Background: Fine Needle Aspiration Cytology (FNAC) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. FNA may also be performed at laparoscopy or laparotomy under direct vision when image guided FNA fails to provide diagnostic tissue. In experienced hands, FNA is safe, minimally invasive, accurate, and cost-effective. However, the main aim of this study is to assess the role of FNAC in the evaluation of focal liver lesions. Patients and method: This prospective study was conducted over one year, on 100 patients in Kurdistan Center for Gastroenterology and Hepatology (KCGH) and in Sulaimani General Teaching Hospital. All patients were properly assessed by history analyses and thorough clinical examination. Laboratory investigations including hematological, biochemical, viral markers, and tumor markers were requested. Thus, ultrasonically guided FNA was performed after obtaining a written informed consent from the patients. Results: FNAC showed that eighty patients (80%) had secondary liver metastasis. Ten patients (10%) had HCC; three patients had hemangioma; one patient had abscess; and 6 patients had inconclusive result; two patients had simple cyst. Apart from mild post procedure pain, no complication or mortality had been recorded. Conclusion: FNAC is simple, easy, rapid and a minimally invasive procedure that has an acceptable diagnostic yield for focal liver lesions.

Background  Helicobacter pylori (H. pylori) infection in gastric mucosa may cause systemic inflammatory reaction, which increases risk of cardiovascular disease and atherosclerosis.  Objectives This study aimed to assess the association between H. pylori infection and serum high sensitivity C-reactive protein (hsCRP), and carotid intima media thickness. Patients and Methods This is a case control study, conducted at Kurdistan center for Gastroenterology & Hepatology from Dec. 2012 to March 2014. One hundred patients with dyspepsia and positive H. pylori. 75 (39 males and 36 females) non dyspeptic apparently healthy subject with H. pylori negative as control group were assessed. The serum sample tested for H. pylori infection and Hs-CRP using ELISA and stool sample examined by using Rapid Immunoassay method to detect H. pylori antigens. Results The mean hs-CRP level was significantly different (P<0.01) between patients and controls. A significant correlation between different tests of H. pylori and hs-CRP level was found (p < 0.01). A significant correlation was found between hs-CRP level and internal carotid artery (ICA), common carotid artery (CCA) thickness in patients (p < 0.01). Conclusion H. pylori infection was significantly associated with higher serum hs-CRP.There was significant correlation between hs-CRP and carotid intima-media thickness.

Background It is known that blood group antigens are related to the development of peptic ulcer and gastric carcinoma. Infections due to H. pylori are most widespread among the developing regions due to poor standard of public health. Objectives This study sought to determine the seroprevalence of H. pylori in asymptomatic individual in Sulaimani and to correlate such prevalence with age, gender, blood group and Socioeconomic state. Methods This study conducted in Ali Kamal Consultation clinic, Kurdistan Teaching center of Gastroenterology & Hepatology (escorts of patients) and students from University of Sulaimani, from the 1st of January to the 20th of November 2013. Serum samples from 188 apparently healthy subjects were tested for the presence of IgG and IgA antibody to H. pylori by use of ELISA test. ABO blood grouping was also done by hemagglutination test. Results Of the 188 subjects, there were 92(48.9%) males and 96 (51.1%) females. The age range was 20 to 49 years. The overall prevalence of H. pylori infection in our study was 68.1%. H. pylori antibodies were positive in 73(79.4%) males and 55(57.3%) females, showing no significant difference P=0.079. The overall seroprevalence was found in 57.1% subjects between 20-29 years of age, 75.8% in subjects between 40-49 years of age showing significant difference P=0.045. Distribution of ABO blood groups in H. pylori positive group were, A=70.2%, B=32.4%, AB=57.1% and O=86.1%, with a statistically significant link for blood group O (p=0.001). H. pylori sero-positivity was higher in low social state 59(93.7%), moderate social state 47(87%) then lowest in high social state 22 (31%), P = 0.032. Conclusions This study demonstrated that H. pylori infection can be related to ABO blood group, age and social state. People of blood group O, 40-49 years of age and low social state are more prone to develop this infection.

Background  Percutaneous Liver Biopsy (PLB) is commonly used for assessing the histopathological status of the liver and thus deciding on diagnosis, prognosis, and management plan of patients.  Objectives To assess the value of Percutaneous Liver Biopsy in decision making in patients referred to Kurdistan Centre for Gastroenterology and Hepatology (KCGH), and searching the common causes of liver enzyme abnormalities especially in patients with the unknown clue of diagnosis. Patients and Methods This study was performed in Kurdistan Center for Gastroenterology and Hepatology, between April 2018 and January 2019; Sixty-three patients have been included in this study, which was referred for PLB with different intentions; after appropriate pre-procedural preparation PLB was performed with the aid of a radiologist, and post-procedural follow up of patients was done for 6 hours in the ward.  Results The reason of referral for PLB was diagnostic, prognostic, and management in 79.8%, 14.3%, and 6.3% respectively. Common diagnoses in a diffuse parenchymal liver lesion with or without elevated liver enzymes were AIH in 15.8%, DILI in 14.3%, and NASH 14.2%. Percutaneous liver biopsy changed the preliminary diagnosis in 52.3%, and management plan in 34.9% of cases. As PLB is an invasive procedure, 31.7% of patients developed complications, which is in decreasing order including right upper quadrant pain 15.9%, right shoulder pain 5.9%, combined right upper quadrant pain, and right shoulder pain in 3.2%, and vasovagal reaction in 3.2 %. Conclusion Percutaneous liver biopsy is a valuable investigation in deciding on diagnosis, the prognosis of liver lesions, and it will help the management plan. The three most common diseases which should be excluded in every patient with diffuse parenchymal liver lesions or elevated liver enzymes are AIH, DILI, and NASH.