- Pain occurs regularly after eating (1-3 hours after eating in gastric ulcers) or slowly from
3-5 hours after eating in duodenal ulcers.
- The pain recurs regularly every day at a certain time after meals, lasting 2-3 weeks if not treated; if treated, the pain only decreases or disappears when taking medication and only disappears completely after 1 week to 10 days. This point helps us distinguish it from "pseudo-ulcer" pain (less than 3 days), a variation of liver colic.
- The pain recurs periodically after 1 or more years, usually in the cold season.
- Pain is reduced when eating, drinking milk or taking antacids, increased with sour foods,
Maybe you are interested!
-
![Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output ports bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the routers service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a routers per-hop behavior is based only on the packets marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being frozen, or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the routers buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connections shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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![Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output ports bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the routers service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a routers per-hop behavior is based only on the packets marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being frozen, or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the routers buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connections shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output port's bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the router's service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a router's per-hop behavior is based only on the packet's marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being "frozen", or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the router's buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connection's shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Stress coping skills in credit-based learning activities of university students - 22 -
Organizing project-based learning in advanced mathematics for engineering university students - 13 -
Teaching Method of Literature Subject Based on Student's Ability in Secondary School -
Theoretical Basis of Traditional Costing Method and Activity Based Costing Method (Abc)
high acidity (pineapple, lemon,...)
- Pain characteristics: like twisting, rarely hot, burning like in inflammation
stomach.
- Accompanied by belching or heartburn. Vomiting when there are complications. Constipation.
- Patients may lose weight due to decreased appetite due to pain, but some people gain weight due to eating.
or drink a lot of milk to relieve the pain.
2.1.2. Atypical form :
- Burning pain, after eating and cyclical.
- Twisting pain, after eating but irregular cycle during the year.
- Twisting pain, not much related to meals but cyclical.
- Painless form is only detected when there are complications of perforation or hemorrhage.
20-25% of cases.
- Only 30% of duodenal ulcer patients have typical pain.
2.1.3. Physical signs: in gastric ulcer are very poor, however, a comprehensive examination is necessary to find lesions of other diseases that can cause pain in the epigastric region (atypical). Usually the patient has mild anemia, insomnia, or anxiety. Sometimes the patient can pinpoint a pain point in the epigastric region.
2.2. Paraclinical
2.2.1. Contrast-enhanced gastroduodenal X-ray: a good method for diagnosing lesser curvature and duodenal ulcers, less sensitive to superficial ulcers or inflammation, now gradually being partially replaced by endoscopy.
2.2.2. Gastroduodenoscopy: is the best means to diagnose and monitor gastric and duodenal ulcers. Through endoscopy, we can biopsy or stain the mucosa for a more accurate diagnosis. Biopsy is a means to diagnose degenerative ulcers (cancer) and Helicobacter pylori infection by staining with Giemsa, Starr or doing a rapid urease test (Clo test), detecting urea released by Helicobacter pylori on biopsy tissue samples.
2.2.3. Other means: to detect Helicobacter pylori infection: diagnostic serum, gastric biopsy culture,...
3. Complications
3.1. Gastrointestinal bleeding
3.2. Perforation of the stomach and duodenum
3.3. Pyloric stenosis
3.4. Cancerization
4. Treatment principles:
4.1. Lifestyle changes: avoid factors that favor ulcers.
4.2. Use of medication
- Antacids.
- Acid-reducing drugs: H2 receptor antagonists, proton pump inhibitors.
- Medicine to protect the stomach lining and increase the resistance of the stomach lining.
- HP killer.
HEPATITIS
TARGET
1. List the causes of hepatitis.
2. Describe the clinical and paraclinical presentation of acute and chronic hepatitis.
1. Definition
Hepatitis is a condition of liver parenchyma damage, characterized by the presence of
inflammatory cells
Hepatitis lasting less than 6 months is called acute hepatitis, lasting more than 6 months is called chronic hepatitis.
