Cholestatic hepatitis is a pathological condition of the liver that is observed in patients with impaired outflow of bile and inflammation of the biliary system. After a detailed diagnosis, a specialist can detect in the patient components of bile that accumulate in the liver. This is due to a disruption in the normal functioning of the bile ducts and a deterioration in bile synthesis. The causes of cholestatic hepatitis are quite difficult to establish, since this type of disease is observed in rare cases after chronic hepatitis. Most often, the disease is diagnosed in older people and in patients with disorders of the biliary system.
The appearance of cholestatic hepatitis is often associated with cholestasis - a pathological condition of the body when the normal flow of bile into the duodenum decreases or completely stops. This phenomenon is associated with a violation of the synthesis and excretion of bile due to inflammatory processes in the liver tissue.
The following factors are also considered to be the causes of this pathology:
- A chronic type of hepatitis that develops into cholestatic hepatitis. The presence of latent viral hepatitis can cause serious complications, including inflammation of the liver parenchyma with further disruption of the outflow of bile.
- Epstein-Barr virus. The infection, which is classified as a herpes virus, can cause the development of cancer and inflammatory processes in vital organs. Pathogens can be present in the body of a healthy person without manifesting themselves in any way; only after weakened immunity do the first symptoms of infection begin to appear.
- Mycoplasmosis and ureaplasmosis. These pathologies are characterized by inflammation of the genitourinary system, due to human infection with mycoplasmas and ureaplasmas, which are transmitted through contact and household contact.
- Taking oral contraceptives, hormonal drugs and broad-spectrum antibiotics. These medications directly affect the functionality of the liver and other organs that control the production of hormones. As a result of such intervention, inflammatory processes may occur.
- Excessive consumption of alcoholic beverages. Ethyl alcohol affects healthy hepatocytes, which disrupts the patient’s production of special enzymes that break down toxic substances. This leads to chronic liver diseases.
- The influence of radioactive substances. Radioactive substances tend to accumulate in the human body and cause cancer pathologies and chronic liver diseases.
- Pathology of one or more organs of the biliary system. Such diseases can be inherited, congenital or acquired. Even minor inflammation of the bladder can cause cholestatic hepatitis.
Pathology can also occur due to endocrine diseases, the presence of cancerous tumors of various etiologies and during pregnancy. During pregnancy, a woman's hormonal levels change, which affects the functionality of liver cells.
The signs of this pathology are similar to the symptoms of chronic liver diseases.
First of all, cholestatic hepatitis is classified by the following symptoms:
- Skin itching. Due to the fact that bile components accumulate in the liver, they can penetrate into the general bloodstream and enter various parts of the body. This leads to burning and itching of the skin throughout the body.
- Yellowing of the sclera of the eyes and skin. In a patient, this symptom may be accompanied by the appearance of xanthomas (specific rashes of a yellowish tint). As a rule, xanthomas occur at the joints on which the greatest pressure is exerted.
- Changes in the color of urine and feces. Feces become clay-light in color, and urine becomes richly dark in color.
- Structural changes in the liver. The organ increases in size so much that it can be easily felt during palpation. Inflammatory processes in this organ can move to the spleen, causing it to increase in size. Such symptoms are accompanied by pain in the right hypochondrium.
- Low-grade body temperature, which is accompanied by a feverish state. This phenomenon can easily be confused with ordinary intoxication of the body, so you should pay attention to the accompanying symptoms.
- Lack of vitamins such as A, D, E and K. Hypovitaminosis of various types has its own characteristic symptoms, so the doctor should pay attention to this and add vitamins that a person needs to the therapeutic course.
The entire clinical picture depends entirely on the severity of cholestasis. With the obstructive type, a sharp deterioration in the patient’s condition is observed.
After the patient goes to a hospital or specialized center, the doctor conducts an initial examination using palpation. The specialist examines the organs through the anterior abdominal wall and collects an anamnesis. Then he orders laboratory tests. A blood test shows increased amounts of bilirubin, alkaline phosphatase and cholesterol in the blood. Such data will help confirm the presence of pathology.
One of the instrumental examination methods is also prescribed to obtain a detailed image of the organ being studied and to understand the extent of the damage.
These analysis methods include:
- ultrasonography;
- magnetic resonance;
- computed tomography.
The techniques are based on various radiations, with the help of which a medical worker can view all organs.
CT uses X-ray radiation to examine bone structures and soft tissues for areas of inflammation. MRI is based on electromagnetic waves that create resonance as they pass through tissues of varying densities. This allows you to get a photo with a three-dimensional image. Ultrasound is the safest technique, but the resulting images are inferior to the quality of photos from CT and MRI.
In some cases, a liver biopsy is resorted to. A sample of organ tissue is taken from the patient for further study and histological analysis.
First of all, the patient should identify the exact cause of the pathology and eliminate it. This may be due to taking medications, poor diet, chronic liver disease, or work involving radioactive radiation.
To do this, you should contact a specialist who will conduct tests and diagnoses, and then prescribe a course of therapy. If a girl took oral contraceptives or hormones that were not suitable for her body, the specialist will prescribe other methods of contraception.
If not healthy lifestyle, the specialist prescribes a comprehensive treatment for the disease, which consists of a special diet that excludes certain food, exercise and refusal from bad habits.
If a patient has hypovitaminosis, then a specialist must prescribe the necessary vitamin. This may be tocopherol or calciferol (vitamin D), retinol acetate (vitamin A) and phylloquinone (vitamin K).
In addition to vitamins, hepatoprotectors on a plant or phospholipid basis are prescribed to support liver functionality.
Such hepatoprotectors include:
- Karsil;
- Essentiale Forte;
- Rezalut;
- Phosphogliv and others.
In advanced cases, surgery may be required to remove stones from the bile ducts and gland or complete removal of the gallbladder, due to the failure of non-surgical treatment methods.
When treated with medications, surgery, or ignoring this type of pathology, various complications can occur. This could be hormonal imbalances after taking hormonal medications or the appearance of dyspeptic stomach disorders due to taking medications.
There is a risk of degenerative spinal diseases. The most common is osteoporosis, which occurs due to calcium deficiency and a sedentary lifestyle. In this case, the doctor prescribes a comprehensive intake of calcium supplements, physiotherapeutic procedures and a special regimen that excludes the use of alcohol and cigarettes.
Ignoring the disease can provoke the formation of stones in the gallbladder or ducts, which will lead to inflammation and the flow of bile into the abdominal cavity. As a result of such phenomena, the patient develops abdominal abscesses or biliary peritonitis.
Prevention of cholestatic hepatitis
To reduce the risk of possible chronic hepatitis, a person must adhere to certain rules. They will allow you to identify the pathology in time and stop its further development.
These rules include:
- timely medical examinations;
- limited consumption of heavy, fatty, spicy foods, carbonated and alcoholic drinks;
- consultation with a doctor about taking oral contraceptives, antibacterial drugs and hormones;
- timely treatment of liver diseases;
- maintaining a healthy lifestyle.
