scholarly journals Child Pugh Score as a Predictor of Large Oesophageal Varices in Chronic Liver Disease Patients

2020 ◽  
Vol 3 (1) ◽  
pp. 37-41
Author(s):  
Awasthi Girish ◽  
Tirtha Man Shrestha
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Tertiary Care ◽  
Disease Patient ◽  
Chronic Liver ◽  
University Teaching ◽  
Oesophageal Varices ◽  
Variceal Hemorrhage ◽  
Abdominal Sonography

Introduction: Variceal hemorrhage is a major complication of chronic liver disease. If patients at low or high risk of having esophageal varices (EV) could be identified by the Child Pugh score in predicting the size of oesophageal varices in patients with chronic liver disease. The main objective of this study was to determine whether Child Pugh Score can be used as a predictor of large oesphageal varices in chronic liver disease patient. Methods: A prospective cross-sectional study was conducted in emergency and medicine ward of Tribhuvan University Teaching Hospital from August 2015 to December 2015 with diagnosed chronic liver disease without history of previous medication for varices and any surgical intervention were studied. Patients underwent physical examination, hematological and biochemical tests and abdominal sonography and upper gastrointestinal endoscopy. Presence and absence of esophageal varices size was noted and correlation with Child Pugh Score and it’s associated variables studied. Results: Alcoholic liver disease was the major cause for chronic liver disease with most common age group involved being 41-50 years and 72% prevalence of esophageal varices. A statistically significant association was found between oesophageal varices grade and Child-Pugh’s classification grades i.e., the higher grade of oesophageal varices is associated with advanced grade of Child’s classification. Conclusions: Child Pugh Score had a predictive value to diagnose esophageal varices in chronic liver disease patients. The predictive accuracy as compared to the gold standard test “UGI endoscopy” showed that these parameters cannot replace endoscopy as the diagnostic test but can be used as a screening tool especially in a country like Nepal where availability of endoscopy facilities and access to tertiary care hospitals is an issue.

scholarly journals A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 228-234
Author(s):  
Karthick M ◽  
Prabakaran P T ◽  
Rajendran K ◽  
Gowrishankar A ◽  
Halleys Kumar E ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Chronic Liver ◽  
First Episode ◽  
Oesophageal Varices ◽  
Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to  Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

scholarly journals Thickening of Gallbladder Wall in Chronic Liver Disease - A Marker for Esophageal Varices

2013 ◽  
Vol 6 (1) ◽  
pp. 18-20
Author(s):  
Shamsi Ara Begum ◽  
Arif Akbar Saibal ◽  
Kanta Das ◽  
Sharmistha Dey ◽  
Akhtar Uddin Ahmed ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Gallbladder Wall ◽  
Chronic Liver ◽  
Wall Thickening ◽  
Oesophageal Varices ◽  
Group A ◽  
The Mean ◽  
Group B

This study was done to find out the relationship between gallbladder wall thickening and esophageal varices in chronic liver disease (CLD) patients. A total of 61 CLD patients were included and divided into two groups. Group A included 13 CLD patients with no oesophageal varices and Group B composed of 48 CLD patients with esophageal varices. Mean gallbladder wall thickness (GBWT) of Group B was 5.6±0.2mm compared to 2.7±0.1mm of Group A. The mean differences of GBWT were statistically significant between group A and group B (P<0.05). The mean GBWT was significantly (p<0.05) higher in CLD patients with grade III and IV varices (6.1±.8 mm) compared to grade I and II (3.9±0.7 mm). The result suggests that GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients. DOI: http://dx.doi.org/10.3329/imcj.v6i1.14713 Ibrahim Med. Coll. J. 2012; 6(1): 18-20

scholarly journals Severity of thrombocytopenia with different grades of esophageal varices in chronic liver disease patients undergoing gastroscopy’s in a Tertiary Care Hospital.

2019 ◽  
Vol 26 (10) ◽  
pp. 1742-1747
Author(s):  
Raj Kumar Lohana ◽  
Riaz Hussain Awan ◽  
Seema Nayab ◽  
Khadim Hussain Awan ◽  
Faqir Muhammad Awan
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Chronic Liver ◽  
High Yield ◽  
Care Hospital ◽  
The Mean

