الفهرس 
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Abstract
Portal hypertension is a detrimental complication of liver diseases,
which results from increased resistance to the portal blood flow into the
liver. As a serious sequela of cirrhosis, it causes increased morbidity and
mortality due to critical complications, such as ascites, bleeding from
gastro-esophageal varices, and encephalopathy.
Esophageal varices is one of the most serious complications of portal
hypertension in liver cirrhosis. Ruptured varices may increase mortality.
Patients are also prone to hepatorenal syndrome, ascites, hepatic
encephalopathy, and other complications. Due to the reported role of renin
angiotensin system in the pathogenesis of portal hypertension, we studied
angiotensin-converting enzyme (ACE) levels in portal hypertension
patients with and without esophageal varices.
The aim of this work is to assess the ability of angiotensinconverting enzyme (ACE) level in discriminating portal hypertension
patients and its association with the presence of esophageal varices.
In this study we investigated 35 portal hypertension patients with
esophageal varices, 35 portal hypertension patients without esophageal
varices, in addition to 35 healthy controls.
All patients were submitted to the followings: full history taking, full
clinical examinations for disease diagnosis and radiological investigation
including duplex ultrasound of the liver and an upper gastrointestinal
endoscopy was used to assess different grades of esophageal varices, and
Routine laboratory Investigations were performed.
The results of this study revealed that: As regard laboratory and
clinical data, portal hypertension patients with esophageal varices had a
highly significant higher levels of AST, direct and total bilirubin, INR than
Summary
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portal hypertension patients without esophageal varices, however, portal
hypertension patients with esophageal varices had a highly significant
lower levels of hemoglobin, platelets, albumin than portal hypertension
patients without esophageal varices. In addition, both portal hypertensive
patients groups showed a highly significant higher levels of alanine
transferase (ALT), AST, alkaline phosphatase (ALP), gamma glutamyl
transferase (GGT), direct bilirubin, INR, urea, creatinine than healthy
group and a highly significant lower levels of Albumin, total protein than
healthy group.
PHTN with EV group had a highly significant higher Child score
than PHTN without EV group. Majority of patients in PHTN with EV
group were significantly associated with Child B and C (51.4% and 25.7%
respectively) while majority of patients in PHTN without EV group were
significantly associated with Child A and B (85.7% and 14.3%
respectively).
The study revealed that 20% of PHTN with EV group had
encephalopathy, 34.3% had ascites and 80% had splenomegaly but no
patients in PHTN without EV group had encephalopathy, ascites or
splenomegaly.
As regard Studying ACE levels and its correlation with different
parameters.
Serum ACE was significantly higher in PHTN patients with EV
compared to healthy group and to PHTN patients without EV.
Serum ACE levels in PHTN patients with EV showed high
significant associated with lower hemoglobin. Also, we found that serum
ACE was significantly higher in PHTN patients with large varices and in
patients with blood transfusion.