Compliance with these basic rules will allow a person to avoid various pathologies of the liver, cardiovascular system and degenerative diseases.
Cholestatic hepatitis is a fairly rare pathology, the pathogenesis of which is based on intrahepatic cholestasis with deterioration of the excretory function of cells and damage to the ducts. The frequency of detection of the disease does not exceed 10% among all chronic hepatitis. Cholestatic hepatitis mainly occurs in older people. Despite its relatively low prevalence, the disease is difficult to treat due to the fact that it is not always possible to clearly establish its cause. Gastroenterology studies the etiology and pathogenesis, as well as the development of new methods of treating cholestatic hepatitis. Diagnosis and treatment of the disease is carried out by a gastroenterologist together with a hepatologist and a surgeon.
Causes of cholestatic hepatitis
This pathology may be caused by intrahepatic or extrahepatic stagnation of bile.
In the first case, a violation of the outflow of bile is possible both at the level of liver cells and at the level of intrahepatic ducts. The cause of bile stagnation at the liver level is often the transition of acute viral hepatitis B, C or other types into a chronic form. Also, in some cases, intrahepatic cholestasis is caused by liver damage due to Ebstein-Barr viruses, herpes, cytomegalovirus, and mycoplasma infection. Cholestatic hepatitis can be caused by taking various drugs, such as chlorpromazine, some diuretics, antibiotics, anabolic steroids, and contraceptives. The occurrence of intrahepatic cholestasis is sometimes preceded by exposure to toxins, alcohol, and poisons. Cholestatic hepatitis also develops against the background of endocrine diseases.
Extrahepatic cholestasis may result from obstruction of large ducts. In this case, its possible causes are blockage of the common bile duct by a stone, chronic calculous cholecystitis, chronic pancreatitis, cancer of the head of the pancreas and tumors of other organs of the hepatobiliary system. Against the background of cholestasis in the liver, destruction of hepatocytes occurs with subsequent dysfunction of the organ. In some cases, it is not possible to establish the cause of the disease, which is interpreted as idiopathic cholestatic hepatitis.
Symptoms of cholestatic hepatitis
The symptoms of cholestatic hepatitis are similar to those of other chronic liver diseases.
The distinctive features are more pronounced jaundice and skin itching, which is often the first manifestation of the disease. Itching in this case is caused by the entry of bile acids into the blood due to stagnation of bile in the liver. Also, patients with cholestatic hepatitis often develop xanthomas, which look like yellow spots. In this case, the color of feces, as a rule, becomes lighter, and the urine darkens. Palpation reveals an increase in size and increased density of the liver without splenomegaly. During an exacerbation, an increase in temperature and mild symptoms of intoxication are possible. The severity of the clinical picture depends on the severity of cholestasis.
Diagnosis of cholestatic hepatitis
Laboratory and instrumental research methods play an important role in diagnosing the disease. Of the laboratory techniques, the main one for diagnosing cholestasis is a biochemical blood test. A biochemical study reveals an increase in the level of bilirubin due to the direct fraction, an increase in the level of transaminases, alkaline phosphatase (more than 5 times), gamma-glutamine transferase and cholesterol. You can also determine an increased amount of phospholipids, B-lipoproteins and bile acids in the blood. To confirm the viral etiology of the disease, specific markers are studied using ELISA and PCR methods. A characteristic serological marker of intrahepatic cholestasis is the determination of antimitochondrial antibodies.
Of the instrumental methods, ultrasound of the liver and gallbladder is mandatory.
and ultrasound examination reveals signs of chronic hepatitis. Ultrasound of the biliary tract, gallbladder and pancreas can confirm or exclude extrahepatic cholestasis. If there are difficulties in diagnosing cholestasis, retrograde cholangiopancreatography, percutaneous transhepatic cholangiography or cholecystography is performed, which can detect stones in the bile ducts in cases where they are not visible on ultrasound. Modern non-invasive methods for identifying the causes of cholestatic hepatitis are MR-pancreatocholangiography and MRI of the hepatobiliary zone. To study morphological changes, a puncture biopsy of the liver can be performed, although it does not play a decisive role in the diagnosis of cholestasis.
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Symptoms
The main clinical symptom is itching of the skin, which is not relieved by symptomatic remedies, and icteric discoloration of the skin and sclera. In some cases, skin itching precedes jaundice. It develops unevenly, but patients remain in good health for a long time. In addition, in most cases there is generalized skin pigmentation and xanthelasma. Extrahepatic signs are rarely observed. The liver is usually small in size, protrudes 1.5-3 cm from under the costal arch, dense, with a smooth edge. The described clinical symptom complex is combined with an increase in the content of bilirubin, cholesterol, beta-lipoproteins and the activity of alkaline phosphatase in the blood serum, while an increase in the thymol test and gamma globulins is observed in less than half of the patients.
Diagnostics.
Practical difficulties arise when distinguishing chronic aggressive hepatitis from Botkin's disease, especially the recurrent course. Unlike chronic hepatitis, Botkin's disease occurs with a prodromal period and is characterized by less severe hepatolienal syndrome and extrahepatic manifestations of the disease. It is important to increase the activity of enzymes (aldolase, aminotransferases), exceeding the indicators of their activity during exacerbation of chronic hepatitis. At the same time, dysproteinemia is much more pronounced in chronic hepatitis.
To diagnose chronic persistent hepatitis, a puncture biopsy of the liver is necessary, since laboratory data are not specific. Data from histological examination of liver punctures allow for differential diagnosis with fatty hepatosis and benign hyperbilirubinemia.
Treatment.
A rest regime and elimination of the effects of various factors that are important for a diseased liver must be ensured. Diet No. 5 is used. In case of exacerbation of the process, as well as concomitant diseases of the gastrointestinal tract, Diet No. 5a is prescribed. Drugs that improve liver cell metabolism - vitamins, cocarboxylase, lipoic acid, amino acids and protein hydrolysates - are prescribed for all forms of chronic hepatitis. Lipoic acid and lipoic acid amide (lipamide) are used in a dose of 0.025 g 2-4 times a day orally for 30-60 days; sodium salt of lipoic acid in the form of a 2% ampoule solution is administered parenterally. Glutamic acid is prescribed in a daily dose of 1-1.5 g for a course of 30-60 days.
For aggressive hepatitis, 20-25 mg of prednisolone per day is recommended, for cholestatic hepatitis - 25-35 mg. The dose of the drug is reduced slowly, only after 2-3 months they switch to maintenance doses (15-10 mg). Delagil is prescribed at a dose of 0.25-0.51 in combination with 5-15 mg of prednisolone. Course duration is from 1.5 to 6 months. Azathioprine is used in a dose of 50-150 mg in combination with 5-10 mg of prednisolone. The duration of the course is from 1 month to several years.
