الفهرس 
Chronic Liver Disease in ChildrenOnly 14 pages are availabe for public view
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Abstract
Chronic liver diseases in children are relatively common disorders with minimal symptoms but long-term risk of significant morbidity and mortality particularly in developing countries. They are defined by continuity of clinical or biochemical evidence of hepatic dysfunction for longer than 6 months.
Vitamin A is the name of a group of fat-soluble retinoids, including retinol, retinal, retinoic acid, and retinylesters.
Malabsorption of dietary fat and fat-soluble vitamins including vitamin A is one of the major complications of childhood cholestatic liver disorders, vitamin A absorption depends on concentration of intraluminal bile acids adequate for micellar solubilisation. Therefore, the reduced biliary secretion of bile acids during cholestasis causes vitamin A malabsorption and potential deficiency of vitamin A.
The aim of our work was to measure the serum level of vitamin A in children with chronic liver diseases (CLDs) and correlate them with the severity of liver dysfunction in the Hepatology Clinic in Children’s Hospital– Ain Shams University.
This is case control study included:
Patients: sixty patients of children and adolescents following up at the Pediatric Hepatology Clinic at Faculty of Medicine Ain Shams University in the period from March 2012 to November 2012. They comprised 25(41.7%) females and 35(58.3%) males, their ages ranged from 5 to 18 years with mean of age and ± SD (10.9 ±3.8).
Controls: Thirty healthy child attending out patients clinic, at Faculity of Medicine Ain Shames University. They comprised 13(43.3%) females and 17(56.7%) males, their ages ranged from 5 to 17years with a mean of age ± SD (10.8 ±3.9).
- All patients were subjected to the following:
1. Personal history: age, sex, residence and social class.
2. Medical history suggestive of chronic liver diseases.
3. Clinical examination.
a) General examination; with special emphasis on jaundice, pallor, cyanosis.
b) Abdominal examination; with special emphasis on liver size, consistency, surface and edges; spleen size.
c) Eye examination an ocular examination will be performed by a paediatric ophthalmologists, including direct assessment of the cornea and conjunctiva by slit-lamp, supplemented with tests to asses eye dryness and tear production (Schirmer test).
4. Laboratory investigation:
a) Liver function tests (e.g. total and direct bilirubin, aminotransferase enzymes, serum albumin and prothrombin time).
b) Serum vitamin A by ELISA technique.
This study showed 20(33.33%) of patients had metabolic causes (11Glycogen storage diseases, 5Wilson disease, two patients had Nieman pick diseases and one patient was Lipid storage disease, one patient was alpha-1 antitrypsin deficiency), 9 (15%) of patients had congenital hepatic fibrosis, 9(13.33%) of patients had Autoimmune hepatitis, 7 patients (11.67%) had HCV, 3 (5%) of patients had Budd chiari disease, 3 (5%) of patients had Polycystic liver and kidney, and 9(15%) of patients were other causes as follow:-
Two patients had chronic hepatitis, two patients had allagile syndrome, one patient had crigglar najar syndrome, one patient had hepatic cysts, one patient had billiary atresia, one patient had Familial intrahepatic cholestasis and one patient had HSM for investigation.
Our study shows that 12(20.0%) patients were Child A classification and 45(75.0%) of patients were Child B, 3(5.0%) of patients had Child C classification.
In our study 19(31.67%) of patients had cholestatic liver disease while 41(68.33%) of patient had non cholestatic liver disease.
In the current study there was 27(45%) of patients with normal BMI and 33(55%) of patients was underweight, 14(23.3) of patients were less than 5th percentile for Height and 18 (30%) of patients were less than 5th percentile for Weight.
There was significant decreasing in serum Retinol level among cases than among control
Our study shows that serum Retinol level could be used in discrimination of cases from controls at a level of ≤ 21.14ug/dl, with 93.3% sensitivity and 100% specificity.
Our study shows significant correlation between serum Retinol level and hepatomegaly in children with chronic liver disease.
There was negative correlation between level of serum Retinol and level of transaminase enzymes.
There was no significant correlation between child classification and severity of deficiency of serum Retinol.
There was no significant difference between cholestatic and non cholestatic group as regard the deficiency in serum Retinol.
Our study shows no correlation between anthropometric measurement and severity of deficiency in serum Retinol among cases.
In our study there was no significant correlation between deficiency in serum Retinol level and severity of eye dryness using slit lamp, shrimmer test and FBUT.