A Study of Association of Portal Vein Diameter And Splenic Size With Gastro-Oesophageal Varices in Liver Cirrhosis Patients

Abstract

50 patients with cirrhosis of liver admitted in SMS Hospital, Jaipur were selected for the study. Ultrasonography was performed in all the cases and diameter of portal vein and spleen size was recorded. Endoscopy was performed in all the selected cases to look for oesophageal varices. Out of 50 patients 40(80%) had oesophageal varices at the time of presentation. Average Spleen size in variceal group (14.69±1.08)cm was higher than in non-variceal group(12.45±0.65)cm, p<0.01. The average portal vein diameter of patients in nonvariceal group was 11.78±1.58mm and that of patients with varices 14.05±2.26 mm, p <0.01. There was a positive correlation between spleen size and the Grades of oesophageal varices (r=0.6771) and the difference was statistically significant(p<0.01). There was a positive correlation between Portal vein Diameter and grades of oesophageal vaices (r=0.7465),p<0.01. In our study it was also found that there was a weak but definite correlation between Portal Vein Diameter and Spleen size(r=0.5369) which was statistically significant (p<0.01). Hence from the present study it can be concluded that as the Grades of Varices increases the Spleen size and Portal Vein Diameter also increases.

Study of Portal Vein Diameter and Spleen Size by Ultrasonography and Their Association with Gastro-esophageal Varices

“…There was 94.5 % sensitivity and 75 % specificity for prediction for presence of esophageal varices when the cutoff value (by ROC curve analysis) of spleen size for was >13.9 cm. For cutoff value of spleen size >13.5 cm, Shanker et al 15 reported 90% sensitivity and 80% specificity for prediction for presence of esophageal varices which is in consistency with our results.…”

“…Positive correlation between PVD and grades of esophageal varices and also between spleen size and variceal grading were described by Shankar et al 15 Further, Mandal et al 12 , and Nemichandra et al 22 in their studies described direct correlation between portal vein diameter and spleen size. These studies are consistent to our study.…”

“…Ng et al, 14 found a mean PVD of 10.5 ± 2.6 mm among patients without esophageal varices and mean PVD of 11.5 ± 2.4 mm among patients with varices. The average PVD was 11.78 ± 1.58 mm in non-variceal group and 14.05 ± 2.26 mm in variceal group( p <0.01) by Shanker et al 15 The best cutoff of PVD for prediction of esophageal varices for our study population was >12.25 mm (Sensitivity = 92.72%, Specificity = 90%). Shanker et al 15 , in India, reported PVD > 12.20 mm, value similar to ours, as a predictor of esophageal varices with sensitivity of 80 %, and specificity of 80 %.…”

Non-Invasive Predictors of Gastro-Oesophageal Varices

“…Mandal et al, 7 reported serum albumin of 3.484±0.402 in patients without varices and 2.52±0.421 in patients with varices (P>0.10). Shanker et al, 9 reported that serum albumin was lower (2.3±0.5 gm/dl) in patients with varices than in patients without varices (3.2±0.4 gm/dl; P<0.01). Sarwar et al, 10 also described low serum albumin to be an independent factor associated with presence of oesophageal varices, however another study by Cherian et al, 11 described insignificant correlation between serum albumin and oesophageal varices.…”

“…Our study had sensitivity of 87.9 % and specificity of 41.7% for cutoff platelets count of <144,000/ mm 3 . Shanker et al, 9 reported platelet count of <120,000/mm 3 to be 90% sensitive and 50% specific in predicting oesophageal varices. Thomopoulos et al, 12 mentioned platelet count of <118,000/mm 3 to be a good predictor for presence of varices with sensitivity of 95% and specificity of 73 %.…”