2. Causes
2.1. Caused by viruses: A, B, C, D, E.
2.2. Caused by bacteria: leptospira infection, typhoid, riskettsia infection,...
2.3. Due to alcohol
2.4. Fatty liver disease
2.5. Due to drugs: high doses of acetaminophen, anti-tuberculosis drugs, birth control pills, etc.
2.6. Due to toxins
2.7. Autoimmune hepatitis
2.8. Wilson's disease
2.9. Hereditary hemochromatosis
2.10. Due to α1-antitrypsin deficiency
2.11. Due to ischemia
3. Clinical
Most patients have no obvious symptoms and are discovered incidentally during testing. About 25% of patients have typical clinical manifestations suggestive of hepatitis such as right hypochondriac pain and jaundice.
3.1. Acute hepatitis
The disease can be divided into 4 stages:
3.1.1. Incubation period
Lasts on average from several weeks to several months depending on the pathogen. Most patients have no specific symptoms.
3.1.2. Onset period
- Mild fever without chills.
- Fatigue, poor appetite, muscle pain, joint pain.
- Sometimes there is pain in the liver area, dark yellow urine.
3.1.3. Full development period
- Dark urine appears first, then jaundice and mucous membranes appear. At this time, the fever gradually decreases and then disappears completely.
- Symptoms of physical weakness (fatigue, poor appetite, nausea or vomiting, etc.).
- May itch.
- May cause bowel disorders: diarrhea or constipation.
- The liver may be enlarged and painful on examination.
- Can progress to fulminant hepatitis with symptoms of acute liver failure causing blood clotting disorders (skin and mucous membrane bleeding, gastrointestinal bleeding, etc.), impaired consciousness, gradually entering hepatic coma within 8 weeks from the onset of the disease, and possibly death. In acute liver failure, leg edema and ascites are usually very mild while blood clotting disorders and impaired consciousness are prominent.
3.1.4. Recovery period
Symptoms gradually decrease and disappear, and the patient recovers completely after 1-2 months. Some patients may have prolonged jaundice, but not more than 6 months.
3.2. Chronic hepatitis
In the early stages, there are usually no clinical symptoms of fistula. The patient may only feel slightly tired, have poor appetite, mild jaundice, etc., or have no symptoms at all. After many years, the first symptom that concerns the patient is often a manifestation of complications such as decompensated cirrhosis (leg edema, ascites, oliguria, abnormal skin and mucosal bleeding, etc.) or liver cancer (enlarged, hard, painful liver, rapid deterioration of general condition).
4. Paraclinical
4.1. Tests to diagnose hepatitis
- Quantification of liver transaminase enzymes: AST (SGOT) and ALT (SGPT).
- Lactate dehydrogenase (LDH).
- Bilirubin.
- Alkaline phosphatase (ALP).
- γ glutamyl transpeptidase (GGT).
- Protein electrophoresis.
- Blood clotting function.
- Diagnostic imaging: ultrasound, CT scan, MRI,…
- Liver biopsy.
4.2. Diagnostic tests for the cause:
Depending on different causes, for example:
- Hepatitis B: HBsAg, Anti-HBs, Anti-HBc (IgM: acute inflammation), HBeAg,
Anti-HBe, HBV DNA.
- Hepatitis C: Anti-HCV, HCV RNA.
5. Treatment principles
Depending on the specific cause of hepatitis, we have separate treatment directions.
CIRRHOSIS
TARGET
1. List the causes of cirrhosis.
2. Describe clinical and paraclinical symptoms of cirrhosis.
3. List the prognostic factors for cirrhosis according to Child-Pugh.
4. List common complications.
5. State the treatment principles.
1. Definition:
- Cirrhosis is the result of chronic and progressive liver disease, resulting in the widespread destruction of liver parenchyma cells, replaced by scar tissue and regenerative nodules that disrupt the normal structure of blood vessels and liver lobules.
- Histologically cirrhosis is defined as:
Liver parenchymal cell necrosis.
Portal fibrosis extends into the lobule.
