الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is a common,
serious complication in patients with cirrhosis and ascites.
Initially considered a fatal complication of cirrhosis, with
mortality above 90%, the condition may be currently treated
with an in-hospital mortality rate around 20- 30%
Recently, the concept of relative adrenal insufficiency
(RAI) has been used to describe a subnormal adrenal response to
adrenocorticotropin in severe illness, in which the cortisol
levels, even though high in terms of absolute value, are
inadequate to control the inflammatory situation
The term hepatoadrenal syndrome has been used to
describe such an association between liver disease and adrenal
failure and the definition of this term extends beyond the
occurrence of sepsis, which is a frequent complication of liver
failure.
This work was done to study adrenal insufficiency in
ascitic cirrhotic patients with and without spontaneous bacterial
peritonitis
In our study we studied adrenal insufficiency in ascitic
cirrhotic patients. 100 patients with HCV-related end stage liver
disease & ascites and only 50 patients of them had spontaneous
bacterial peritonitis who were admitted to national liver institute in the
period from July 2011 till January 2012 was the studied groups.
All patients were subjected to the following:
• Thorough history taking
• Full clinical examination
• Child –Pugh classification and score
• MELD (Model of End stage Liver Disease) score
107
• Routine laboratory tests as:-
6. Liver enzymes(ALT,AST)
7. Serum albumin, Serum bilirubin
8. HCV antibodies - HBsAg
9. Alpha feto protein
• Review of medical records showed all patients had HCVrelated
end stage liver disease & negative HBsAg
• Abdominal U/S
• Diagnostic abdominal paracentesis
• Blood samples to measure:
serum cortisol levels before & 30 minutes after short
corticotropin test
It was found that:
• Prevalence of adrenocortical insufficiency was 79% in all
patients, being seen in 70% with HCV-related end stage
liver disease & ascites, 88% with HCV-related end stage
liver disease & spontaneous bacterial peritonitis.
• There was statistically significant difference between
groups regarding to Child-Pugh Classification ( p-Value <
0.05).
• There was statistically significant difference between
groups regarding to MELD score (p-Value < 0.05).
• There was a highly statistically significant difference
between group A & B as regard white blood cell . (p-
Value < 0.001).
• There was –ve correlation between Alpha fetoprotein and
second sample cortisol in group A. There was –ve
correlation between Alpha fetoprotein and first and
second sample cortisol in group B.
• There was a highly statistically significant difference
between group A & B as regard to total leucocytic coun in
ascitic fluid .
• There was + ve correlation between second samples
cortisol and total leucocytic count in ascitic fluid in group
A. • There was significant association between adrenal
insufficiency and total leucocytic count in ascitic fluid in
group B .
• There was a highly statistically significant difference
between group A & B (p-Value < 0.001) as regard ascites.