patients were found to have OV by UGE.
Group II: 25 Patients hade no OV by UGE.
This study revealed that Baseline MELD score as well as Child-Pugh score and other predictors as platelet count were significantly higher among patients with OV than those without OV.
In multivariate analysis , the present study showed that patients with MELD score ≥11 or platelet count ≥ 142.5 had a higher incidence of presence of OV.
It is found that MELD score is more accurate than CTP and other non-invasive predictors such as platelet count in predicting presence of OV in patients with liver cirrhosis.