Spontaneous bacterial peritonitis(SBP) in liver cirrhosis

Cirrhosis und its con~pliu~tions, pathophJ!siology

169

und clinical aspects

HELICOBACTER PYLORI AND HEPATIC ENCEPHALOPATHY

PROPHYLAXIS WITH NORFLOXACIN OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS Braticevi&_B. Chkila*. B.Bratkvici** *Medical Clinic II. Department of Gastroenterology, University Hospital Bucharest. **‘IX. Burghele Hospital. Bucharest. Romania.

C~~Fi&iinteaeu A.V&V. D.Hwvat. D.PemmC D sbmac. A.Vkm Clinical Hospttal Osijek. General H.&M Vinkovd, Clinical Hospital Centre Rijeka, CdOATlA

The mechanism of hepatic encephalopathy is unknown but several factors are thought to play a part. Nevertheless, ammonia seems to play a major role. It is produced by the breakdown of protein by intestinal bacteria and a high blood ammonia is seen in most patients. Ammonia can be generated by the urease activity present in gastric mucosa. The aim of this study was to investigate the effect of Helicobacter pylon as an urea - splitting bacteria on the hepatic encephalopathy in decompensated alcoholic liver disease. Patients and Methods: 109 patients with decompensated alcoholic liver disease were included in this randomized, three - centre study. H. pylon infection was assessed by a urease test and histology after Giemsa stain. Hepatic encephalopathy was assessed by a high blood ammonia and clinical sings. /Results. 69 patients (63,30/o) were H. pylori positive. Hepatic encephalopathy we found at 56 patients (51,4%), 53 patients (48,6%)were without encephalopathy. Among 56 patients with encephalopathy 41 patients (73,2%) were H. pylon positive and among the 53 patients without encephalopathy only 28 patients (52,8%) were positive for H. pylori. Conclusion: patients with decompensated alcoholic liver disease and H. pylori infection have a higher risk for hepatic encephalopathy than patients without H. pylon infection.

Spontaneous

Group of 94 patients with liver cirrhosis and endoscopically confirmed esophageal varices , (aged 25-74, median 60 years) and 30 healthy controls (aged 25-67, median 51 years) were examined. Toshiba Sonolayer SSA 270 with 3.75 MHz linear probe was used. The portal vein was enlarged ( > I3 mm) in 47 % of patients , gallbladder wall was more than 3 mm in 29 % of pts, spleen enlargement ( > I3 cm) was present in 69 % of pts. Portosystemic collateral circulation was confirmed 67 times - in 64 % of pts. Hepatofugal flow was diagnosed only in 4 % of pts There was a statistically significant difference (p < 0.001 ) in PFV (10.22 +/- 3. 73 vs. 16.47 +/- 3.37 cm/s) and MFV (5.99 +/- 2.71 vs. 10.4 +/- 2.5 cm/s ) between pts and controls. Similarly, a significant difference in common hepatic artery diameter ( 5.65 +/- 0.95 vs. 4.4 +/- 0.46 mm ) was confirmed. There was found a correlation between degree of portal hypertension determined by CDU and Child-Pugh classification of liver cirrhosis and degree of oesophageal varices, confirmed endoscopically. Patients with splenorenal collaterals and recanalized umbilical vein had less number of esophageal bleeding than patients without these shunts or with dilated left gastric vein We consider the values of PFV 7 cm/s and MFV 5 cm/s as specific for the diagnosis of portal hypertension. Dilatation of the hepatic artery is the result of increased arterial liver blood flow in cirrhosis. From diagnostic point of view, the unfavorable feature of this sign is that the common hepatic artery was measurable only in 65 % of cases Spleen enlargement exhibited the highest sensitivity. Collateral portosystemic circulation and excessive deceleration or reversion of portal vein flow seems to be the most specific confirmation for ultrasonographic diagnosis of portal hypertension

of cirrhosis.

prognosis of SRP in patients with and without Norfloxacin

prophylaxis.

METHODS: 60 cirrhotic patients with ascites were studied and were divided in two groups: 30 patients with Norfloxacin prophylaxis 400 m&/day for one year (group I), and 30 patients without prophylactic treatment (group 2). All the patients were matched for age. etiology of cirrhosis and Child score. The two groups were compared after one year of surveillance by means of the Students test. RESULTS:

CONCLUSIONS: Patients receiving prophylaxis with Norfloxacin had a decreased number of episodes of SBP but the associated clinical features ( hepatic encephalopathy and renal failure) were severe and the episodes were unresponsive to treatment. Our study ‘s final results do not recommend long term Norfloxacin prophylactic treatment.

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DIAGNOSIS OF PORTAL HYPERTENSION M. S&ntova . V. KuuEova 3rd Department of Medicine , Medical School of Comenius University , Bratislava, Slovakia

bacterial peritonitis is a severe complication

AIM: This study compares the frequency, clinical features. etiology and

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SPONTANEOUS BACTERIAL PERlTONlllS(SBP) IN LIVER CIRRHOSIS A.V.Dioiu : Gtflia Motoi Fundani Hospital - Medical Clinic, Bucharest Romania Aim of the study: To evaluate the prevalence of SBP in cinMi patients and to establish correlation with diit parameters. MaMe/ and meffmd . It is a retrospective study on 384 patienk with liver cirmosisandascites.Wedividedthemintohnrogrwps:A=22patients withSBP,andB=362patientswiMutinfectedascttes.Wemadea one year f&w-up study . Diagnosis of SBP was based cn c&sic criteria NBC count ever 0,s x 10 OA) or neubcphytia (over 0,3 x IOg A) without any other explanation, positive culture of ascitic fluid on the hempculture medium WC in ascites over 0,5 x IO 9 II without any intraabdominal infecticns cause . Resuk BPS was found in 872% of patients; 318% were asymptomatic, 636% had abdcminai pain, 63,6? were feverish. Patients with SBP had a longer period of ascites evekt tion (12,6+2,4 months vs 9,1 9,Ol months - p4),01 ) ,a higher in& dence of zabetes mettiis (la,8 % in tot A vs 8,24% in lot B p