الفهرس 
Chapter [1] : Introduction
Chapter [3-A] : Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
Cirrhosis is the irreversible fibrosis of the liver, the end stage of a final shared pathway in chronic damage to a major vital organ. SBP is a potentially lethal complication of ascites. SBP is an infection of ascites that occurs in the absence of a contiguous source of infection. SBP probably originates with the passage of bacteria from the intestinal lumen to the systemic circulation and then to the ascetic fluid. Although the concentration of bacteria in ascitic fluid is low, the inflammatory response, as estimated by the concentration of polymorphonuclear leukocytes and cytokines (tumor necrosis factor-and interleukin-6) in ascitic fluid and blood, is very intense.
IL-17A is a proinflammatory cytokine released by T cells that have a role in host immune defense and inflammation. Intestinal Paneth cells have been shown to synthesize IL-17A and respond to inflammatory stimuli by overproducing IL-17A.This mechanism has recently been implicated in liver-related acute kidney injury.
Aim of the work was to Study the diagnostic performance of IL17A in the ascetic fluid as a marker of ascitic fluid infection and whether patients with elevated IL17A in the setting of SBP are at a higher risk for the development of AKI.
A cross-sectional prospective, case-control hospital based study was conducted recruiting Sixty cirrhotic patients; 40 patients with cirrhotic ascites secondary to HCV but not with SBP and 20 patients with cirrhotic ascites secondary to HCV with SBP; History taking, clinical examination and laboratory investigation were done for all subjects. IL17 was repeated after one week, while liver and renal function tests, white blood cell count, and ascitic fluid PMN cell count and cultures were repeated 48 hours after diagnosis of SBP and 24 hours after antibiotic withdrawal.
we found that serum and ascitic levels of IL-17 in cirrhotic patients with spontaneous bacterial peritonitis were significantly higher than in patients with cirrhosis without spontaneous bacterial peritonitis. Also, we found significant decline in both serum and ascitic fluid IL17 levels with successful treatment of spontaneous bacterial peritonitis.
Also, it was found that these elevated levels of IL17 in serum and ascitic fluid were significantly associated with decline of baseline GFR and its improvement with successful treatment and reduction of IL 17 levels in serum and ascites, denoting the involvement of IL17 in extrahepatic – kidney - organ injury. Other finding included higher Child-Turcotte-Pugh, MELD and MELD-Na scores and lower ascitic fluid total protein among cases with SBP.
In summary, we found that IL17 is strongly associated with the process of spontaneous bacterial peritonitis and related to hepatic and renal function deterioration.