Sanatorium-resort treatment is indicated for chronic persistent hepatitis in the inactive stage, complicated by diseases of the biliary tract and gastrointestinal tract, without thermal procedures on the liver area. Gastrointestinal sanatoriums are recommended. For chronic aggressive and cholestatic hepatitis, sanatorium-resort treatment is not indicated.
Chronic aggressive and cholesgatic hepatitis progresses to cirrhosis in 20-30% of cases. Persistent hepatitis in most patients ends with stabilization of the process, in a minority the activity remains, transition to cirrhosis of the liver is observed very rarely.
Prevention.
Prevention consists primarily of preventing the spread of viral hepatitis (especially B and D). Due attention should be paid to the elimination of industrial and household intoxications, limiting the unjustified use of a number of medications. The effectiveness of treatment depends on a well-organized clinical examination of persons who have had hepatitis B and D. If there is an established diagnosis of chronic hepatitis, all patients require active clinical observation.
- Chronic hepatitis with minimal activity
- Autoimmune hepatitis and its treatment
- Treatment of chronic persistent hepatitis
- Cryptogenic hepatitis
- Reactive hepatitis and its treatment
diagnostichouse.ru
Features of liver functions
The functions performed by the liver are varied:
- The liver synthesizes. This organ creates a variety of hormones, without which the successful functioning of the body is impossible: cholesterol, enzymes, acids, proteins, vitamins, macroelements, and so on.
- For the fetus, the liver is a hematopoietic organ.
- It neutralizes and removes from the body various foreign impurities, allergens, excess hormones, macroelements, and so on.
- The liver is also involved in digestive processes.
- It creates and stores blood and glycogen reserves.
- Regulates the body's carbohydrate balance.
Unfortunately, the modern way of life negatively affects the entire body in general and the liver in particular. Eating fatty and unhealthy foods, bad habits, constant stress, environmental pollution - all this weakens us. And like any living organ, the liver is susceptible to various diseases.
The most common liver diseases are various hepatitis. They come in different origins: radiation, viral, autoimmune, and so on.
They occur differently and are treated differently. Some are vaccinated, and some are not yet vaccinated.
Symptoms of the disease and its treatment
The reasons for the development of the cholestatic type of disease are precisely untreated or undetected types of hepatitis. Due to inflammatory processes in the liver, bile stagnates, it is poorly excreted, and quickly spreads throughout the body, poisoning it.
In turn, the chronic cholestatic type of hepatitis is divided into two large types, the treatment of which is in most cases similar: passive, benign hepatitis and active, aggressive hepatitis. With cholestatic hepatitis, symptoms do not appear, and they can only be distinguished using laparoscopy and liver puncture biopsy.
During exacerbation of the cholestatic type of hepatitis, the symptoms are:
- elevated temperature;
- pain on the right in the abdomen, under the ribs;
- rashes;
- change in color of organisms' secretions;
- enlargement and hardening of the liver;
- pain after eating;
- the appearance of yellow spots in the corners of the eyes.
When the exacerbation subsides, the symptoms remain the same, they just weaken slightly. Diagnosis of the disease is possible in different ways. In any case, these are various ultrasounds, punctures, and so on. These are blood and secretion tests. This includes external observation and self-assessment of the patient’s condition.
In the modern world, hepatitis is treated, perhaps not as easily as we would like, but quite successfully. In case of acute cholestatic hepatitis, hospitalization is mandatory. Also, a mandatory procedure for the treatment of hepatitis of any type is detoxification, that is, helping the liver cope with the load.
Diet is important to reduce the load on the liver. Of course, during treatment and recovery, experts recommend giving up bad habits, following a daily routine, stressing your body less, sleeping more and spending time in the fresh air more often. For successful treatment, it is necessary to identify and eliminate the causes of cholestatic disease. That is, comprehensive treatment of all types of hepatitis is necessary.
In acute cases of the disease, in addition to supportive care, broad-spectrum hormonal drugs may be prescribed in small doses. Some surgical intervention is possible.
Complications and lifestyle
Difficulties after cholestatic hepatitis are varied. These may also be complications caused by surgery and due to taking hormones or other medications. Complications in the functioning of the esophageal system are possible.
In addition, osteoporosis may develop. To prevent this from happening, it is necessary to take additional calcium, increase the proportion of calcium-containing foods in the diet and try to avoid a lifestyle that contributes to the development of osteoporosis (again, move more in the fresh air, smoke less and drink alcohol).
If the cholestatic type is not treated, stones form in the bile ducts, which can become inflamed and, in rare cases, cause the development of biliary peritonitis. This disease also negatively affects the functioning of the heart and gastrointestinal tract. It is possible to develop pancreatitis, the development of fistulas and abscesses and other unpleasant symptoms.
In addition, a specific complication that can occur after this type of hepatitis is a deficiency of fat-soluble vitamins.
The liver, without fully recovering, cannot perform its job perfectly. To prevent this condition, it is necessary to take vitamin complexes or separately missing vitamins orally.
After suffering from an illness, it is important to avoid heavy loads on the body, including long-distance travel. It is necessary to maintain a healthy diet, avoid foods and methods of preparing them that are harmful to the liver, limit sugar, salt, spices, and spicy foods.
The restrictions include a variety of canned food, mushrooms, spices, dough, and so on. It is important to consume more calcium-containing foods such as cottage cheese. It is better to avoid drinking coffee and caffeine-containing products. It is important to consider that you need to eat in moderation: it is better to eat more often, but in smaller portions.
Of course, eliminating physical activity completely would be unnecessary. Moderate exercise and walking in the fresh air are beneficial and will strengthen the body as a whole. It is important to maintain emotional calm. For a successful and quick recovery, the absence of stress and nervous situations is necessary.
You should not take choleretic drugs. It is necessary to undergo tests twice a year to make sure that the disease is completely defeated, and it is advisable to undergo a course of vitamin therapy at least once a year. But even in the periods between courses, it is necessary to support the body with vitamins, try to avoid diseases and the use of heavy medications such as antibiotics.
If you notice symptoms in yourself or those close to you, you should consult your doctor. And then, until complete recovery, constant consultations with the treating specialist are necessary.
Please don't neglect your health!
ogepatite.ru
Description and etiology of the disease
Cholestatic hepatitis is any form of liver disease that causes liver inflammation and bile flow problems. Identifying the cause of cholestasis and understanding the mechanism of its development serve as the basis for therapeutic or surgical treatment.
Gallstone disease is the main cause of the disease. The most common cause of cholestatic hepatitis is cholelithiasis, which obstructs the general bile flow. Physical forms of obstruction occur, for example, if the common bile duct is compressed by a tumor, interfering with the proper functioning of the liver or the normal transport of bile through the ducts. Very often the cause of the disease is incompletely cured or advanced hepatitis. Obstruction in the flow of bile can occur due to medications, drugs, alcohol, and poisoning. The disease develops due to exposure to Epstein-Barr viruses, cytomegalovirus or mycoplasma infection, autoimmune diseases and some hereditary problems.
