الفهرس 
ASCITIS
Portal hypertensionOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is a common
and severe complication in cirrhotic patients with ascites which
occurs in 10-30% of patients with cirrhotic ascites admitted to
hospitals with amortality rate ranging between 30-50% mainly
due to renal failure. The diagnosis of SBP is made when the
polymorph nuclear leukocyte(PMNL) count in ascitic fluid is
greater than 250 cells per cubic millimeter.
This prospective case-control study was performed to
evaluate tumor necrosis factor-α (TNF-α) and Interleukin-6 (IL-6)
in patients with spontaneous bacterial peritonitis (SBP) and sterile
ascites due to liver cirrhosis admitted to Internal Medicine inpatient wards of Ain shams university hospitals. Twenty patients
within group 1 (cirrhotic patients with SBP) and 20 patients
within group 2 (cirrhotic patients with ascites without evidence of
SBP) were included,and 10 healthy as control.
The mean age of SBP group was similar to the mean age
of the sterile group. All were presenting with cirrhotic ascites
according to clinical, laboratory and ultrasonic criteria regardless
to the presence or absence of clinical evidence of SBP. All
patients included in this study were subjected to history taking, physical examination, laboratory tests including; complete blood
count, liver function, prothrombin time, serum creatinine and
serum TNF-α and IL-6, and abdominal ultrasound and ascitic
fluid examination which included cell count, total proteins and
TNF-α and IL-6.
There were no statistically significant differences between
septic and aseptic groups regarding all socio-demographic
characteristics including; age, gender, residence, occupation,
marital status, educational level and smoking history (p>0.05).
There were no statistically significant differences between septic
and aseptic groups regarding all complaints (p>0.05); except for
fever. SBP group had significantly higher prevalence of fever
than sterile group (70% versus 20%, respectively) (p<0.01). The
percentage of abdominal pain or discomfort was higher in SBP
group than in sterile group (70% versus 40%, respectively) with
nearly significant p-value (p=0.056).
There were no statistically significant differences between
septic and aseptic groups regarding etiology and duration of liver
disease (p>0.05).
There was no statistically significant differences between
septic and aseptic groups regarding past history of abdominal paracentesis (p>0.05). The percentage of patients with previous
abdominal paracentesis was 65% in SBP group and 55% in sterile
group (p>0.05), also there was no statistically significant
differences between septic and aseptic groups regarding past
history of pervios attack of SBP was 15% in SBP group and10%
in sterile group (p>0.05).
SBP group had significantly higher prevalence of
abdominal tenderness than sterile group (70% versus 40%,
respectively) with nearly significant p-value (p=0.056).
There were no statistically significant differences between
the first and the second groups regarding all laboratory findings of
ascitic fluid (p>0.05).
We have found that ascitic TNF-α, serum TNF-α and
ascitic IL-6, serum IL-6, were higher among patients with SBP
than patients without SBP .
In conclusion, ascitic TNF-α, serum TNF-α and ascitic IL-
6,serum IL-6 are significant dependent predictors for SBP in
patients with advanced CLD and recommend for ascitic and
serum sample could obtained for the patients admitted in the
hospital with cirrhosis with ascitis, and examination of these
samples for levels of TNF&IL-6, for early prediction of SBP to
avoid comlication.