الفهرس 
Portal HypertensionOnly 14 pages are availabe for public view
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Abstract
P
ortal hypertension (PH) is the most important complication that develops in patients with cirrhosis of the liver and remains a leading cause of morbidity and mortality worldwide. Portal hypertension can lead to ascitis, formation of an extensive network of portosystemic collateral vessels, portosystemic encephalopathy and sepsis.
It is generally accepted that hyperdynamic status, an increase in cardiac output and a decrease in systemic vascular resistance, occur in patients with portal hypertension. The esophagogastric varices are often collaterals; however, the rupture of varices is sometimes lethal.
Bacterial infections are frequently diagnosed in cirrhotic patients with gastrointestinal hemorrhage. Cirrhotic patients with variceal bleeding are subjected to several invasive thera-peutic procedures which could break the natural defence barriers.
The present study was designed to study the systemic hemodynamic changes and rate of bacteremia in patients with portal hypertension.
Fifty five known PH patients 41 males and 14 females ,their ages ranged from 1to 18 years old with a mean (±SD) age of 8.9 ± 4.3 year were recruited from hepatology clinic, the Children’s Hospital, Ain Shams University, in the period from January 2012 to September 2014.
The patients were divided into two groups according to the type of endoscopic procedure (diagnostic and therapeutic).All patients were subjected to history taking, clinical examination, routine investigations including complete blood count, liver enzymes, serum albumin, total and direct bilirubin and prothrombin time. Blood culture was withdrawn as an investigation for bacteremia befor and 30 miniutes after the the upper GIT endoscopy (diagnostic and therapieutics). Cardiac output evaluation was done through measuring cardiac index using echocardiography.
from the results of this study, a negative correlation was found between blood components (total leucocytic count, platlet count, and hemoglobin level) and both bleeding attacks frequency and the splenic size of the studied groups.
Regarding the hyperdynamic state of portal hypertension, 50.9%of the PH patients had high cardiac index while the the other 49.1% had normal cardiac index.
Also this study showed the effect of propranolol on cardiac index as all patients who didn’t start propranolol had a statistically significant higher cardiac indices than those who started propranolol.
The rate of bacteremia in relation to the variceal endoscopic band ligation was statistically insignificant 3.8% (one patient) in relation to both endoscopic sclerotherapy and diagnostic endoscopy.