Cholestasia
Description:
Cholestatic syndrome (a cholestasia, from Greek χολή — bile and Greek — standing) — reduction of intake of bile in a duodenum because of disturbance of its education, excretion or removal owing to pathological processes which can be localized on any site from sinusoidal membranes of hepatocytes to a faterov (duodenal) nipple. In many cases of a cholestasia the mechanical blockade of bile-excreting system leading to mechanical jaundice no.
The cholestatic syndrome is subdivided on intra hepatic and extrahepatic.
Hlestaz's symptoms:
- jaundice
- light kcal
- dark urine
- increase in a liver
- skin itch
Laboratory signs of a cholestasia:
increase in level of the bilirubin (conjugated) in blood
increase in activity of the alkaline phosphatase (AP) in blood (especially hepatic isoenzyme)
increase in activity gamma глутамил - transpeptidases (γ-GTP) in blood
increase in activity of leucineaminopeptidase (LAA) in blood
increase in activity 5 nucleosidases in blood
increase in level of cholesterol in blood
increase in level of bile acids in blood
increase in level of copper in blood
increase in level of urobilinigen in urine
It must be kept in mind that others can exert on many indicators impact than a cholestasia of change in an organism in this connection the isolated their interpretation can be wrong. It is also necessary to note that standard biochemical methods of a blood analysis allow to reveal cholestasia signs at delay of a passage of bile not less than for 20% in this connection they cannot be considered precursory symptoms (Popov V. G., 1993).
Expressiveness of symptomatology in general and separate signs of a cholestasia can vary considerably at various diseases from minimum to high.
Accessory sign of a cholestasia is availability of dense bile (a biliary sladzh) in a gleam of a gall bladder. Authentically it is possible to confirm existence of a cholestasia by means of a gepatobiliarny stsintigrafiya on delay of intake of radiopharmaceutical in a duodenum.
Hlestaz's reasons:
Intra hepatic is connected with disturbances of synthesis of components of bile and their receipt in bilious capillaries. Reasons: pre-natal infection, sepsis, endocrine frustration (hypothyroidism), chromosomal frustration (trisomy 13,17/18), medicinal therapy, inborn disturbances of metabolism (galactosemia, mucoviscidosis, insufficiency of alfa1-antitrypsin), family syndromes (Alazhill's syndrome, etc.).
Extrahepatic is connected with disturbance of a passage on biliary tract in connection with disturbance of structure and function of bile-excreting system: atresia of biliary tract, cyst of a holedokh, other anomalies of biliary tract, choledocholithiasis, prelum of channels, pachycholia syndrome, dyskinesia of biliary tract.
Hlestaz's treatment:
If the causative factor of a cholestasia, perhaps etiological treatment is known: removal of a stone, tumor resection, timely cancellation of medicine, abstinence, deworming, etc. In the presence of mechanical obstruction of a bilious path and impossibility of radical treatment it is necessary recovery of a drainage of bile (balloon dilatation of strictures, endoprosthesis replacement, a biliodigestivny anastomosis).
Dietary restrictions include reduction of animal fats in a diet (in the presence of a steatorrhea), the use of the margarine containing triglycerides with an average length of a chain (do not contain in foodstuff, their absorption happens without participation of bile acids). At development of hypovitaminoses replacement therapy by vitamins orally or parenterally depending on weight of manifestations, existence of jaundice, a steatorrhea, the response to treatment is necessary. At impossibility of determination of level of vitamins B to serum treatment is appointed empirically, especially in the presence of jaundice.