The disease is more often observed in older people. The risk of cholestasis increases during pregnancy; in addition, women are more likely to experience atresia (congenital pathology, absence or disorder of the biliary tract) and drug-induced cholestasis. Newborn babies are more likely to develop cholestasis due to liver immaturity.
Types of cholestatic hepatitis
This form of the disease affects the cells and bile ducts of the organ. When the virus enters the liver, infected hepatocytes (liver tissue cells) begin to multiply faster, affecting the bile ducts and intestines. The body’s immune system begins to fight the infected hepatocytes, and an inflammatory process develops in the liver, connective tissue grows, and fluid (infiltrate), consisting of blood plasma and lymph, accumulates. Sometimes inflammation occurs not inside the liver, but near the bile ducts, so the disease is divided into the following types:
- Intrahepatic - occurs at the cellular level and is associated with damage to hepatocytes (liver tissue cells) and damage to the intrahepatic bile ducts.
- Extrahepatic - occurs due to blockage of the bile ducts or compression from the outside (mechanical damage to the extrahepatic bile ducts).
Symptoms of cholestasis
Already 10-12 days after extrahepatic obstruction (closure of the lumen of a hollow organ), cholestatic hepatitis develops and general symptoms appear. Depending on the stage of development of the disease, symptoms may differ, but the main picture is common for congestive phenomena - nausea, fatigue, itching and severe jaundice, sometimes immunoallergic reactions such as rash, eosinophilia, and fever appear.
Cholestasis causes severe itching of the skin. The disease can occur in two phases: acute and sluggish. The degree and severity of cholestasis are proportional to changes in clinical indicators, namely with respect to an increase in the concentration of bilirubin, cholesterol, copper levels, etc. Signs of the disease in the sluggish phase are similar to the acute form, although less pronounced and painful. But they cannot be ignored, otherwise the disease will worsen. The acute period is accompanied by the following symptoms:
- Severe skin itching, manifested in the form of scratches. The exact cause of the itching is not yet entirely clear.
- Fever.
- Abdominal pain, especially in the upper right part.
- Change in color of urine and feces.
- Yellowish formations on the eyelids (xanthelasmas).
- Yellowness of the skin, which appears as a consequence of increased levels of serum bilirubin.
- Enlargement and hardening of the liver.
Diagnostics
Ultrasound diagnostics is part of diagnostic measures. In order to accurately make a diagnosis and eliminate the possibility of error (to distinguish this pathology, for example, from Botkin’s disease), the patient must undergo a complete examination of the body. Diagnosis of the disease is carried out using the following methods:
- Biochemical blood test for enzymes (bilrubin, cholesterol, alkaline phosphatase, gamma-glutamine transferase, B-lipoproteins and bile acid).
- Ultrasound of the biliary tract and gallbladder, confirming or excluding extrahepatic cholestasis.
- Liver biopsy.
- Analysis of secretions.
- Liver puncture.
- Laparoscopy.
- The presence or absence of antibodies is determined by enzyme-linked immunosorbent assay (ELISA)
- Polymerase chain reaction (PCR) analysis will help confirm or refute the infectious origin of the disease.
The first appearance of symptoms is a serious reason to urgently visit a doctor. Self-medication of chronic cholestatic hepatitis is unacceptable. Only a qualified specialist will accurately diagnose and prescribe the correct therapy.
If the diagnosis is confirmed, immediate hospitalization is required. First of all, with cholestatic hepatitis, it is necessary to detect and eliminate its root cause so that there is a positive outcome in treatment. Depending on the stage of hepatitis and the degree of tissue damage, recovery lasts several months, and sometimes even several years. The disease can cause complications, and then you will need to undergo a special health course in a medical sanatorium. If the patient has indolent symptoms, it is advisable to order tests and conduct outpatient treatment with a hepatologist. For acute cholestatic hepatitis, the following medical prescriptions and prescriptions are carried out:
- Immediate hospitalization to the hepatology or infectious diseases department.
- Maintaining bed rest.
- A diet requiring the complete exclusion of fried, fatty and spicy foods. The menu should include dairy and fermented milk products, boiled poultry and fish.
- Moderate doses of Prednisolone are prescribed, with a gradual reduction in dosage.
- Severely irritating itching is relieved by “Bilignin” or “Cholesteramine”.
- Lipotropic drugs are prescribed: vitamin A, B12, E, lipoic acid, Essentiale.
- Ursodeoxycholic acid preparations are recommended to improve well-being, reduce jaundice, relieve exacerbations, and reduce ALT activity.
- In case of obstruction of large bile ducts, surgical intervention is performed.
Complications
During the recovery period, it is necessary to limit the stress on the body, temporarily avoid long trips and entertainment events. It is extremely important to maintain a proper diet, pay special attention to cooking recipes, limit sugar, salt, spices, and alcohol.
Prevention
A proper lifestyle is the key to health. Moderate consumption of alcohol, quitting smoking, unnecessary use of medications, and limiting fatty foods will help avoid this very unpleasant disease. If you have any problems with the liver, consult a doctor in a timely manner and be treated until complete recovery. After an illness, it is advisable to take tests twice a year to know for sure that the disease has completely receded. It is necessary to maintain the body weakened by the disease with vitamins and maintain a healthy lifestyle in order to avoid new diseases, the treatment of which involves the use of heavy medications, such as antibiotics.
infopechen.ru
This is a rare form of chronic hepatitis and is observed in 5-10% of cases. The history includes a cholestatic variant of acute viral hepatitis and, less commonly, complicated by purulent-inflammatory processes, chronic cholecystitis, cholelithiasis, biliary atresia in newborns, as well as the use of various medications.
Chronic cholestatic hepatitis in the ACUTE stage is characterized by severe skin itching, fever, moderate pain in the right hypochondrium, discoloration of urine and feces, xanthelasmas, intense jaundice of the skin, enlarged and dense liver. The spleen is rarely palpated. From the laboratory tests, it is noted that indicators of the activity of the inflammatory process are within normal limits or increased by 2-3 times, the levels of thymol and sublimate samples have not changed for a long time. Characteristic is a significant increase in total cholesterol, beta-lipoproteins, total and direct bilirubin, and alkaline phosphatase activity. Leukocytosis and accelerated ESR are often detected. Possible CIVE syndrome is an increase in the number of leukocytes, hyperlipemia and fever with an increase in temperature to 38-39 ° C. Viral etiology is confirmed by the detection of specific markers of hepatitis.
Ultrasound examination of the liver and biliary tract reveals visualization of intrahepatic ducts (normally not visible). A scanogram with AI198 fails to identify specific signs of cholestatic hepatitis.
The stage BEYOND ACHIEVEMENT is characterized by an improvement in clinical and laboratory parameters. Nevertheless, slight itching of the skin, subictericity of the skin and sclera, and an enlarged liver persist. A moderate (compared to the exacerbation stage) increase in bilirubin, total cholesterol, beta-lipoproteins, and alkaline phosphatase is detected. Levels of albumin, gamma globulin, ALT and AST are usually normal.
