Background: Extra-hepatic portal vein obstruction (EHPVO) due to portal vein thrombosis is an important cause of portal hypertension in several region including India. The cause of thrombosis in these patients remains unclear. Objective of the study was to study the demographic features, etiology, clinical, laboratory findings with special reference to thrombophilic factors like protein C, protein S and antithrombin III deficiency in children with EHPVO.Methods: The prospective analysis of 62 patients of EHPVO (<14 years of age) was done in the Department of Hepatology, SCB medical College, Cuttack. After detailed history, clinical examination, Ultrasound abdomen /color Doppler and Upper GI endoscopy, the subjects were analyzed for any deficiency of thrombophilic factors like protein C, protein S and antithrombin III.Results: A total of 62 patients (37 Male, 25 Female) with mean age of 8.3+3.1 years were studied. Growth retardation was present in the form of wasting (alone) 20.9%, stunting (alone) 25.8% and both wasting and stunting was found in 9.8% cases. History of neonatal, umbilical sepsis and umbilical vein catheterization was found in 15.9% and 10.2% of cases respectively. Haemorrhage from oesophageal varices was prevalent symptoms in 85.9% patients. Splenomegaly was found in 91.9% patients and ascites in 9.4% patients. 47 patients studied for protein C, S and antithromibin III. 14 patients were found to have thrombophilia: protein C deficiency in 9, protein S deficiency in 8, Antithrombin III deficiency in 6.Conclusions: The etiology of EHPVO in the majority of patients remain still unclear. It is commonly associated impaired somatic growth. The risk of EHPVO increases in the presence of thrombophilia, resulting from deficiency of naturally occurring anticoagulant proteins like Protein C, Protein S and Antithrombin III.

Background: Acute on chronic liver failure (ACLF) is a recently recognised entity in chronic liver disease patients. Data regarding ACLF in terms of clinical presentation, etiology of underlying cirrhosis, precipitating factors, prognostic factors are lacking from eastern India. The present study was undertaken to evaluate the above factors along with the assessment of short-term mortality (4 weeks) in patients of ACLF.Methods: In this prospective observational study, 120 patients diagnosed as ACLF were included. A comparison of complications, biochemical profiles and prognostic scores was made between the survivor and non-survivor groups.Results: Of the 120 ACLF patients included, the mean age was 44.9±8.6 years and the male to female ratio was 2.5:1. Common clinical presentations were jaundice (100%), ascites (88.3%), hepatic encephalopathy (60%). The most common etiology for underlying CLD was alcohol (51.7%) followed by chronic hepatitis B (20%) and chronic hepatitis C (15%) infection. Alcohol hepatitis (40%) followed by hepatotropic viral infections (20%) and drug-induced liver injury (15%) were common identifiable precipitating agents. After a follow-up period of 4 weeks, 56 (46.6%) out of 120 patients died. The presence of sepsis, hyponatremia, renal failure, and coagulopathy was significantly associated with high mortality. Mortality was higher among patients having high Chronic liver failure consortium- acute on chronic liver failure (CLIF-ACLF) grade and closely related to the number of organ failures.Conclusions: ACLF is a rapidly progressive syndrome in chronic liver disease patients, having high short-term mortality.

In this prospective study, two hundred and fifty four patients diagnosed to be having AVH were analyzed with reference to clinical profile & viral markers and statistical analysis was done. Isolated viral infection was documented in 102 (40.1%) patients where as more than one hepatotrophic viruses caused AVH in 27(10.6%) patients. Non A-E Virus was the major case of sporadic AVH (40.1%), HBV & HEV were the etiological agent in 23.6% & 25.1% respectively. HAV was detected in 16.5% of the patients and the HCV was incriminated rarely as cause of sporadic AVH. The demographic, clinical and biochemical profile amongst isolated & mixed viral infection were found to be similar. However, HBV-AVH had significant prolonged course (p<0.001) and HAV-AVH was found to have significantly higher number of patients pursing a course of relapsing hepatitis. However HAV infection amongst adults in the present study was not found to cause severe liver disease except in few cases.

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