الفهرس 
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Abstract
SUMMARY
• Doppler sonography is an attractive, non invasive and accurate
method for evah ration of portal and hepatic venous
hemodynamics and p .ediction of the risk of variceal bleeding.
• Portal blood flow undergoes complex changes with the
progression of chrc nic liver disease (CLD). As the disease
progresses, there is increasing obstruction to portal venous flow
at the level of sino. oids that is offset by reciprocal increase in
hepatic artery flow. Moreover, CLD impairs the compliance of
hepatic veins, (which normally exhibit triphasic waveform pattern
on Doppler study I decreasing and flattening their phasic
oscillations.
• The aim of this study is to evaluate the diagnostic value of
Doppler ultrasonography of portal and hepatic venous
haemodynamics in prediction of esophageal varices and bleeding
of such varices.
• This study was cone lucted on 65 patients with chronic liver
disease and 10 caseu as a control group. Patient with CLD were
classified into 3 groups :
- Group (A): CLD with esophageal varices and history of bleeding
(bleeders) - ( N = 25).
- Group (B): CLD” ith esophageal vances and no history of
bleeding (non bleedes) (N= 20).
Group (C): CLD without esophageal varices (N = 20).
Group (D): Control group (N= 10)
• Thrombocytopenia was associated with the presence of
oesophageal varices :md supports the notion that portal
hypertension leads to hy persplenism.
• Also a significant decrease of serum albumin was noted
among all studied patien ts compared to controls.
• Cirrhotic changes of the liver and splenomegaly by
ultrasound were statisti cally more frequent among the studied
patients compared to controls.
• There was a ste tistically positive correlation between
presence of esophageal, ’arices and Child-Pugh score.
• In this study there was a statistically significant difference
between patients with and without ascites regarding hepatic veins
waveform patterns.
• Doppler of portal ’rein haemodynamic parameters revealed
that there was statisticaly significant difference between patients
with and without esophageal varices in velocity, congestion index
and flow volume, while :he difference of portal vein diameter was
not significant.
• Doppler of hepatic ”\eins waveform pattern among our patients
with chronic liver disease was triphasic in 41.6%, biphasic in
38.4% and monophas ic in 20%.
• Analysis of varianc-e revealed that Doppler waveform patterns
of hepatic veins were not significantly correlated to portal vein
hemodynamic param eters,
• Regression analysis showed that the correlation between the
hepatovenous wave pattern and the presence of varices is very
poor. The proportion of varices that can be predicted is
approximately 3% (R-square 0.027) (table 22) which is not
statistically significa It. Also hepatic veins waveform patterns as a
predictor of bleeding from varices is not statistically significant.
• Doppler study of splenic artery revealed a significant
difference between the studied groups as regarding resistive index
while pulsatility inde x was not significant.
• Multiple regression analysis of data revealed that congestion
index, flow volume of portal vein and Child-Pugh class were
statistically signifies nt, predictors of the presence of esophageal
varices among patie nts with chronic liver disease. On the other
hand, the size of v trices and the resistive index of the splenic
artery are statistically significant predictors of variceal bleeding.
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