In the acute stage, hospitalization is indicated.
Bed rest.
DISINTOXICATION THERAPY is mandatory.
Prescription of moderate (1 mg/kg/day) doses of prednisolone with a slow and gradual reduction is justified. For painful itching, bilignin (5-10 g 3 times a day), cholesterol (4-5 g 3 times a day) are prescribed.
At any stage of the disease, lipotropic drugs are recommended: vitamin A (10,000 units per day), B12 (100 mcg once a day), E (100 mg per day), lipoic acid (0.025 three times a day), Essentiale ( intravenously 10-20 ml or orally up to 6 capsules per day).
The most modern and promising means for the treatment of cholestasis are URSODEOXYCHOLIC acid preparations (10 mg/kg/day). They provide an improvement in well-being, a reduction in jaundice, relieve exacerbations, and often reduce ALT activity to normal.
Medical examination of patients with chronic hepatitis is carried out in a polyclinic constantly throughout the illness. It must be remembered that patients with chronic persistent and especially chronic active hepatitis pose a danger to others during the period of activation of the process. It is preferable to hospitalize them in a specialized hepatology or infectious diseases department.
LIVER CIRRHOSIS
Currently, liver cirrhosis is regarded as the final stage of liver destruction from acute viral hepatitis through chronic viral hepatitis directly to cirrhosis.
The opinion that various toxic substances (for example, alcohol) and medications lead to toxic hepatitis and then to cirrhosis of the liver should be considered outdated. It has been proven that liver cirrhosis in more than 50% of patients is the result of exposure to the hepatitis B virus and alcohol.
Thus, the main and main thing in the formation of liver cirrhosis is the impact of hepatitis B, C and D viruses (Dunaevsky O.A., 1993, Podymo-va S.D., 1994, Sherlocks, 1975).
There is, however, rarely, a congenital predisposition to liver cirrhosis due to a deficiency of alpha-1 antitrypsin in the blood.
CLASSIFICATION OF LIVER CIRRHOSIS (DUNAEVSKY O. A., 1993)
1. Small nodular cirrhosis.
2. Large nodular cirrhosis.
3. Mixed cirrhosis.
4.Biliary cirrhosis.
SMALL NODULA CIRRHOSIS OF THE LIVER
Occurs in 75-85% of all patients with liver cirrhosis. Cirrhotic changes are diffuse in nature, the size of hyperplasia nodes does not exceed 5-10 mm (Dunaevsky O.A., 1993).
The history includes a past history of acute viral hepatitis B, C and D, chronic viral hepatitis, identification of markers of hepatitis B, C and D in the past. In adults, in addition, long-term alcohol abuse is detected.
Patients complain of weakness, loss of appetite, periodic darkening of urine for a long time, and repeated nosebleeds. The main clinical picture is a dense, slightly enlarged or normal-sized liver, an enlarged spleen, and ascites. In addition, spider veins, palmar erythema, fingers like “drumsticks”, and less commonly xanthomatous plaques are observed. The disease lasts for a long time without or with erased jaundice of the skin. Intense and persistent jaundice is characteristic of the final stage of the disease.
The activity of ALT and AST is usually normal or slightly increased. The indicators of the thymol test and gamma globulins are significantly increased, and the amount of albumin, sublimate test, prothrombin index, and T-suppressors is sharply reduced.
When scanning with Au198, it is possible to detect a scanographic decrease in the size of the liver, an increase in the left lobe, a diffuse decrease in the accumulation of the isotope, and a decrease in the accumulation of the isotope in the spleen.
Ultrasound examination of the liver reveals increased echogenicity, expansion of the portal vein (15-20 mm), and an increase in the size of the spleen.
LARGE NODULARY CIRRHOSIS OF THE LIVER
Large-nodular cirrhosis of the liver is less common than small-nodular cirrhosis - in 20-25% of patients. Regeneration nodes in the liver with a diameter of more than 5-10 mm.
The patient has a history of icteric forms of viral hepatitis and chronic viral active hepatitis. Alcohol abuse and other causes are rarely identified.
Patients are often worried about weakness, decreased performance, poor appetite, nausea, vomiting, joint pain, and flatulence.
The clinical picture is characterized by wavy jaundice, changes in the color of urine and feces, signs of portal hypertension (spider veins, palmar erythema, splenomegaly, ascites, venous collaterals). The liver is of normal size with a dense, sharp edge.
In contrast to small nodular cirrhosis, the activity of the inflammatory process is higher, and the sublimate test is noticeably reduced (1.0 ml and below). The levels of thymol test and gamma globulins are high, and the amounts of albumin, prothrombin index, and T-suppressors are reduced. Markers of hepatitis B, C and D are detected relatively often.
Scanning and ultrasound findings of the liver are similar to those for small-nodular cirrhosis of the liver.
MIXED LIVER CIRRHOSIS
The diagnosis is established after the death of patients by the presence of approximately the same number of small and large hyperplasia nodes. It is almost impossible to make a clinical diagnosis (Dunaevsky O.A., 1993).
BILIARY CIRRHOSIS OF THE LIVER
The rarest form. It is observed in 5% of all patients with liver cirrhosis (Dunaevsky O.A., 1993).
The history includes a history of cholestatic variants of acute viral hepatitis and chronic cholestatic hepatitis. Other causes (chronic cholecystitis, cholelithiasis, cholangitis, biliary atresia) are much less common. A history of alcohol abuse is not common.
If the disease is a consequence of a cholestatic variant of acute viral hepatitis or chronic cholestatic hepatitis, then it is usually called primary biliary cirrhosis. In the case when the formation of the disease is associated with a long-term chronic disease of the biliary tract, then such biliary cirrhosis is called secondary.
Primary biliary cirrhosis affects elderly and senile people much more often (Dunaevsky O.A., 1993). This can be explained by the fact that the time period required for the transition of chronic cholestatic hepatitis to biliary cirrhosis is significantly (in years) longer than for the formation of other liver cirrhosis.
Patients consult a doctor with complaints of severe, painful itching and yellowness of the skin. In addition, they are worried about weakness, malaise, poor appetite, decreased performance, severe pain in the right hypochondrium, and prolonged fever. In contrast to the cirrhosis described above, the liver is ENLARGEED, but the spleen is not palpable. Signs of portal hypertension appear late and are not clearly expressed. Ascites can be noticed after several years of illness, closer to the final stage. However, very often, and in the early stages of the development of the disease, xanthomatous plaques are detected, especially localized on the eyelids (Dunaevsky O.A., 1993). Biliary cirrhosis is characterized by constantly high levels of cholestasis (direct bilirubin, total cholesterol, alkaline phosphatase, beta lipoproteins). The activity of the inflammatory process is minimal. ALT and AST levels have been within normal limits or slightly elevated for many years. The level of sublimate test and T-suppressors decreases markedly in the terminal stage of the disease. The indicators of the thymol test and prothrombin index remain unchanged for a long time. The level of immunoglobulin M increases noticeably.
