Abstract
Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals; group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cut-off value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cut-off value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.
Highlights
Introduction and Aim of the WorkThe identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening
The possibility of identifying cirrhotic patients with esophageal varices or presence of other collateral by non-invasive means is appealing, in that it could decrease the necessity of endoscopic screening with reduced healthcare costs
While on combining factors we found that PV diameter + ammonia level + splenic vein diameter at their cut-off values mentioned before gave 100% sensitivity and 96% specificity, the same result found on combining PV diameter + ammonia level, when combining splenic vein diameter + ammonia level (Table 6)
Summary
The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. Portal hypertension leads to the formation of portosystemic collateral veins, of which esophageal varices have the greatest clinical impact and the most severe complications. They are discovered on endoscopy in up to two thirds of decompensated cirrhotics. The possibility of identifying cirrhotic patients with esophageal varices or presence of other collateral by non-invasive means is appealing, in that it could decrease the necessity of endoscopic screening with reduced healthcare costs. Ammonia (NH4) levels cannot serve as a laboratory marker for portal-systemic encephalopathy, being neither specific nor highly sensitive [5], there may be a correlation with severity [6]
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