MISCELLANEOUS
24 25
CLINICAL PROFILE OF CHRONIC LIVER
DISEASE IN CHILDREN: EXPERIENCE FROM
A TERTIARY CARE TEACHING HOSPITAL IN
SOUTH INDIA
Prasanth K. Sobhan , Bindu Sarojam, Rekha Krishnan,
A. Santhosh Kumar, Krishnadas Devadas
Government Medical College, Thiruvananthapuram, India
E-mail address: drprasanthks01@gmail.com (P.K. Sobhan).
Background and Aim: Chronic liver diseases consti-
tute one third of referral to paediatric gastroenterology
(PGE) OP from various centres in North India from the
published data. Our centre is the only tertiary care teach-
ing hospital under public sector in the state of Kerala with
a PGE clinic. In this context, we undertook this study to
determine the clinical prole of chronic liver disease in
children from South India. The study was done to deter-
mine the aetiology as well as clinical prole of chronic liver
disease in children from a tertiary care teaching hospital
in South India.
Methods: All children (age < 12 years) diagnosed with
chronic liver disease (CLD) from our PGE clinic during
the period February 2014 to April 2017 were enrolled in
this observational study. All underwent detailed history
and clinical examination. Complete hemogram, liver func-
MISCELLANEOUS
tion tests and ultrasound of abdomen were done in all
patients. Aetiology directed investigations including liver
biopsy were done wherever necessary.
Results: 91 children were diagnosed with CLD during
the study period. Aetiology of CLD were neonatal cholesta-
sis syndrome in 27 (29.7%) patients of which 22 had
biliary atresia (22/27, 75.9%); wilsons disease in 17 (18.7%);
NAFLD in 15 (16.5%); autoimmune liver disease (AILD) in
8 (8.8%); vascular diseases {EHPVO (5/6) and Budd Chiari
Syndrome (1/6)} in 6 (6.6%); congenital hepatic brosis
and glycogen storage disease in 3 patients (3.3% each); scle-
rosing cholangitis in 2 (2.2%); chronic hepatitis B in 2 and
chronic hepatitis C in 1 and cryptogenic in 8.8%.
Conclusion: In our series, commonest etiology for
CLD was biliary atresia in infancy and Wilsons disease
beyond infancy. NAFLD is also being increasingly diag-
nosed.
CONFLICTS OF INTEREST
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2017.05.176
S98
DIAGNOSTIC ACCURACY, SAFETY AND
IMPACT OF ENDOSCOPIC ULTRASOUND
FINE NEEDLE ASPIRATION OF ENLARGED
LEFT ADRENAL IN PATIENTS WITH
DECOMPENSATED CIRRHOSIS
Amit Agarwal, Narendra S. Choudhary,
Rinkesh K. Bansal, Sanjiv Saigal , Neeraj Saraf,
Haimanti Sarin, Gagandeep Kaur, Rajesh Puri
Medanta The Medicity, Gurgaon, India
E-mail address: sanjivsaigal@hotmail.com (S. Saigal).
Background and Aim: The conventional ultrasound
and CT guided FNA of left adrenal is difcult due to
anatomic location and presence of collaterals. EUS guided
FNA of adrenals offers several advantages like real-time
vision, proximity to target and avoidance of collaterals
by Doppler application. There is no data on outcomes of
endoscopic ultrasound (EUS) guided ne needle aspira-
tion (FNA) of adrenals in patients with decompensated
cirrhosis other than case reports.
Methods: The prospective study included patients with
decompensated cirrhosis and adrenal enlargement. The
indications of EUS guided FNA were fever of unknown
origin (n = 2), weight loss (n = 1) and to look for metastatic
disease in prospective liver transplant recipients with
hepatocellular carcinoma (n = 2). Platelet and fresh frozen
plasma transfusion before procedure were given in pres-
ence of platelet count <50,000/cmm (n = 1) or INR >1.5
(n = 1). The data is shown mean SD or median (range).
Results: Five patients with decompensated cirrhosis
underwent EUS guided FNA of left adrenal. All patients
were males, aged 52 10 years. The etiology of cirrhosis
was non-alcoholic steatohepatitis related/cryptogenic in
3 and alcohol in 2 patients. The severity of liver disease
was as follows; Childs score 10 (911) and MELD score
21 (1223), platelet count 15,000 (43,000267,000)/cmm,
INR 1.29 (1.172.13). EUS guided provided a diagnosis in
all 5 patients; 3 patients had adrenal histoplasmosis and
2 patients with hepatocellular carcinoma had metastatic
disease. Thus empirical antitubercular which is a com-
mon practice could be avoided in 3 patients and futile
liver transplantation could be avoided in 2 patients. The
patients with metastatic hepatocellular carcinoma had
unilateral adrenal enlargement. The representative images
are shown in Figure 1. None of patients had any procedure
related complication.
Conclusion: EUS guided FNA can be used safely to
diagnose adrenal lesions in decompensated cirrhosis.
2017, INASL