The scanogram does not reveal any features compared to other cirrhosis, with the exception of a relatively rare accumulation of the isotope in the spleen. An ultrasound examination of the liver reveals dilated intrahepatic ducts, the liver is enlarged in size and has increased echogenicity. The disease lasts for years and decades.
Let's consider the general principles of treatment of cirrhosis in general:
1. Bed rest, with access to the toilet.
2. Diet. Table No. 5 is prescribed. Patients with ascites are prescribed table No. 7a (protein no more than 1 g/kg of the patient’s weight per day, salt restriction). Fluid consumption is up to 1 liter per day.
3. Since the doctor is dealing with a mature autoimmune disease, a stable effect from treatment with interferon has not been obtained (Sorinson S.N., 1996).
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Hepatitis is an inflammatory liver disease, which in most cases develops as a result of the effects of viruses on the body. Cholestatic hepatitis is a fairly rare disease, which in terms of detection frequency is no more than 10% among all hepatitis. Most often it occurs in elderly patients, but it can also occur in children. Let us consider the features of the development and treatment of pathology.
To understand exactly how this type of hepatitis differs from others, it is necessary to study the nature of the pathology and the mechanism of its development.
Cholestasis is a disease that is characterized by a decrease in the flow of bile into the duodenum (this phenomenon is associated with a violation of its formation, excretion and/or excretion).
The pathogenesis of cholestatic hepatitis is based on cholestasis with deterioration of the excretory function of cells and damage to the ducts.
If you observe this process under a microscope, you will notice that individual hepatocides have brownish-green dotted appearances in the cytoplasm (bile, which is not able to get out of the cell). Depending on the location, this pathology can have two forms:
- intrahepatic (develops in the liver);
- extrahepatic (can develop in the biliary tract).
Cholestatic hepatitis has the following types:
- recurrent;
- progressive;
- aggressive;
- active and inactive;
- long;
- benign.
Cholestatic hepatitis can occur in acute and chronic forms. In its acute form, the disease is characterized by the manifestation of vivid symptoms and can result in recovery, transition to a chronic form, or death of the patient. Chronic hepatitis can lead to serious complications such as cirrhosis or cancer.
Causes
The main reason for the development of cholestatic hepatitis is undiagnosed or undertreated hepatitis. Factors promoting development:
Viruses that can cause cholestatic hepatitis:
- Epstein-Barr virus (a type of virus from the gammaherpesvirus subfamily of the herpesvirus family);
- herpes virus (herpes simplex virus types 1 and 2, which is transmitted by contact);
- cytomegalovirus (a genus of viruses from the betaherpesvirus subfamily of the herpesvirus family);
- hepatitis viruses class A, B, C, D, E;
- mycoplasma (a genus of bacteria of the Mycoplasma class that do not have a cell wall).
Hepatitis often occurs against the background of other, no less serious diseases, so when the first symptoms appear, you should immediately consult a doctor, since treatment aimed solely at treating the liver may not produce results.
Clinical picture
The manifestations of cholestatic hepatitis are not much different from other liver diseases. It manifests itself with the following symptoms:
The occurrence of all of the above symptoms is a reason to immediately visit a medical facility. Specialists whose help may be needed in this case:
- therapist;
- gastroenterologist;
- hepatologist;
- surgeon.
The disease most often occurs in older children, and girls suffer more severely from it. This pathology develops under the influence of various viruses. The development of chronic cholestatic hepatitis can also be caused by blockage of a gallstone or compression of the bile duct, or cancer of the head of the pancreas.
In most cases, this pathology in childhood patients turns into biliary cirrhosis - this is a disease that develops against the background of damage to the bile ducts, and there is a gradual replacement of liver tissue with fibrous elements.
Examination and fight against hepatitis
Difficulties may arise when diagnosing this pathology, since cholestatic hepatitis without some diagnostic measures is almost impossible to distinguish from Botkin’s disease, and in this case, the main role is played by blood test indicators, because enzymatic indicators are higher in cholestatic hepatitis.
How to determine pathology?
Treatment is prescribed only after the attending physician has carried out the necessary diagnostic measures. List of main diagnostic measures:
Treatment regimen
After confirming the diagnosis, the specialist chooses treatment tactics. In most cases it looks like this:
- the patient is immediately hospitalized in the hepatology or infectious diseases department;
- in order to restore the strength necessary to fight this serious disease, the patient is advised to remain in bed;
- medications are prescribed to help eliminate unpleasant symptoms.
List of drugs necessary for the treatment of cholestatic hepatitis:
In case of obstruction of the biliary tract (large), surgical intervention is indicated. Proper nutrition in this case is also not in last place.
The patient must strictly follow the diet and know which foods should be consumed and which should be excluded from the diet.
Products that should be present in the diet:
- dairy and fermented milk products and dishes made from them;
- poultry meat (boiled);
- fish fillet;
It is necessary to exclude:
- dishes prepared by frying;
- spicy dishes;
- fatty meats;
- offal and canned food;
- cocoa;
- baking;
- alcoholic drinks.
Also, for cholestatic hepatitis, vitamin complexes are prescribed (it is especially important to take those that contain vitamins B, A, and E). Decoctions of rosehip and corn silk are also useful.
Complications, prognosis and prevention
Complications that arise as a result of the effects of cholestatic hepatitis on the body are far from harmless, especially in the absence of proper treatment. These are, in particular:
Despite the protracted course, if you seek qualified help in a timely manner, the prognosis is favorable. It is very difficult to protect yourself from this disease, but it is still possible. First of all, you need to follow certain recommendations and follow some rules:
- prevention of viral hepatitis;
- timely treatment of diseases;
- balanced diet;
- giving up bad habits (especially when it comes to drinking alcohol);
- lack of uncontrolled use of medications (many drugs have a negative effect on the liver);
- regular medical examinations (they help not only to detect hepatitis at an early stage, but also other equally dangerous diseases).
Hepatitis is a disease that today spares no one. Bad habits (alcoholism, drug addiction), poor environment, poor nutrition and other negative factors contribute to the spread of many deadly diseases. In most cases, a person destroys himself. Therefore, in order to protect yourself from many dangers, you need to know the “enemy in person” and study all the ways to combat it.
Bile is an important biological fluid secreted by the liver and involved in the digestion process. Hepatic bile can be directed into the duodenum or into the gallbladder. The composition of bile includes primary and secondary bile acids, bile pigments, phospholipids and others.
Bile components such as cholesterol and bilirubin are not excreted in the urine, so the entire burden of removing them falls on the bile. Therefore, one of the main functions of liver secretion is excretory. Diseases associated with the outflow of bile and its accumulation in the blood include cholestatic hepatitis.
Description of the disease
Chronic forms of hepatitis include cholestatic hepatitis - a diffuse liver disease in which inflammation of the tissues of this organ occurs due to stagnant bile in it.