The tumors regenerate but are non-functional.
2. Cause:
2.1. Alcohol:
Alcohol causes liver damage to varying degrees:
- Fatty liver.
- Alcoholic hepatitis.
- Cirrhosis.
2.2. Hepatitis B, C
2.3. Medicine
2.4. Iron overload
- Congenital: due to iron metabolism disorders.
- Secondary: due to diseases requiring long-term blood transfusion.
2.5. Copper overload: Wilson's disease
2.6. Biliary obstruction:
- Congenital (no extrahepatic biliary obstruction).
- Secondary (with extrahepatic biliary obstruction).
2.7 . Budd-chiari syndrome: hepatic vein obstruction.
2.8. Heart failure : chronic right heart failure cardiac cirrhosis.
2.9. Malnutrition
2.10 . Infections, parasites: liver flukes, congenital syphilis.
2.11. Spontaneous: no cause is known.
Cirrhosis can be caused by one cause or by many causes.
same impact
3. Symptoms
3.1 . Compensated cirrhosis
- This is the early stage of cirrhosis, clinical symptoms are not obvious, rarely detected, only discovered by chance because of its complications: gastrointestinal bleeding due to ruptured esophageal varices, or other diseases detected through abdominal surgery or through routine health check-ups.
- The liver is usually large, painless, firm, with sharp edges, smooth or bumpy surface,...
- Definitive diagnosis at this stage is based on liver biopsy showing cirrhosis.
3.2 . Decompensated cirrhosis
This is the late stage of cirrhosis, clinical manifestations are quite obvious with many
symptoms. There are two syndromes:
3.2.1. Portal hypertension syndrome : about 60% of cases of cirrhosis have
portal hypertension (> 20 cmH 2 O).
Clinical symptoms of portal hypertension syndrome include:
+ Dilation of portal-systemic veins:
. Subcutaneous abdominal collateral circulation.
. Esophageal varices.
. Rectal varicose veins.
+ Ascites.
+ Enlarged spleen.
3.2.2. Hepatocellular failure syndrome
The liver has a great capacity for compensation. Therefore, when cirrhosis is in the late stage and decompensated, the symptoms become obvious. The main symptoms are as follows:
- Digestive disorders: loss of appetite, indigestion, diarrhea, unusual constipation.
- Jaundice - mucous membranes
- Skin and mucous membrane bleeding.
- Dropsy.
- Swollen feet.
- Pulse, red palms.
- Endocrine disorders: Men: impotence, breast enlargement.
Female: menstrual disorders, inability to conceive.
- Neuropsychiatric disorders: memory loss, more severe disorientation of space and time, more severe coma.
3.2.3. Liver examination: decompensated cirrhosis usually has a shrunken liver, there are also cases of enlarged liver with the following characteristics: no pain, sharp edges, firm density, surface is often not smooth or can have a smooth surface depending on the cause.
3.3. Paraclinical
3.3.1. Liver function tests : disturbances
* Protein electrophoresis: decreased albumin, increased globulin (gamma globulin), A/G ratio <1.
* Prothrombin ratio: decreased, in cirrhosis often decreased < 60%. Quick time: prolonged.
Estered cholesterol
* Rate ---------------------------: decrease
Total cholesterol
* BSP discharge test (+)
* Tests for liver cell necrosis: transaminase enzymes (SGOT, SGPT) may be normal or increased.
Increased transaminase indicates progressive cirrhosis. Conversely, normal transaminase indicates stable cirrhosis.
3.3.2 . . Peritoneal fluid testing
Peritoneal fluid in cirrhosis is classified as: transudates
Based on the serum-peritoneal fluid albumin gradient (SAAG)
In cirrhosis: SAAG 1.1g/dl
3.3.3. Endoscopy: to look for signs of portal hypertension.
3.3 . 4. Ultrasound
Ultrasound contributes to diagnosis through imaging of changes in liver tissue structure, peritoneal fluid, splenomegaly, and dilated portal veins.
3.3.5. Liver biopsy