Chinese Medical Journal

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PORTAL HYPERTENSION 39

dominal mass in 54 cases, general malaise and epistaxis in 42 each, irregular feverishness in 39, melena in 19, and hematemesis in 17. Besides, edema of the legs and diarrhea were present in 8 cases each, and jaundice and epigastric pain in 4 cases each. The duration of symptoms dating from the discovery of an abdominal mass varied from one month to twenty-two years, and in most of the cases the history was longer than a year’s duration (Table 3). No apparent difference in symptomatology can be seen between the intrahepatic and extrahepatic groups of cases.

Table 3. Duration of the abdominal mass before admission

= Less than 144-5 6-10 11-20 More than Un- Not reDuration 1 year years years years 20 years noticed corded Intrahepatic 16 20 3 2 1 6 Extrahepatic 5 1 1 1 Total 16 25 9 3 1 7 2

A history of hematemesis was present in 17 out of 60 cases, or an incidence of 28.3 per cent (5 cases in which the record was incomplete were excluded). Of these, 14 belonged to the intrahepatic group and 3 to the extrahepatic group. Their incidence of hematemesis was 27.5 per cent and 33.3 per cent respectively. The bleeding was either massive or recurrent in nature. In the 17 cases with hematemesis, it occurred once in 8 cases, twice in 4 cases and more than three times in 5 cases. All the 3 cases of extrahepatic portal bed block had more than three attacks of hemorrhage before admission.

CLINICAL FINDINGS

1. Splenomegaly. Fifty-four patients complained of an abdominal mass, but the spleen was found to be enlarged in all the 65 cases. We arbitrarily divided them into three groups: 1. where the lower pole was within 3 em below the costal margin—3 cases; 2. within 8 cm from the costal margin—29 cases; and 3. beyond 8 em from the costal margin33 cases. In a few cases, the spleen was just palpable below the costal margin but actually its upper part was enlarged with the diaphragm pushing upward. Hence, in addition to palpation, percussion must be performed in order to determine the actual size of the spleen.

2. Hepatomegaly, The liver was not palpable in 28 cases. A slight enlargement of the liver with its edge extending within 3 em below the costal margin was found in 21 cases, 3 being of the extrahepatic type. The liver was found moderately enlarged to within 8 em below the costal margin in the remaining 16 cases, among which only 1 was of the extrahepatic type of portal obstruction. The incidence of hepatomegaly