Patients and methods
-Place of the study
Tropical Medicine and Gastroenterology Department of Sohag University Hospital.
-Type of the study
Prospective cohort study.
-Study period
Duration of study will be one year after protocol acceptance.
-Patients
This study will include 100 cirrhotic Patients presenting with upper gastrointestinal variceal bleeding.
-Inclusion criteria
Patients who met the following inclusion criteria were enrolled:
1-History of chronic liver disease. 2-Impaired liver function. 3-Portal hypertension syndrome (indicated by esophageal varices and/or variceal dilation).
4-Diagnostic imaging confirming liver cirrhosis on ultrasound who admitted to the hospital with symptoms of hematemesis and/or melena underwent clinical and laboratory examinations and an upper gastrointestinal endoscopy and were diagnosed with UGIB due to ruptured esophageal (ESOVs) and/or gastric varices (GASVs).
* Exclusion criteria
1. UGIB caused by other cases such as Mallory-Weiss syndrome and esophageal or gastrointestinal ulcers.
2. UGIB due to ruptured veins in conditions other than increased portal pressure like portal hypertension syndrome unrelated to cirrhosis.
3. Patients with portal vein thrombosis.
4. Patients used anticoagulant.
* Methods of the study
All participants will be subjected to:
* Complete history taking.
* Clinical examination:
1. Vital signs (pulse 60-100, blood pressure 90/60-120/80 and temperature 36.5-37.3).
2. Complete general and local examination.
* Laboratory investigation:
1. Complete blood count (Hemoglobin (Hb), white blood cells (WBC) and platelet).
2. Liver function test as alanine transaminase (ALT), aspartate transaminase (AST), Albumin, total bilirubin, Prothrombin time (PT), Prothrombin concentration (PC), International normalized ratio (INR) and child pugh score).
3. Serum creatinine,urea and C-reactive protein (CRP).
4. Ascitic fluid study for patients with ascites.
* Assessment of risk and predicting outcomes by:
1. ABC score.
2. C-watch score.
3. Rockall score.
* Radiological investigation
Abdominal ultrasound with comment on:
* Liver size, echopattern, surface and focal lesion.
* Portal vein diameter, patency and presence of collaterals.
* Spleen size, echopattern and splenic vein diameter.
* Presence of ascites or not.
* Intervention:
Upper endoscopy with comment on:
* Size of varices, extension of varices and stigmata of recent bleeding.
