Santiago ME, Rodríguez MA

Language: Spanish
References: 22
Page: 44-50
PDF size: 83.15 Kb.

ABSTRACT

Antecedents. Cirrhosis is a frequent disease, that occupies the sixth cause of mortality in our country and is the first cause of hospitalization in the Service of Gastroenterology of Hospital Juárez de México. Its main complication is the digestive hemorrhage habitually by esophageal varicose. Objective. To determine risk indicators for variceal hemorrhage in relation to varicose size, portal flow and clinical stage in patients with cirrhosis. Material and methods. Prospective, observational, descriptive study in a group of cirrhosis carrying adult patients with hepatic insufficiency with and without digestive hemorrhage. Results. 62 patients, 39 women and 23 men were included, with age average of 48.8 years. Of these, 39 had hemorrhage and 23 no. The most frequent cause of this was esophageal varicose in 61%. The commonest etiology of the cirrhosis was ethanol in 83.8%. Patients of moderate hepatic insufficiency (Child-Pugh B), the carriers of esophageal varicose degree 4 and 5, those that had a portal diameter greater than 13 mmHg and those of hepatoleakage flow had greater percentage of hemorrhage. Conclusions. According to the present study, there were found as factors of risk for variceal hemorrhage: masculine sex, degree of hepatic insufficiency, carriers of varicose degree 4 and 5, portal diameter greater of 13 mm Hg associated to hepatoleakage flow. Nevertheless, the degree of hepatic insufficiency (p = 0.021) and the size of esophageal varicose only had statistical significance (p = 0.002).

REFERENCES

1. Vesalius A. De humani corporis fabrica libri septem. Basel, 1543, libri V, cap 8, p 624.

2. Carswell R. Pathological anatomy. Illustrations of the elementary forms of disease. London: Longman; 1838.

3. von Rokitanski C. Handbuch der pathology anatomie. Wein Braummuler, Seidel, 1849.

4. Monterrubio D, Marín E, Larrauri J, et al. Epidemiología de la cirrosis hepática en la ciudad de Puebla. Rev Gastroenterol Mex 1987; 52: 175-8.

5. Reyes B, Márquez C. Correlación entre cirrosis hepática y desnutrición. Rev Gastroenterol Méx 1996; 61: S89.

6. Rodríguez-Hernandez H, Guerrero JF, Jacobo JS, et al. Análisis de supervivencia en pacientes cirróticos. Rev Gastroenterol Méx 1996; 61: 226-32.

7. Martínez de los Santos G, Rodríguez Magallán. Epidemiología de la Cirrosis por alcohol en el Hospital Juárez de México. Rev del HJM 1994; 61: 72-4.

8. Lebrec. Methods to evaluate portal hypertension. Gastroenterol Clin North Am 1992; 21: 41. Review.

9. Huet PM, Pomier-Layrargues G, Villanueve JP, et al. Intrahepatic circulation in liver disease. Semin Liver Dis 1986; 6: 277.

10. Boyer TD. Portal hypertensive hemorrhage: pathogenesis and risk factors. Semin Gastrointest Dis 1995; 6: 125.

11. Pagliaro L, D’Amico, Luca A, et al. Portal Hipertension: diagnosis and treatment. J Hepatol 1995; 23: 36.

12. Henderson. Management of variceal bleeding in the 1990s. Cleve Clin J Med 1993; Nov-Dec: 431. Review.

13. Brewer. Treatment of acute gastroesophageal variceal hemorrhage. Med Clin North Am 1993; 77: 993. Review.

14. Grace. Prevention of initial variceal hemorrhage. Gastroenterol Clin North Am 1992; 21: 149. Review.

15. Conn. Propranolol in the prevention of the first hemorrhage from oesophageal varices: a multicenter, randomized clinical trial. Hepatology 1991; 13: 902.

16. Lebrec. Methods to evaluate portal hypertension. Gastroenterol Clin North Am 1992; 21: 41. Review.

17. Polio J, Groszmann RJ. Hemodinamic factors involved in the development and rupture of esophageal varices: A pathophysiologic approach to treatment. Semin Liver Dis 1986; 6: 318.

18. Merkel C, Bolognesi M, Bellon S, et al. Prognostic usefulness of hepatic vein catheterization in patients whit cirrhosis and esophageal varices. Gastroenterology 1992; 102: 973.

19. Burrough A, Mezzanotte G. Cirrhotics with variceal hemorrhage: The importance of the time interval between admission and the start of analysis for survival are rebleeding rates. Hepatology 1989; 9: 801.

20. Cales P. Gastroesophageal endoscopic features in cirrhosis: Observed variability, interassociation, and relationship to hepatic dysfunction. Gastroenterology 1990; 98: 156.

21. Violi F, Ferro D, Basili S, et al. Hyperfibrinolysis increase the risk of gastrointestinal hemorrhage in patients with advanced cirrhosis. Hepatology 1992; 15: 672.

22. North Italian Endoscopic Club for the study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: a prospective multicenter study. N Engl J Med 1988; 319: 983.