Blood Ammonia as Predictor for Esophageal Varices and Risk of Bleeding
Blood Ammonia as Predictor for Esophageal Varices and Risk of Bleeding
Assessment of blood ammonia level as a non-invasive predictor for presence of EV and risk of
 bleeding
A prospective cross sectional study on 150 consecutive patients screening for esophageal
 varices.

 Patient groups groups:

 Group (1): 100 patients with esophageal varices

 Group (2): 50 chronic liver disease patients with no esophageal varices as a control group.

 All patients will be subjected to:

 1. - Detailed history-taking

 2. - Full clinical examination

 3. - Laboratory investigations:

 -  Complete blood picture (CBC)

 -  Erythrocyte sedimentation rate (ESR)

 -  Renal function tests

 -  Liver function tests

 -  Prothrombin time and activity

 -  Viral markers (HCV Ab - HBV Ag)

 -  Blood ammonia level.

 4. - Pelviabdominal US: Ultrasound examination of the liver, portal venous system, spleen,
 kidney and other abdominal organs.

 5. - Upper GITendoscopy:

 -  Varices will be classified according to the Japanese classification 1996,

 -  The Baveno 11 score will be used to differentiate between mild and severe portal
 hypertensive gastropathy.
Inclusion Criteria:

 -  patients with chronic liver disease

 Exclusion Criteria:

 -  Patient in hepatic encephalopathy or coma.

 -  Patient in active bleeding or with history of bleeding within the two weeks prior to
 entry in the study .

 -  Patients with heart failure.

 -  Patients with renal failure.

 -  Patient with hepatocellular carcinoma and portal vein thrombosis.

 -  Patient taking Beta blockers.