Cardiac Dysfunction in Patients with Liver Cirrhosis.

BACKGROUND: The clinical picture in cirrhosis is dominated by the classical complications such as ascites, bleeding varices, portal hypertension and encephalopathy. Cardiac dysfunction in patients with cirrhosis, which contributes significantly to the morbidity and, mortality though prevalent, is less studied and not widely recognized entity since it is largely asymptomatic at rest, with overt heart failure seen mainly during pharmacological stress, transjugular intrahepatic portosystemic shunt, liver transplantation. METHODS: It is a cross sectional study done on patients admitted in wards or attending to outpatient department of Liver unit, Bir Hospital, between May 2015 to May 2016. Diagnosis of cirrhosis was based on clinical examination, lab parameters, ultrasound examination, endoscopy and/or liver biopsy. Cirrhotic patients after assessing the exclusion criteria were recruited for the study. Child Pugh and model for end stage liver disease scores were calculated to assess the liver function. Cardiac function was evaluated by resting pulse, mean arterial pressure, electrocardiography, and 2 dimensional echocardiography. RESULTS: Diastolic dysfunction was seen in 61.9%(48) and was more common in alcoholic group (63.2% Vs 58.6%). Systolic dysfunction was seen in 6.6% of alcoholic patients only. 51.4% had cirrhotic cardiomyopathy according to the criteria (proposed by World congress of gastroenterology in 2005). Prolonged QTc of >0.44 seconds was noted in 79%, mainly in child pugh C, with model for end stage liver disease score >10. CONCLUSIONS: Cardiac dysfunction is prevalent with sizeable number of patients with cirrhosis especially in the form of diastolic dysfunction independent of etiology. QTc prolongation might be an early indicator of cardiac dysfunction and is directly correlated with child pugh and model for end stage liver disease scores.

Prevalence of Tuberculosis in Patients with Liver Cirrhosis.

BACKGROUND: Studies have shown that patients with liver cirrhosis are more susceptible to tuberculosis because of immune dysfunction; however there are only limited data. We carried out this study to know the prevalence and clinical characteristics of tuberculosis in patients with liver cirrhosis. METHODS: In this retrospective study, medical files of 200 consecutive patients admitted with diagnosis of liver cirrhosis in the medical ward of liver unit, Bir Hospital from January 2011 to December 2014 were evaluated for the presence of TB and clinical characteristics of these patients were analyzed. RESULTS: Eighteen patients were diagnosed to have tuberculosis with a prevalence of 9%. The median age of patients with tuberculosis and liver cirrhosis was 53 (35-71) years and M: F ratio was 2:1. 67%, P=0.01). Median CTP score of patients were 8.5 (5-12) (CTP A: B: C: 3:7:8). Extra pulmonary tuberculosis was more common (67%) than pulmonary (33%). In extra pulmonary tuberculosis, distribution was as pleural effusion (n=4), abdominal (n=4), intestinal (n=2), peritoneal (n=9), and pott's spine (n=2). CONCLUSIONS: Tuberculosis is prevalent in patients with liver cirrhosis. Extra pulmonary tuberculosis was more compared to pulmonary tuberculosis. Tuberculosis was common in decompensated liver cirrhosis than compensated liver cirrhosis .