Coagulation disorders in patients with liver cirrhosis

Coagulation disorders in patients with liver cirrhosis

168 COAGULATION CIRRHOSIS Pupers read by title DISORDERS IN PATIENTS WITH LIVER D. Benedeto Stoianov. G. Bielakovic. A. Naaomi, T. Tasic Clinic fo...

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168

COAGULATION CIRRHOSIS

Pupers read by title

DISORDERS IN PATIENTS WITH LIVER

D. Benedeto Stoianov. G. Bielakovic. A. Naaomi, T. Tasic Clinic for Gastroenterology and Hepatology Clinical Center Nis, Yugoslavia

DIAGNOSIS

OF PORTAL VEIN THROMBOSIS

M. Szantova . V. KUDEOV~~ 3ti Department of Medicine, Medical School of Comenius University, Bratislava, Slovakia

Background: Liver cirrhosis is frequently associated with a bleeding tendency. Aims: To evaluate coagulation disorders in patients with liver cirrhosis with and without digestive bleeding. Methods: Platelet counts, coagulation and fibrinolysis tests were studied prospectively in 52 patients with liver cirrhosis (26 bleeders and 26 non-bleeders) irrespective of the type of cirrhosis in the period of 3 years. The patients were in different grades of liver failure, 23 with Child-Pugh class B and 29 with Child-Pugh class C. Nine patients died from gastrointestinal haemorrhage and five from hepatic encephalopaty and coma in follow up period. Results: Platelet count was significantly reduced (pO.O5). These tests in both groups were prolonged in comparison with normal values. FII (50.63; 56.75) FV (58.00; 63.31) and FVII (42.69; 46.08) levels were reduced in both groups. In 6 patients died from gastrointestinal haemorrhage FDP (>lO micrograms/ml), fibrinogen (mean 1.4 g/l), fibrinolysis (<2h), and AT-3 (mean 28.8%) values showed fibrinolytic state. Summary: Coagulation disorders were present in all our patients with liver cirrhosis, bleeders and non-bleeders both. Hyperfibrinolysis patients died from gastrointestinal was present in most haemorrhage.

Portal vein thrombosis (PVT) is a rare condition The prevalence in autopsy studies was reported from 0.05 to 0.5 %. Most otten it is seen as a complication of malignant or inflammatory abdominal disease, liver cirrhosis or hypercoagulative states. Eighteen cases of PVT diagnosed by Color Doppler Ultrasound (CDU) are reported. Toshiba Sonolayer SSA 270 with 3.75 Mhz linear probe was used. Each patient had confirmed diagnosis of PVT by another diagnostic procedure In 11 pts angiography & computed tomography were performed and they were conclusive in 8 of them. Eight patients were submitted to surgery intervention and diagnosis of PVT was confirmed in 6 of them. The arterio/portal ratio of hepatic blood flow was calculated by dynamic scintigraphy in 4 patients and it confirmed diagnosis of PVT. In three patients was diagnosis confirmed by MRI Complete PVT was described in 3 patients, incomplete PVT in 9 patients and cavernomatous transformation of portal vein in 6 patients. In conclusion, CDU was found to be the most effective, least expensive and least invasive of the commonly used imaging methods It is indicated in patients with esophageal bleeding resistent to sclerotherapy , particularly when liver disease does not explain the presence of varices

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CYTOKINES AND NITRIC OXIDE DERIVATIVES (NO) AFTER VARICEAL BLEEDING: CORRELATION WITH PORTAL AND SPLENIC BLOOD FLOWS C.Chagneau (l), F.Kaffy (l), C.Bordetie (l), J. C. Lecron (2), C.Millet (3), A.Wahl (4), M.Piriou (4), L.Tailboux (5), M.Beauchant (l), CSilvain (1). (1) Hepatology, (2) Hormonoloy, (3) Biophysics, (4) Biochemistry and (5) Radiology Units, Jean Bernard Hospital, Poitiers, France.

HELICOBACTER PYL4H-u INFECTION IN ALCOHOLIC AND VIRUS INDUCED CIRRHOSIS

After variceal bleeding, the hyperdynammic circulation state of cirrhosis and the kinetics of NO derivatives and cytokines stimulating inducible NO synthase are poorly understood. h: plasma kinetics of nitrates, nitrites, GMPc and cytokines IFN-1, ILl-p, IL-6, IL-8, IL-lo, IL-15) and (TNF-a, correlation with portal and splenic blood flows. Patients and Methods: cirrhotics after acute variceal bleeding treated by endoscopy associated (Gl, n=5) or not with octreotide (G2, n=5) and non cirrhotic controls with upper GI bleeding (C, n=5). Dosage of cytokines were performed by ELISA, nitrates and nitrites by chromatography, GMPc by radioimmunoassay at day@)O,Dl,D2,D4andD7 (Gl andG2)andDO,Dl andD4 (C). Portal and splenic flows were measured by US Doppler at D 1, D2, D4 and D7. Results : 1) Plasma GMPc levels (moy at D4: G1=5.9; G2=10.3; C=lO.O umol/l, NS), nitrates (moy at D4: G1=38.7, G2=28.6, C=76.0 umol/l) were increased compared to basal levels; plasma TNF-a, IFN-7, ILl-13, IL-lo, IL-15 not detectable and IL-6 and IL-8 increased (NS); portal and splenic flows increased at D4 (Gl;G2, NS) with no correlation with plasma NO derivatives and cytokines levels. Conclusion : After variceal bleeding, the plasma levels of GMPc correlate with nitrates and are less increased in patients treated with octreotide suggesting its role on NO production and the portal and splenic flows are elevated.

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M. Krstic, D. Tomic, G. Jankovic, R. Jesic, N. Milinic, T. Milosavljevic, A. Pavlovic and R. Grbic. Institute of Digestive Diseases, Clinical Center of Serbia, Belgrade, Yugoslavia The aim of this study is to determine incidence of H. pylori among cirrhotic patients and to explore its relationship to demography and etiology of cirrhosis. Twenty-four biopsy proven cirrhotic patients were included in a study. H.pylori was determined by endoscopy with antral histology (N=24) and rapid ureasa test (N=24). Etiology of cirrhosis was classified as alcoholic or virus induced. The rate of H.pylori infection was related to age, gender, etiology and portal hypertension. Ten alcoholic and 14 viral (B or C) cirrhotics, with median age of 52 years and male:female ratio of 1:1,2 were studied. Overall H.pylori incidence was 54,5%. The incidence varied from 52,5 % to 56,4% in man and women, and from 60% to 48% in the younger and older than the median age. Sixty percent of alcoholic and 50% of viral cirrhotics were H.pylori positive. In patients with oesophagesl varices and portal hypertensive gastropathy, the H.pylori was as common as in patients without them. The incidence of H.pylori in cirrhosis is 54,5% . It is unrelated to age, gender, etiology and presence of portal hypertension.