[Investigation of insulin resistant in patients with liver cirrhosis and its relationship with severity of disease]

Insulin resistance and glucose intolerance are commonly associated with liver cirrhosis. Resistance to insulin is an important prognostic factor in liver cirrhosis. To determine the relationship between insulin resistance and severity of liver cirrhosis. This was a descriptive-analytic study carried out on 76 patients with stablished liver cirrhosis in Booali hospital [Qazvin] in 2006 and 2007. Their fasting blood sugar, serum insulin level and oral glucose tolerance test [OGTT] were measured. Patients divided into three groups of A, B and C according to the child-pugh classification. Insulin resistance was determined by the homeostasis model assessment [HOMA-IR] in all patients. Data analysis was performed using t test, variance analysis, chi-square and Fishers exact test. Cirrhosis was found to be strongly associated with insulin resistance [60.5%] and the values obtained for prevalence of insulin resistance for groups A, B, and C of Child-Pugh Classification were%31.6,%66.7 and%74.1, respectively. The relationship between IR and severity of liver cirrhosis was significant, statistically [p=0.01]. Diabetes mellitus was diagnosed in 26 subjects [34.2%], impaired glucose tolerance in 24 [31.6%] and normal glucose tolerance in 26 [34.2%] using OGTT. Insulin resistance increased with stage of liver cirrhosis as defined by Child-Pugh score

[Non-alcoholic steatohepatitis presenting as metastatic liver masses]

Non-alcoholic steatohepatitis is a form of chronic hepatitis. Fatty degeneration may involve liver focally or as a whole. The patient was a 41-year-old woman who was diabetic and admitted in Buali hospital in Ghazvin because of right flank pain, fever, vomiting and diarrhea. The patient was treated as pyelonephriris. Liver function tests were as below: ALT: 62 [40] AST: 54 [40], Alkaline Phosohatase: 378 [306]. Imaging study of liver and kidney showed multiple masses in liver that documented again in CT scan of abdomen. Liver biopsy was performed ultrasonography guided. Macrovesicular fatty changes were seen histologically and documented again by review of liver specimens. No any malignant structure was identified. The patient was treated as diabetic patients. Focal fatty infiltration can be misdiagnosed as liver metastasis; it is seen as nonspherical lesion in CT scan, without mass effect, with density similar to water. Guided biopsy of the liver can help to have the correct diagnosis