The clinical significance of upper gastrointestinal bleeding etiology score in determining variceal bleeding

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common, and potentially life threatening condition, which can be divided into variceal and non-variceal sources of bleeding. OBJECTIVE: To examine the validity of the upper gastrointestinal bleeding etiology score compared to the current gold standard, the emergency Esophagogastroduodenos-copy (EGD), for determining the etiology of UGIB. METHODOLOGY: 101 patients presenting with upper gastrointestinal bleeding presented in the emergency department of Capital Hospital, Islamabad between February 2010 and March 2012 were in- cluded in this cross-sectional study. The upper gastrointestinal bleeding score was computed for each case by accounting for the clinical parameters of previous diagnosis of cirrhosis or signs of chronic liver disease × 3.1, presence of red vomitus × 1.5, and red N/G aspirate × 1.2. Each parameter was given a score of 1 if present, and 0 if absent, with a total score ≥3.1 favoring variceal bleed, and a score of <3.1 indicating non-variceal bleeding as a cause of UGIB. Esophago-gastroduodenoscopy was performed within 72 hours of presentation. RESULTS: The mean ± SD age of the patients was 50.2 ± 14.1 years ranging from 18 to 80 years. Out of 101 patients, 56% were males while the remaining 44% were females. The sensitivity of the UGIB score was 78.2% and the specificity was 84.3%. The positive predictive value (PPV) was 91.5% and negative predictive value (NPV) was 64.2%. The overall diagnostic accuracy of UGIB score in determining variceal bleeding was found to be 80.2%. CONCLUSION: Variceal bleeding is a common cause of UGIB in Pakistan. UGIB etiology score is a highly sensitive and specific clinical tool in determining the etiology of UGIB as either variceal or non-variceal bleeding.

Clinical and Pathological Comparison of Pyogenic and Amoebic Liver Abscesses

BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liver abscesses were divided into two groups: the pyogenic (n = 47) and amoebic group (n = 21), which were analyzed for differences in clinical and laboratory findings. RESULTS: Amoebic liver abscesses presented most frequently in young adults (14 - 30 years;71%), whereas pyogenic liver abscesses were most commonly observed in adults 41 - 50 years (49%). Indirect hemagglutination test revealed a 100% positive response in the amoebic group, whereas 68% of the pyogenic group presented with blood/pus culture. Multiple abscesses were observed in 66% and 24% of patients in the pyogenic and amoebic group, respectively. CONCLUSIONS: Pyogenic abscesses were commonly observed in older patients, and were associated with features such as markedly deranged liver function test, higher prothrombin time, and multiple abscesses, compared to amoebic abscess. Early and improved diagnoses and differentiation between the two conditions, followed by the correct treatment, can help prevent serious complications and lead to an overall improved mortality rate.