Objectives: To correlate severity of thrombocytopenia with different grades of esophageal varices in chronic liver disease patients undergoing EGD in a tertiary care hospital. Study Design: Cross sectional study. Setting: Gastroenterology & Hepatology Department at Liaquat National. Period: Six months from Jan to June 2016. Material and Methods: Seventy six subjects of chronic liver disease were recruited and studied for correlation between platelet count and esophageal varices by gastroscopy while the data was analyzed in SPSS version 17. Period: From July 2016 to Dec 2016. Results: There were 55 (72.4%) males and 21 (27.6%) females. The mean age was 45.6 ± 14.7 years. 10 (13.2%) had Hepatitis B, 58 (76.3%) Hepatitis C, 01 (1.3%) Wilson’s disease, 03 (3.9%) Autoimmune disease and 04 (5.3%) Alcoholic liver disease. 09 (11.8%) had Child-Pugh Class A, 41 (53.9%) Class B and 26 (34.2%) had Class C. The mean platelet count was 85/µl ± 40.2/µl. Out of 76 patients 70 (92.1%) had esophageal varices. 23 (30.3%) had grade III varices, 19 (25%) had grade II, 14 (18.4%) each had grade I & IV and 06 (7.9%) had grade 0 varices. Conclusion: thrombocytopenia can predict the occurrence of esophageal varices in cirrhotic population while gastroscopy has high yield for varices.

scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM &gt;9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM &lt;20 kPa and platelets &gt;150,000) and expanded Baveno VI criteria (LSM &lt;25 kPa and platelets &gt;110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was &gt;10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

scholarly journals Challenging management of severe chronic disorders in acute pandemic situation: Chronic liver disease under COVID-19 pandemic as the proof-of-principle model to orchestrate the measures in 3PM context

2021 ◽  
Vol 12 (1) ◽  
pp. 1-14
Author(s):  
Lubomir Skladany ◽  
Tomas Koller ◽  
Svetlana Adamcova Selcanova ◽  
Janka Vnencakova ◽  
Daniela Jancekova ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Tertiary Care ◽  
Chronic Liver ◽  
Active Management ◽  
Comprehensive Treatment ◽  
List Type ◽  
Individualized Care ◽  
Chronic Disorder ◽  
Tertiary Center

AbstractChronic liver disease management is a comprehensive approach requiring multi-professional expertise and well-orchestrated healthcare measures thoroughly organized by responsible medical units. Contextually, the corresponding multi-faceted chain of healthcare events is likely to be severely disturbed or even temporarily broken under the force majeure conditions such as global pandemics. Consequently, the chronic liver disease is highly representative for the management of any severe chronic disorder under lasting pandemics with unprecedented numbers of acutely diseased persons who, together with the chronically sick patient cohorts, have to be treated using the given capacity of healthcare systems with their limited resources. Current study aimed at exploring potentially negative impacts of the SARS CoV-2 outbreak on the quality of the advanced chronic liver disease (ACLD) management considering two well-classified parameters, namely, (1) the continuity of the patient registrations and (2) the level of mortality rates, comparing pre-COVID-19 statistics with these under the current pandemic in Slovak Republic. Altogether 1091 registrations to cirrhosis registry (with 60.8% versus 39.2% males to females ratio) were included with a median age of 57 years for patients under consideration. Already within the very first 3 months of the pandemic outbreak in Slovakia (lockdown declared from March 16, 2020, until May 20, 2020), the continuity of the patient registrations has been broken followed by significantly increased ACLD-related death rates. During this period of time, the total number of new registrations decreased by about 60% (15 registrations in 2020 versus 38 in 2018 and 38 in 2019). Corresponding mortality increased by about 52% (23 deaths in 2020 versus 10 in 2018 and 12 in 2019). Based on these results and in line with the framework of 3PM guidelines, the pandemic priority pathways (PPP) are strongly recommended for maintaining tertiary care uninterrupted. For the evidence-based implementation of PPP, creation of predictive algorithms and individualized care strategy tailored to the patient is essential. Resulting classification of measures is summarized as follows: The Green PPP Line is reserved for prioritized (urgent and comprehensive) treatment of patients at highest risk to die from ACLD (tertiary care) as compared to the risk from possible COVID-19 infection. The Orange PPP Line considers patients at middle risk of adverse outcomes from ACLD with re-addressing them to the secondary care. As further deterioration of ACLD is still probable, pro-active management is ascertained with tertiary center serving as the 24/7 telemedicine consultation hub for a secondary facility (on a physician-physician level). The Red PPP Line is related to the patients at low risk to die from ACLD, re-addressing them to the primary care. Since patients with stable chronic liver diseases without advanced fibrosis are at trivial inherent risk, they should be kept out of the healthcare setting as far as possible by the telemedical (patient-nurse or patient- physician) measurements. The assigned priority has to be monitored and re-evaluated individually—in intervals based on the baseline prognostic score such as MELD. The approach is conform with principles of predictive, preventive and personalized medicine (PPPM / 3PM) and demonstrates a potential of great clinical utility for an optimal management of any severe chronic disorder (cardiovascular, neurological and cancer) under lasting pandemics.

scholarly journals Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease

SpringerPlus ◽  
2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Soichiro Shibata ◽  
Satoru Joshita ◽  
Takeji Umemura ◽  
Tomoo Yamazaki ◽  
Naoyuki Fujimori ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Risk Score ◽  
Esophageal Varices ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Spleen Size
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