Chalyi M. Clinical-laboratory and instrumental criteria for differential diagnostics of hepatic and extrahepatic portal hypertension

The dissertation is devoted to the improvement of differential diagnostics of hepatic and extrahepatic portal hypertension (PH) based on the identification of informative clinical and biochemical and instrumental criteria. For the first time, stratified diagnostic signs of hepatic and extrahepatic PH and a prognostic estimation of the probability of diagnosis of PH forms in the presence of established diagnostic criteria were made. Thus, the significant diagnostic criteria for hepatic PH were the presence of clinical manifestations of hepatic encephalopathy of grade 2–3 (OR=10.80), a combination of cytolytic and cholestatic syndromes (OR=9.71), the level of prothrombin index <75% (OR=13.78), international normalized ratio >1.3 (OR=7.07), the presence of small intestine bacterial overgrowth (OR=7.29), hepatic-splenic arterial index >51% (OR=8.92), and diagnosis of hepatic encephalopathy 2-3 degrees according to electroencephalography (OR=20,44). For differential diagnosis of extrahepatic PH, significant criteria were the age of a patient with PH less than 37 years old (OR=27.39), the level of prothrombin index >85% (OR=22.32), fibrinogen level > 4 g/l (OR=19.81) and diagnosis of portal hypertensive gastropathy (OR=21.0). All that allowed to make the algorithm of differential diagnostics of hepatic and extrahepatic portal hypertension. There was proved the efficiency of electroencephalography usage for diagnostics of hepatic encephalopathy degree comparing to test of numbers link and flicker-test. There was established that in 70,6% patients with PH disorders of intestinal biocenosis were revealed in form of small intestine bacterial overgrowth that was diagnosed in 1,7 folds more frequent in patients with hepatic form of PH (2=8,2, р=0,005). There was grounded the advisability of diagnostics of small intestine bacterial overgrowth for prevention of PH complications because the development of small intestine bacterial overgrowth in patients with hepatic PH was associated with degree of varicose dilatation of esophageal veins (r=0,57; р<0,05) and ascites (r=0,40; р<0,05).