A case report of an ethanol-related decompensated chronic liver disease with complications

Decompensated chronic liver disease, is a histopathologically defined condition with a variety of clinical symptoms and complications, some of which are associated with an increased risk of in-hospital mortality. Cirrhosis is predicted to affect 100 (range 25-400) per 100,000 people worldwide, with a male-to-female ratio of one. Patients with ethanol-related cirrhosis have a 5-year death rate ranging from 60-85%. One of the leading causes of cirrhosis is alcoholism. However, it can also be caused by non-alcoholic steatohepatitis (NASH), autoimmune disorders, and viral hepatitis. The decompensated chronic liver disease carries a 9.7 times greater chance of mortality. Cirrhosis is a histologic diagnosis, but a combination of clinical, laboratory, and imaging characteristics can help confirm a cirrhosis diagnosis. For evaluating liver cirrhosis, a liver biopsy continues to be the gold standard. A non-invasive approach to assessing liver cirrhosis is transient elastography (FibroScan). Patients with severe cirrhosis may experience several significant sequelae that complicate their clinical path. These include portal hypertension and related side effects, such as gastroesophageal varices, splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma. In decompensated chronic liver disease, treatment focuses on underlying liver disease, dietary changes, and long-term medical management to control underlying problems. For patients who do not react to other medications, liver transplantation can be an effective long-term therapy option.

Facet Joint Injections in Patients with Low Back Pains and Facet Arthropathies - Our Experience

Chronic back pain is a common and frequent clinical presentation in any population. Presence of disc disease, facet syndrome, and vertebral body disease are usually addressed by the radiologists. Facet joints are proven to be the culprit in 15 – 45 % of patients with low back pain. We wanted to compare effectiveness of fluoroscopy and computed tomography guided lumbar facet injections for pain relief in patients with facet arthropathies and mild canal stenoses. METHODSThis is a retrospective cross-sectional study performed in the Department of Radiology at our Hospital in Dhahran. This record-based study was performed in our department from Jan. 2015 - 2020. All patients (N = 112) who underwent fluoroscopy and computed tomography (CT) guided facet injections (either alone or with epidural injections) for relief of chronic back pains (due to facet arthropathies and mild canal stenoses) were included, and grouped as (i) facet injections under fluoroscopy (F), and (ii) facet injections under CT guidance (C). Patients with acute disc prolapse, trauma to spine, lumbar surgeries, moderate to severe lumbar stenoses, spondylolisthesis, known systemic arthritides, those not suitable for the procedures, and those lost to follow-up were excluded. Repeat procedure within one year for recurrent complaints was used as a measure of effectiveness of the procedure. Proportional Z-test was used, and a p-value less than 0.05 was considered to be significant. RESULTSOut of a total of 112 patients, 64 were females (57 %) and 48 were males (43 %). The mean age was 56.4. Twenty out of 78 patients with facet injections under fluoroscopy and 3 out of 34 patients with facet injections under CT underwent repeat procedures (P = 0.042). CONCLUSIONSCT guided facet injections combined with epidural injections may be more effective in relief of lower back pain in patients with facet arthropathies and mild canal stenoses

Study the association between platelets count and grades of oesophageal varies in patients of cirrhosis of liver with portal hypertension

Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.

To Study the Association between Splenic Size and Grades of Oesophageal Varices in Patients of Cirrhosis of Liver with Portal Hypertension.

Chronic liver disease develops when the functional capacity of the liver is deranged, and it is not able to maintain normal physiological conditions. This study was carried to find out the association of portal vein size with gastro-oesophageal varices in diagnosed cases of cirrhosis of liver, so that this parameters can be used in predicting propensity to oesophageal varices non-invasively, and thus help in starting prophylactic therapy earlier to prevent bleeding and other complications of varices.METHODS100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were included for the study. Ultrasonography was done in all cases to find out the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was performed to see the presence of oesophageal varices of different grades. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient. p Value of <0.05 was considered for significant.RESULTSAmong 100 patients studied, 90% patients were found to have oesophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 oesophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of splenic diameter with grades of oesophageal varices, it was found that patients with splenic diameter >13 cm had higher grades of oesophageal varices i.e. 32 patients were grade 2 and 18 patients were grade 3, with p<0.001 and was found highly significant.CONCLUSIONSIn this study, we found that with increasing spleen size there are chances of formation of higher grades of oesophageal varices and both are also having positive association.

The Relationship between Oesophageal Varices, Portal Vein Diameter And Splenic Length (Antero-Posterior)

Objective: In this study our main objective is to evaluate therelationship between Oesophageal varices, Portal veindiameter and splenic length (antero-posterior).Methodology: This Cross-sectional comparative studyconducted at the Department of Hepatology, BangabandhuSheikh Mujib Medical University (BSMMU) from Jan 2010 toDec 2011 where 50 Patients with cirrhosis of liver attending thedepartment of Hepatology, BSMMU were included as apopulation in this study.All the data was checked and edited after collection. It wasexpressed as Mean and SD. Data has been analyzed byANOVA. p value of less than 0.05 was considered statisticallysignificant. Statistical analysis was done by using SPSS-15(Statistical package for social sciences) win version 15software programme.Results: During the study, the mean age was43.12±15.68years. The highest frequency of cirrhosis patientswas found in 41-50 years age groups (Frequency 12). Leadingcause was HBV (68%) followed by HCV (12%), NBNC (12%),Wilson’s disease (6%) and both HVB& HCV (2%). Also,grade-3 mean portal Vein diameter was found 12.67±2.47 mmwhereas; mean splenic length (antero-post.) was 13.82±2.12cm.Conclusion: Splenic antero-posterior measurement is not areliable predictor for sizes of oesophageal varices. Furtherstudy is needed for better outcome.

