Assessment of Portal Venous Pressure and its Correlation with Obstructive Jaundice.

Pokhrel S*, Chaudhary JK*, Adhikari SK**

Abstract


INTRODUCTION: Obstructive jaundice due to blockage in the biliary system causes a change in the liver milieu and can be manifested as liver dysfunction which carries an increased risk of postoperative morbidity and mortality. Knowledge of portal pressure in patients with normal liver function and without history of biliary obstruction is important as it gives the baseline portal pressure of our patents. Similarly, knowing the change in portal pressure secondary to bile duct obstruction and its relation with liver function can help to differentiate those patents which are prone to high risk of postoperative morbidities and mortalities so that preventive measure can be applied. This study was designed to find the baseline portal venous pressure and changes in the portal pressure due to biliary obstruction in patients operated in National Academy of Medical Sciences(NAMS) Bir Hospital.

METHOD: Patients with clinical, laboratory and radiological parameters suggestive of obstructive jaundice who had not undergone any form of preoperative biliary drainage were subjected as study group after taking informed consent and approval from the Institutional Review Board(IRB). Similarly, patients with normal liver function and without clinical history, radiology and laboratory parameters suggestive of biliary obstruction and had undergone laparotomy for other indications were included as control group after taking consent. Right gastroepiploic vein or its major tributaries in the greater omentum was used for pressure measurement with the help of in
built pressure transducer manometer of Min Ray ventilator system.

RESULT: Twenty patients in each arm were included for the study and sex distribution in each arm was comparable. There were no difference in the mean age of the study population in two
arms(p=0.446). Mean portal pressure in control group was 8.8 mm of Hg (SD=0.767) and median value of 9 mm of Hg. Mean portal pressure of study group was 12.95 (SD 2.605) with a significant statstcal difference between two groups(P=<0.001). There were no correlation between age and measured portal pressure in control group. Similarly, duration of jaundice did not show any correlation with the portal pressure. However, preoperative total bilirubin level and alkaline phosphatase level showed strong positive correlation with measured portal pressure in study group. Regression analysis also showed preoperative total bilirubin and alkaline phosphatase level are determining factor for increased portal pressure in study group. Increased portal pressure did not show significant correlation with other liver function test parameters.

CONCLUSION: Mean portal pressure of nonjaundiced patents without deranged liver function did not show any change in value with the age of the patents. There was significant rise in the portal
pressure than the control group in patients with obstructive jaundice and it positively correlates with total bilirubin level and alkaline phosphatase level.

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