Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in diagnosis of intra-abdominal lymphadenopathy / Moustafa Saeed Mohammed Ahmed ; Supervised Sahar Seif Alnasr Alwakil , Hussein Hassan Okasha , Emad Hamza Algemeie

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Introduction: Liver cirrhosis is a major cause of mortality worldwide (Méndez et al., 2007) often with severe sepsis as the terminal event (Tsai, et al, 2006). Over the last two decades, several studies have reported that in septic patients the adrenal glands respond inappropriately to stimulation, and that the treatment with corticosteroids decreases mortality in such patients (Annane et al 2004). Patients and methods This present study was conducted on 80 subjects with liver cirrhosis who were divided into three groups: I. Group A: includes 20 patients with compensated liver cirrhosis. II. Group B: this includes 30 patients with decompensate liver cirrhosis without infection. III. Group C: this includes 30 patients with decompensate liver cirrhosis with infection. Patients with liver cirrhosis were subjected to the following: Routine laboratory investigations SD {u2013} SST (standard dose short synachten test): Measurement of serum cortisol level before and one hour after injection of 250 microgram of tetracosactrin. Results: Baseline corisol was the highest in group A (17.76±1.8), corisol after stimulation was the lowest in group C (17.52±2.94) an delta corisol was the lowest in group B (8.43±2.62) with statistically significant difference in comparison between groups ,we also found that all patients with compensated liver cirrhosis (group A) had normal adrenal function, while in group B only (10%) of patients had AI and in group C majority of patients (80%) had AI. Conclusion: In conclusion, AI forms important part of spectrum of chronic liver disease. Deterioration of synthetic functions of liver disease predicts presence of AI, and these patients should be evaluated for adrenal dysfunction periodically. Adrenal function worsens with progression of liver disease. Steroid replacement in CLD patients at time of stress and critical illness may be beneficial

Issued also as CD