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 endosc...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.展开更多
To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ...To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)展开更多
文摘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.
文摘To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)
