HEPATIC CIRRHOSIS IN JAMAICA

The aetiology, biochemistry, clinical features and complications of hi stologically confirmed hepatic cirrhosis in 45 patients (26 females, 1 9 males) seen at the University Hospital of the West Indies, Jamaica b etween 1984 and 1994 are presented. The age range was 1 to 72 years (m ean 48 years). Abdominal swelling and weight loss were the commonest s ymptoms, occurring in 51% and 47% of patients, respectively. Jaundice was a presenting feature in 44%. Hepatomegaly was present in 71% of pa tients and splenomegaly in 33%. The aetiological factors were. alcohol (36%), bush tea (18%), chronic active hepatitis (11%), drugs (7%), an d haemochromatosis (2%). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24% of the patients also had diabetes mellitus ., 29% were anaemic, 29% were thrombocytopenic, 4% were leukopenic, an d the prothrombin time was prolonged in 22%. The albumin/globulin rati o was reversed in 71% of the patients. The alkaline phosphatase was el evated in 56%, the aspartate aminotransferase was increased in 58% and the gamma glutamyl transpeptidase in 56%. 56% of the patients had mac ronodular cirrhosis; the liver showed a micronodular pattern in 18%; 7 % had biliary cirrhosis; 7% chronic active hepatitis with cirrhosis; a nd 13% showed a mixed macro-micronodular pattern. Ascites and fluid ov erload developed in 44% of the patients. Hepatic encephalopathy occurr ed in 18% and upper gastrointestinal bleeding in 18%.