Abstract
Objective: To correlate the portal vein pulsatility pattern with severity of liver disease in patients with cirrhosis of liver and portal hypertension. Subjects and methods: Doppler signals from the main portal vein of 36 healthy adults and 52 cirrhotic patients with portal hypertension were studied. Severity of liver disease was graded using modified Child-Pugh classification. Pulsatility of portal flow was quantified using portal venous pulsatility index and complete spectral widening was defined as absence of window below the wave base. The Doppler findings were correlated between the study groups. Results: The mean pulsatility index value in control group was 0.37+0.10 and in cirrhotic patients was 0.17+0.03 (Child A- 0.21+0.02, Child B- 0.18+0.02, Child C- 0.14+0.03). The difference between control and cirrhosis group, as well as the difference within different Child classes were statistically significant (P<0.05). None of the patients in control group had complete spectral widening while 76.92% of cirrhotic patients had complete spectral widening (28.5% of Child A, 66.6% of Child B and 100% of Child C). The difference in distribution of complete spectral widening between control and cirrhotic group as well as within the cirrhotic group was statistically significant (P<0.05). Conclusion: Portal vein pulsatility index and spectral widening can reflect the early hemodynamic changes in cirrhotic patients. These changes become more pronounced with increasing severity of liver disease. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 1-8 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7664
Highlights
Cirrhosis is defined by World Health Organization (WHO) as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.[1]
Specific objectives: - To find the mean portal vein pulsatility index (PI) value and distribution of complete spectral widening (CSW) in healthy population. - To find the mean portal vein PI value and distribution of Complete spectral widening (CSW) in patients with cirrhosis and portal hypertension. - To compare portal vein PI and presence of CSW between healthy control group and the patients with cirrhosis of liver. - To evaluate the relation of portal vein PI and CSW to the severity of cirrhosis of liver as determined by modified Child-Pugh classification. - To evaluate the relation of portal vein PI and CSW to the individual ChildPugh Variable
Distribution of patients in different Child-Pugh classes: The total number of patients in cirrhosis group was 52. 13.46% (7) of them were in ChildPugh class A, 40.38% (21) in class B and 46.15% (24) in class C
Summary
Cirrhosis is defined by World Health Organization (WHO) as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.[1] Progressive hepatic fibrosis causes several regional hemodynamic changes like hepatic venous outflow obstruction, changes in hepatic artery resistance and development of portal hypertension with increasing sinusoidal resistance. These hemodynamic changes influence the degree of portal hypertension and liver dysfunction.[2,3]. Bmode sonography is incapable of examining patients of cirrhosis without these late findings.[2]
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