الفهرس 
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Abstract
Just about everyone will experience muscle cramps, but for people living with chronic liver disease and cirrhosis, muscle cramps are more common, causing debilitating pain, adding a significant negative impact to an already difficult disease. A higher prevalence of muscle cramps was found in cirrhotic patients than in non-cirrhotics. Although muscle cramps are benign in nature, their occurrence is associated with bodily pain and decreased physical and social functioning. General health-related quality of life is diminished in cirrhotic patients with muscle cramps. The objectives of this study were to determine the prevalence, characteristics and predictors of muscle cramps in patients with liver cirrhosis attending Specialized Medical Hospital and Mansoura Gastroenterology Centre, Mansoura University. This cross-sectional study was conducted on 200 patients with an established diagnosis of cirrhosis. Later on, patients were divided into two groups. group 1 (Case): cirrhotic patients with muscle cramps and group 2 (Control): cirrhotic patients without muscle cramps. All patients were subjected to history taking, physical examination, laboratory evaluation and radiological evaluation. The severity of liver disease was assessed by Child Turcott Pugh score, MELD score and MELD-Na score, and finally completed the cramp questionnaire for description of muscle cramps after informed consent and visual analogue scale to assess the severity of pain. The summary of the current results: Prevalence of muscle cramps was 73.5% of patients. Regarding the frequency of muscle cramps, 57.1% of patients had weekly cramps, 25.2% had daily cramps and 17.7% had monthly cramps. 57.8% of patients had slight painful cramps, 42.2% had very painful cramps. The median value of visual analogue scale was 2.00. Regarding location of muscle cramps, 88.4% of patients were in the calf, 77.6% of patients had cramps in the toes, 62.6% of patients had cramps in the thighs, 29.3% of patients had cramps in the fingers, 16.3% of patients had cramps in the abdomen and 2.7% of patients had cramps in the neck. As regard to the time of cramps, 77.6% of patients had cramps in both day and night, 15% of patients had nocturnal cramps and 6.1% of patients had diurnal ones. In most of patients, cramps were lasting only for few minutes (89.1%), for hours (6.8%) and for seconds (2.7%). As regard to factors aggravating muscle cramps, cold, sleep and rest were the commonest aggravating factors (53.7%, 49.0% and 46.9%, respectively) followed by post exertion, exertion and standing (22.4%, 19.0% and 4.1%). Regarding the relief, 36.7% of cramps were relieved spontaneously, 23.8% were relieved by medications prescribed by the physician, 15% were relieved by other medications and 8.8% were relieved by taking over the counter pain medications. As regard to medications, 78.2% of patients were on diuretics and 25.2% of patients were on beta-blockers. Regarding comparison of clinico-demographic data between patients with and without cramps (group 1 and 2) age, sex, SBP, DBP, weight, BMI, hematemesis, paracentesis and hepatic encephalopathy, oedema grade II have no significant difference between both groups. While, ascites of different grades (mild, moderate and tense), oedema LL grade III, impaired both sensations in the LL and deep tendon reflex with lost peripheral pulsations were significantly higher in cirrhotic patients with muscle cramps (P = 0.02, 0.01, 0.008, 0.02, 0.02 respectively). Regarding laboratory data, cirrhotic patients with cramps had significantly higher creatinine and serum K, and significantly lower level of total Ca and Mg when compared with patients without muscle cramps (P = 0.01, <0.001, 0.017, 0.018, 0.006 respectively). While Na, TSH, serum albumin, bilirubin, ALT, AST, INR and Child Turcott Pugh score had no significant difference between both groups. Finally, ascites, use of diuretics, serum K, total Ca and serum Mg were independent predictors of muscle cramps in patients with liver cirrhosis (P = 0.01, <0.001, 0.017, 0.018, 0.006 respectively).