Histopathological and doppler findings in children with liver cirrhosis : a correlation study

Cirrhosis is an end stage state of virtually any chronic liver disease. There is great clinical interest in establishing the diagnosis of liver cirrhosis in children by non-invasive means. The aim of this work is to study the correlation between Doppler ultrasound parameters and hepatic histopathological findings in children with liver cirrhosis in an attempt to test the efficacy of these parameters as non-invasive means in diagnosis of cirrhosis. Patients and methods: Twenty two children admitted to Liver Institute, Menoufiya university for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Doppler studies were also preformed on 20 control subjects. Patients only were later subjected to liver biopsy. Histopathological examination of the biopsy specimens showed established cirrhosis in 11 of 22, early cirrhosis in 5 of 22. and no cirrhosis in 6 of 22 children. In patients group, the portal vein velocity was decreased [p < 0.05], the hepatic artery velocity was increased [p<0.05], and the arterio-portal velocity ratio was increased [p< 0.05] relative to the controls. Also, loss of reverse flow component was present in all established cirrhotic patients. For the criteria of the early and established cirrhotic patients, the sensitivities of the loss of reverse flow component in the hepatic vein, portal vein velocity being less than 20 cm/ s,hepatic artery velocity being more than 60 cm/s, arterio-portal velocity ratio being greater than 3.0 were 68.7%, 68.7%, 87.5% and 81.2% respectively. In established cirrhotic patients, the sensitivities of all parameters were 100%. In early cirrhotic patients, the sensitivities of hepatic artery velocity being more than 60 cm/s and arterio-portal velocity ratio being greater than 3.0 were 60% and 40% respectively. Indicators of parenchymal compliance [LRFC], outflow obstruction [decreased PVV] and arterialization [increased HAV, alteration in APVR] were accurate in the diagnosis of established cirrhosis. Also, HAV and APVR were useful in the diagnosis of early cirrhosis. We believe that on the basis of our data, afferent and efferent flow abnormalities monitored with Doppler ultrasound may be useful in the assessment of Patients with liver cirrhosis

Serum aspartate aminotransferase isoenzymes in cholestatic infants and children

Serum aspartate aminotranferase enzyme [AST] and its isoenzymes; the cytosolic [c-AST] and mitochondrial [m-AST] are usually increased in different liver diseases. The aim of this work is to determine the level of AST isoenzymes in infants with cholestasis and to assess the value of such determination in differentiating intrahepatic from extrahepatic causes and also in predicting disease severity. This study included 50 patients suffering from neonatal cholestasis, admitted to National Liver Institute, Menoufiya University. They were: 26 patients with extrahepatic biliary atresia [EHBA]; 13 patients with idiopathic neonatel hepatitis [INH]; 3 patients with paucity of interlobular bile ducts [PILBD]; 3 patients with alpha-one-antitrypsin deficiency [alpha 1-ATD]; 2 patients with septicemia; 1 patient with choledochal cyst; 1 pataient with Niemann Pick disease and 1 patient with primary sclerosing cholangitis [PSC]. Ten normal healthy infants of matched age and sex served as a control group. All patients were subjected to full history taking, thorough clinical examination and appropriate investigations. Aspartate aminoransferase enzyme and its isoenzymes were measured in all groups and it was found that: all patient groups had significantly elevated total AST levels in comparison to the normal controls, the total AST level was significantly higher in patients with INH as compared to those with EHBA, the c-AST level in all patient groups was significantly higher than that in normal controls, all patient groups had significantly elevated m-AST levels in comparison to the normal controls, the m-AST level was significantly higher in patients with INH as compared to those with EHBA, in the subgroups of both EHBA and INH, the c-AST was preferentially elevated in subgroup a [fair outcome, Child class B] while the m-AST was preferentially elevated in subgroup b [poor outcome, Child class C], the m-AST/total AST ratio showed a statistically significant difference between EHBA and INH on one hand and between INH and alpha -1ATD on the other hand. In comparative analysis of m-AST/total AST ratio among various patient groups, we found that there was a high statistically significant difference between EHBA and INH [P<0.01] and according to the cut-off point of this ratio, we found that any homeostatic infant having a ratio more than 0.359 is most probably diagnosed as an intrahepatic cholestasis, while any ratio less than 0.359 is most probably diagnosed as an extrahepatic cholestasis. c-AST level is increased in all groups of cholestatic disorders in which there is mild damage of hepatocyte plasma membrane [cases of fair outcome], while the m-AST level is highly increased in severe hepatocellular injury which cause mitochondrial damage [cases of poor outcome]. Also, we conclude that a cut-off point of 0.359 of the m-AST total AST ratio is useful in differentiating between intra-hepatic and extrahepatic cholestasis