ABSTRACT
Hepatic aminotransferases are sensitive indicators of liver cell injury. In some patients with persistent elevation of such enzymes; routine clinical, laboratory and serological data cannot establish the underlying causes. This study was designed to evaluate such patients both clinically and pathologically as a trial to reach the underlying etiology. Thirty patients with hepatic hypertransaminasaemia of unknown cause [18 females and 12 males], aged 18-50 years [mean age 37.7 +/- 4.6 years], together with ten controls [5 males and 5 females] [matched in age and body mass index with patients]; were included in this study. Both patients and controls were subjected to full history taking, clinical examination, estimation of blood glucose and lipid profile, liver function tests, serum iron and ferrtin estimation, hepatitis viral markers [HBs Ag HCV-Ab], anti Epstien Barr [EBV] and cytomegalovirus [CMV] antibodies, abdominal ultrasonography [U/S]and needle liver biopsy [done only for 15 patients who approved undergoing it. The study revealed that 18 patients had nonalcoholic fatty liver disease NAFLD [bright liver on U/S], eleven patients out of them underwent liver biopsy that showed simple hepatic steatosis in four of them and non-alcoholic steatohepatitis [NASH] in the other seven patients. Most of the eighteen patients with NAFLD were obese, diabetic and hypertensive. Four patients had positive serology for autoimmune hepatitis and two patients had positive serology for cytomegalovirus infection. All patients had normally ranged serum iron and ferritin. The remaining six patients had normal hepatic U/S and negative serology for different hepatic viruses; four of them underwent liver biopsy that revealed simple hepatic steatosis in two of them and non-alcoholic steatohepatitis [NASH] in the other two patients. Conclusion and recommendation: Nonalcoholic fatty liver disease [NAFLD] was found to be the commonest cause of unexplained hepatic hypertransamina-saemia. However, we must be minded with less frequent causes like autoimmune hepatitis and cytomegalovirus infection. Needle liver biopsy and possibly MR imaging of the liver are important investigational techniques for patients with hepatic hypertransaminasaemia associated with normal serum iron and ferrtin levels, negative serology of [autoimmune hepatitis and various hepatic viruses], normal hepatic ultrasonography; to diagnose those with occult hepatic steatosis among them. Estimation of HBV-DNA and HCVRNA by [PCR] could be required for precise exclusion of HBV and HCV infection. Large-scale studies are recommended to verify these findings
ABSTRACT
Muscle cramps are involuntary, painful, visible, or palpable muscle contractions of abrupt onset, generally occurring at rest and are often nocturnal. The pain and contraction resolve spontaneously in seconds to several minutes. The calf is the area most commonly affected, but may affect fingers and hands. The reported prevalence of true muscle cramps in cirrhotic patients varies from 22 - 88%. Clinically; significant muscle cramps occur less frequently [8 - 20%]. Thirty patients were chosen for this study to estimate the prevalence of muscle cramps among patients with liver cirrhosis irrespective of the etiology, to find the role of zinc in the pathogenesis of cramps in patients with liver cirrhosis and to find the relation between the clinical; laboratory; ultra-sonography of the liver and muscle cramps. They were divided into two groups: Group [A] twenty patients with liver cirrhosis were further subdivided according to the presence or absence of muscle cramps into: Sub-Group [A1]: included 14 patients with liver cirrhosis and muscle cramps [7 males and 7 females] with a mean age of 56.5+/-5.25 years. Sub-Group [A2]: included 6 patients with liver cirrhosis without muscle cramps [5 males and 1 female] with a mean age of 57.5+/-4.37 years. Group [B] included 10 patients with congestive heart failure [6 males and 4 females] with a mean age of 55.6+/-11.32 years. Results revealed that muscle cramps was more prevalent in patients with liver cirrhosis, compared to patients with congestive heart failure [70% vs 20% with P< 0.01]. There was a significant relation between the frequency of occurrence of cramps and the presence of haematemisis, Jaundice, ascites, splenic size, portal vein diameter, low serum albumin, high serum bilirubin and low serum sodium, calcium, as well as there was a significant relation between a low serum zinc level and the occurrence of cramps in liver cirrhosis. There was no relation between liver enzyme and serum alkaline phosphatase and cramps in liver cirrhosis. On conclusion muscle cramps are a common symptom in patients with cirrhosis and can be triggered by many factors especially a low serum zinc level