Bile secretion accumulates both in the liver itself and spreads through the bloodstream. This condition often develops in older people, but it is also possible in children.
Attention! Cholestatic disease is quite rare. Among other types of hepatitis, it is only 10%.
Causes
The cause of impaired flow of bile into the duodenum may be located both inside the liver and near the bile ducts. Therefore, a distinction is made between intrahepatic and extrahepatic cholestasis.
Some viruses can provoke the development of intrahepatic cholestasis, including hepatitis, cytomegalovirus, and herpes. With this type of cholestatic hepatitis, not only the liver is affected, but also the bile ducts, so it is considered more severe.
Extrahepatic hepatitis begins to develop due to cholelithiasis, which results in obstruction of large bile ducts. Tumors of the hepatobiliary system, chronic cholecystitis, and pancreatitis can also cause deformation and compression of the bile ducts. Sometimes the cause of the disease cannot be determined; this form is called idiopathic cholestatic hepatitis.
For reference! Sometimes cholestatic liver diseases are caused by medications (hormonal contraceptives and antibiotics, etc.), excessive alcohol consumption, toxic substances and endocrine disorders. Intrauterine infection of the fetus can also occur.
Symptoms
Inflammatory processes in the liver lead to stagnation of bile. The accumulated secretion is located in the liver, and then penetrates the blood, poisoning the entire body. Depending on the degree of activity of the process, there are:
- Inactive benign persistent hepatitis,
- Active aggressive progressive recurrent hepatitis.
Symptoms of cholestatic hepatitis are similar to other liver diseases:
- Jaundice of the skin,
- Discoloration of stool and dark urine,
- Enlarged liver
- Pain in the right hypochondrium,
- Slight increase in temperature.
Skin itching, which often accompanies liver diseases, will be more pronounced with cholestatic hepatitis. After itching of the skin, after some time, the skin and eye sclera become yellow in color.
With cholestatic hepatitis, jaundice is more stable than with other types. A characteristic sign of cholestasis are xanthomas - yellow spots in the corners of the eyes, under the skin. As intoxication progresses, indigestion and a general deterioration in well-being may appear.
After an exacerbation, symptoms may subside. If similar symptoms appear, you should seek help from a doctor.
Laboratory tests during this period will show an increase in copper, cholesterol and bilirubin in the blood, and urobilinogen in the urine.
Treatment
A gastroenterologist treats cholestatic hepatitis. Before starting therapy, the specialist must identify the disease from others. Diagnosis of cholestatic hepatitis includes:
- laboratory tests (biochemical blood test, ELISA and PCR diagnostics, urine test),
- instrumental studies (ultrasound, cholecystography, retrograde cholangiopancreatography, biopsy).
Treatment will depend on the type of hepatitis, the activity of the process and the cause of the disease. If hepatitis was caused by taking medications, alcohol or toxins, then first of all it is necessary to eliminate the damaging factor.
Patients in the acute stage require hospitalization. If there are no indications for placing the patient in a medical facility, then treatment can be carried out at home. An important point in treatment is adherence to bed rest, physical and emotional rest.
Dieting is sometimes considered an alternative to drug treatment. Of course, proper nutrition alone cannot cure the disease. But thermal and mechanical sparing of the organ during this period will benefit the liver. During the treatment period, nutritionists recommend table No. 5 according to Pevzner. The main tenets of the diet are that:
- It is necessary to exclude fried, fatty, spicy foods from the diet.
- Dishes need to be steamed, boiled, baked, and occasionally stewed.
- Take food in small portions 4-5 times a day, warm.
- Maintain drinking regime.
- Eliminate alcohol consumption.
- Take any medications only in consultation with your doctor.
Patients with hepatitis are prescribed detoxification therapy, lipotropic drugs, ursodeoxycholic acid, and prednisolone. If cholestatic hepatitis was caused by extrahepatic causes, then surgery may be necessary. After recovery, you must follow your doctor's recommendations.
Forecast
Cholestatic hepatitis rarely ends in liver cirrhosis. Complications of cholestatic hepatitis can include cholelithiasis, osteoporosis, and bile peritonitis. The circulation of bile through the bloodstream can negatively affect the functioning of the heart and stomach. Timely treatment will help avoid such consequences.
Prevention of this type of hepatitis comes down to timely treatment of diseases of the liver, gall bladder, etc. Attentive attitude to your health before the disease, at the time of treatment and after recovery will allow you to avoid such problems in the future.
This may be useful to you:
One of the main causes of cholestatic hepatitis may be undiagnosed or undertreated forms of hepatitis. In the liver affected by such diseases, inflammatory processes...
Cholestasis is a condition where bile cannot flow from the liver to the duodenum.
Two main differences between the obstructive type of cholestasis:
- when there is a mechanical blockage in the air duct system, which can occur due to gallstones or a malignant tumor,
- metabolic types of cholestasis, which are disorders of bile formation that can occur due to genetic defects or appear as a side effect as a result of frequent use of medications.
The central point in the development of cholestatic hepatitis is considered to be the phenomenon intrahepatic cholestasis- a process in which the content of substances secreted in bile increases in the blood.
Cholestasis, in turn, is caused by a violation of the outflow of bile. As a result, damage to liver cells and inflammation of its tissues occurs.
With prolonged and frequently recurring disturbances in bile flow, cholestatic hepatitis becomes chronic.
Chronic cholestatic hepatitis, characterized by infiltrative changes in the biliary intrahepatic ducts, is fraught with the appearance of primary biliary cirrhosis.
This type of hepatitis is quite rare. This disorder mainly affects older people.
Considering the low percentage of detection of the cholestatic form of hepatitis and the etiology that is not always clear, treatment methods for this disease have been relatively poorly developed.
Cholestatic hepatitis: causes and treatment
Causes of cholestatic hepatitis
One of the main causes of cholestatic hepatitis may be undiagnosed or undertreated forms hepatitis A.
In the liver affected by such diseases, inflammatory processes prevent the normal outflow of bile.
Possible reasons:
pregnancy;
androgens;
birth control pills;
antibiotics (for example, Trimethoprim or Sulfamethoxazole);
abdominal cancer;
biliary atresia and other childhood liver diseases;
biliary injuries;
congenital anomalies of the biliary tract;
gallstones;
acute hepatitis (intrahepatic stagnation of bile occurs both in the bile ducts and at the cellular level. Such a disorder of liver function is usually a consequence of viral forms of hepatitis in the chronic stage);
cystic fibrosis;
intrahepatic cholestasis during pregnancy (obstetric cholestasis);
primary biliary cirrhosis, autoimmune disorder;
primary sclerosing cholangitis associated with inflammatory bowel disease and certain medications (eg, flucloxacillin and erythromycin);
exposure to toxic substances;
narcotics, nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, estrogens, and statins may cause cholestasis and lead to liver damage;
diseases of the endocrine system.
In addition, stagnation of bile in the liver can be caused by various types of herpes viruses and mycoplasmoid bacteria.
