الفهرس 
Hepatitis C virus and hepatitis B virus coinfectionOnly 14 pages are availabe for public view
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Abstract
The most common clinical signs and symptoms of cirrhosis include three aspects: liver dysfunction, portal hypertension and hypersplenism, and the major causes of death for the patients with cirrhosis are hepatic faliure, gastrointestional hemorrhage and severe infections.The diagnosis and prognosis in liver cirrhosis mostly depend upon the Child’s grading system which takes into account the severity of jaundice, ascites, hypoalbuminemia, encephalopathy and prothrombin activity.The criteria of Child-Pugh system are all reflections of hepatocyte function, but not of portal hemodynamics and spleen.The doppler sonograghy is an useful non invasive method which provides good information about blood flow that supplements the information gained by routine sonography.
The aim of the present study is to study the correlation between portal hemodynamics, hypersplenism and severity of liver disease in cirrhotic patients.
To achive this goal, thirty patients with liver cirrhosis and ten healthy subjects were included in the study, the patients were classified in to three groups, group I included ten Child A patients, group II included ten Child B patients and group III included ten Child C patients.
Diagnosis of cirrhosis was based on clinical data, biochemical studies and sonographic imaging. Consent was taken from patients and volunteers to participate in the study.
Patients who were taking portal pressure-lowering drugs such as β-blockers, those with gastrointestinal bleeding in the previous four weeks, those with encephalopathy grade II or more and those with portal or splenic vein thrombosis were excluded from the study.
All patients and healthy subjects were evaluated clinically as regards manifestations of chronic liver diseases (jaundice, ascites, hepatic encephalopathy, previous gastrointestinal bleeding), liver and spleen size. Routine investigations were done including, complete blood picture and liver test profile [serum aspartate and alanine aminetransferase (AST, ALT respectively), serum albumin, serum bilirubin, and prothrombin activity].
Upper gastrointestinal endoscopy was done for detection of esophageal varices and the varix grade if present. Abdominal ultrasonography was done for detection of the size and echogencity of the liver, longitudinal diameter of the spleen, presence or absence of ascites and its degree. Doppler ultrasonography was done for measurement of diameter, cross sectional area, maximum blood flow velocity,mean blood flow velocity and blood flow volume of portal and splenic veins.
Statistical analysis of data obtained from the present study showed the flollowing results:
1- As regrads clinical evaluations:
History of upper gastrointestinal bleeding was more frequent in Child C than in Child A and B patients. Jaundice was more frequent in Child C than in Child A and also in Child B than in A patients. The degree of ascites was significantly lower in Child A than B and C patients. The spleen size was significantly higher in Child C than A and B patients.