Clinics in diagnostic imaging (165). Oesophageal rupture secondary to malposition of an SB tube gastric balloon

Oesophageal rupture is a life-threatening complication of balloon tamponade for bleeding oesophageal varices. We herein describe the clinical course and imaging findings in a 33-year-old Indian man who had a Sengstaken-Blakemore (SB) tube inserted for uncontrolled haematemesis, which was unfortunately complicated by malposition of the gastric balloon with resultant oesophageal rupture. The inflated SB tube gastric balloon was visualised within the right hemithorax on chest radiography after the SB tube insertion. Further evaluation of the thorax on computed tomography confirmed the diagnosis of oesophageal rupture associated with right-sided haemopneumothorax. It is crucial for both the referring clinician and reporting radiologist to recognise early the imaging features of an incorrectly positioned SB tube gastric balloon, so as to ensure prompt intervention and a reduction in patient morbidity and mortality.

Cociente conteo de plaquetas/diámetro bipolar del bazo menor que 909 para predecir várices esofágicas / Platelet count/spleen bipolar diameter ratio below 909 to predict oesophageal varices

Introducción: el cociente conteo de plaquetas/diámetro bipolar del bazo menor que 909 ha sido considerado un buen indicador de la presencia de várices esofágicas. Objetivo: realizar la validación externa del valor del mencionado cociente para el diagnóstico de várices esofágicas. Métodos: estudio de evaluación de pruebas diagnósticas, que incluyó 102 pacientes cirróticos por distintas causas, con predominio de masculinos (55/102; 53,9 %), edad promedio de 55,76 ± 12,6 años. Se efectuaron determinaciones de las variables de laboratorio, ecografía abdominal y endoscopia alta como prueba de referencia. Se realizaron cálculo de sensibilidad, especificidad, valores predictivos y razones de verosimilitud para determinar exactitud diagnóstica para várices esofágicas del cociente. Resultados: el 65,7 % de los casos (n= 67) tenía várices esofágicas. El cociente mostró sensibilidad del 96,30 % (IC 95 %: 87,32-100,00) con un valor predictivo negativo del 97,1 % (IC 95 %: 90,19-100,00). Se confirmó la alta exactitud diagnóstica mediante el análisis por curva COR (siglas en inglés ROC, Receiver Operator Characteristics) (c= 0,927; IC 95 %: 0,873-0,980). Conclusiones: en esta serie fue posible reproducir los resultados que consideran el referido cociente como método de valor para identificar la presencia de várices esofágicas en pacientes cirróticos.

Introduction: a platelet count/spleen bipolar diameter ratio below 909 is considered to be a good indicator of the presence of oesophageal varices. Objective: carry out an external validation of the value of this ratio to diagnose oesophageal varices. Methods: evaluation study of diagnostic tests of 102 cirrhotic patients of various causes, with a predominance of the male sex (55/102; 53.9 %) and a mean age of 55.76 ± 12.6. Determinations were based on laboratory variables, abdominal echography and upper endoscopy as a reference test. Sensitivity, specificity, predictive values and likelihood ratios were estimated to determine the accuracy of the ratio for the diagnosis of oesophageal varices. Results: 65.7 % of the cases (n= 67) had oesophageal varices. The ratio showed a sensitivity of 96.30 % (CI 95 %: 87.32-100.00) with a negative predictive value of 97.1 % (CI 95 %: 90.19-100.00). Diagnostic accuracy was confirmed with ROC curve analysis (c= 0.927; CI 95 %: 0.873-0.980). Conclusions: in the series it was possible to reproduce the results that consider the ratio under study to be a valuable method to identify the presence of oesophageal varices in cirrhotic patients.

Endoscopic hemostatic ligation for ruptured oesophageal varices

From November 1997 to March 1998, 30 patients with ruptured oesophageal varices-caused gastrointestinal hemorrhage underwent the endoscopic variceal ligation by rubber ring. Age of patients ranged from 20 to 78 years. Male to female ratio is 2 to 1. Endoscopic imaging showed grade III of oesophageal varices in 29 patients, spread or spurt bleeding in 21 patients, point bleeding in 9 patients. Emergency hemostatic was performed successfully in 90.47% of the patients. 65.5% of the patients have complete elimination of oesophageal varices within 30 days and by 3 months after procedure, this rate risen to 82.75%. Adverse events and complications of oesophageal variceal ligation were temporary and resolved within some days. The common events were involved in oesopharyngeal region, such as sore throat, bleeding and oesophageal ulcer after the ligation.