A study to correlate hepatic venous doppler findings and mean portal vein velocity with severity of liver disease in cirrhotic patients.

Ø  Diagnosis of liver cirrhosis will be made based on a combination of biochemical findings as well as typical Bmode ultrasound features such as shrunken liver size with irregular outline, ascites, and portal hypertension.

Laboratory parameters that will be done include prothrombin time/international normalized ratio (INR), serum bilirubin and serum albumin. Hepatic encephalopathy will be graded based on the West Haven Grading System from Grade 0 to Grade 4. Ascites will be graded according to ultrasonography findings into 3 categories: Absent, mild, and moderate to severe.

Ø  For cirrhotic patients, disease severity will be assessed using the Child pughs  score, which took into account five conventional clinical (hepatic encephalopathy and ascites) and laboratory (albumin, prothrombin time, and bilirubin values) parameters

Ø  With the patient in the supine position, B’mode ultrasound of the hepatic parenchyma  will be done under the guidance of Dr.Pradeep patil, Professor-Dept of Radiodiagnosis first to assess the liver span, echogenicity, echotexture, and surface nodularity. Pulsed Doppler evaluation of HV will be then performed in the transverse plane and the probe manipulated (either through an intercostal approach or a subcostal approach over the right hypochondrium), until the star’like confluence of the HVs to the IVC is visualized. The HV evaluation will be done after nonforced (quiet) expiration.Doppler signals will be in general, obtained from the right or middle HVs at a distance of 3–6 cm from the junction of the HV and the IVC to increase the impact of hepatic parenchyma changes on the HVWs instead of the IVC flow. The HVW assessments will be made at angles of insonation <60°.

 The HVW will be classified into three groups according to the Doppler signal characteristics:

1. Type 0, triphasic waveform; the presence of a short phase of reversed flow

2. Type I, biphasic waveform; decreased amplitude of the phasic oscillations without the short phase of reversed flow

3. Type II, monophasic waveform; complete flat waveform

Ø  The RPV will be chosen for evaluation as the left portal vein can be subjected to paraumbilical recanalization in some cases of cirrhosis and within the liver. The RPV will be interrogated with the patient in shallow normal respiration and the mean portal vein velocity (MPVV) will be obtained.

·       Then correlation of hepatic vein waveforms changes and mean portal vein velocity with Child-Pugh class will be evaluated.