Mechanism of the disease
Bile is secreted by the liver to help digest fats.
Bile formation begins in bile ducts, which form between two adjacent surfaces of liver cells (hepatocytes) similar to the branches of a tree.
The tubules join together to form larger structures that join to form a small bile duct with an epithelial surface.
The tubules fuse to form the bile ducts, which ultimately form either the right main hepatic duct, which drains to the right lobe of the liver, or the left main hepatic duct, which drains the left lobe of the liver.
The two ducts join to form the common hepatic duct, which in turn joins the duct from the gallbladder to join at the common bile duct.
Then this duct enters the duodenum through the papilla of Vater.
Histopathology
Under a microscope, individual hepatocytes will have a brownish-green dotted appearance in the cytoplasm, which is bile that cannot escape from the cell.
Canalicular bile forks between individual hepatocytes or in the bile ducts can also be seen, representing bile that is already being excreted from the hepatocyte, but cannot go further due to obstruction.
When these plugs occur in the bile ducts, sufficient pressure (from bile buildup) can cause them to rupture, spilling bile into the surrounding tissue, causing liver necrosis.
These areas are called bile lakes, and are usually treated only with extrahepatic obstruction.
Symptoms of cholestatic hepatitis
In general, the clinical picture of cholestatic hepatitis is the same as with other types of liver dysfunction.
Itching.
Pruritus is often the first and main symptom of cholestasis and is thought to be due to the interaction of serum bile acids with opioid receptors. This symptom is explained by the fact that bile acids enter the circulatory system.
Jaundice.
Also, cholestatic hepatitis is characterized by a pronounced icteric syndrome associated with xanthomas - subcutaneous deposits of cholesterol. Jaundice is a rare occurrence in intrahepatic cholestasis; it usually appears in obstructive cholestasis.
The chair brightens.
In patients with cholestatic hepatitis, the color of the discharge changes - the stool becomes lighter. This symptom implies obstructive cholestasis.
Darkening of urine.
The color of the urine becomes dark.
Increased liver size.
This can be detected by palpation.
Enlarged spleen occurring with some types of viral hepatitis, is not observed.
Possible increase in temperature.
During an exacerbation of the disease, patients may have a fever with mild signs of intoxication. In a general sense, the symptoms of cholestatic hepatitis are determined by the intensity of cholestasis.
Diagnosis of cholestatic hepatitis
Cholestatic syndrome can be detected quite reliably using functional diagnostic methods.
However, it is only possible to distinguish different types of cholestatic syndrome only tentatively. From the moment of blockade of the enterohepatic circulation of lipids (and this occurs in all types of cholestasis), the induction mechanisms of enzyme systems that synthesize cholesterol, β-lipoproteins, bile acids, as well as enzymes - indicators of cholestasis are activated: alkaline phosphatase, 5-nucleotidase and others.
Cholestasis may be suspected if there is an increase in the enzymes 5-nucleotidase and alkaline phosphatase (ALP).
5′-nucleotidase catalyzes the hydrolytic elimination of phosphate at position 5 of pentose nucleotides. Although this enzyme is distributed in all tissues, increased activity is usually observed in diseases of the liver and biliary tract.
In rare cases, the optimal test for cholestasis is an increase in serum bile acid levels. However, this is not typically available in most clinical settings.
In the later stage of cholestasis, AST, ALT, and bilirubin may be elevated due to liver damage as a secondary effect of cholestasis.
When diagnosing this disease, as a rule, they use laboratory test data and information obtained through direct examination of the patient himself.
Laboratory methods involve, first of all, blood chemistry.
The purpose of such a study is to determine changes in the level and state of certain bioactive substances, such as: an increase in the activity of transaminases, the level of bile pigment bilirubin, cholesterol and alkaline phosphatase.
In addition, enzyme-linked immunosorbent assay and polysize chain reaction detection methods are used to verify the viral nature of the disease.
A systematic examination of the patient to confirm the diagnosis, first of all, includes ultrasound examination of the liver, pancreas and gallbladder . This helps to determine the presence of extrahepatic cholestasis, as well as to notice possible signs of chronic hepatitis.
In cases where ultrasound technically cannot reveal the full picture of cholestatic complications, including the presence of stones in the bile ducts, additional methods such as cholecystography, cholangiography and cholangiopancreatography can be used.
Treatment of cholestatic hepatitis
First of all, when treating the disease, it is necessary to eliminate those negative factors that contributed to the development of cholestasis.
If this complication was caused by taking medications or intoxication with other substances, it is necessary to stop this practice.
Acute form of cholestatic hepatitis requires urgent hospitalization of the patient. At the same time, to cleanse the body of harmful compounds, a course of detoxification infusion therapy is carried out.
To maintain the normal functioning of hepatocytes, patients at any stage of cholestatic hepatitis may be prescribed taking vitamins A and E from the fat-soluble group, as well as water-soluble AT 12.
Hepatoprotectors, including food supplements containing lipoic acid and drugs from the Essentiale group.
In addition, a special role in the treatment of cholestatic hepatitis plays dietary food.
Over many years of medical practice, a special nutrition program has been developed for patients with liver damage - Diet No. 5.
The diet focuses on foods containing proteins and carbohydrates, while excluding fatty, fried and spicy foods.
Also, the therapeutic diet involves abstaining from drinking alcoholic beverages.
In the presence of extrahepatic cholestasis sometimes resort to surgical intervention. Among such methods are endoscopic removal of gallstones with retrograde pancreatocholagiography, removal of the proximal segment of the pancreas, open cholecystectomy and others.
Complications
During the treatment of cholestatic hepatitis, various complications sometimes arise.
They may be associated with the use of hormonal drugs and other medications or be a consequence of surgical methods for eliminating cholestasis.
Osteoporosis may also develop as part of the clinical syndrome. In this case, to strengthen the skeletal system, patients are advised to take calcium-containing medications or add foods rich in this element to their diet.
Lack of proper attention to cholestatic hepatitis can lead to the formation of stones in the bile ducts, acute forms of cholecystitis, pancreatitis, as well as the occurrence of abscesses and fistulas.
In addition, complications in the functioning of the heart and digestive organs are possible.
Even after healing, the body remains in a weakened state for some time. During the period until complete recovery, it is recommended avoid heavy loads and long journeys.
It is important to adhere to a healthy lifestyle. Nutrition should be balanced, with a limited number of products that are unsafe due to illness. These include salt, sugar, spices, mushrooms, foods high in fat.
To strengthen the body it will be useful to do regular walks in the fresh air. In general, it is necessary to avoid stress by maintaining emotional calm.
Prevention and prognosis
To avoid complications in the liver, first of all, you need to be careful when taking medications, approach the issue of drinking alcohol wisely and consult a doctor in a timely manner.
Timely elimination of factors contributing to the development of cholestasis and properly selected treatment methods can guarantee the patient restoration of normal liver function. published .
If you have any questions, please ask
P.S. And remember, just by changing your consumption, we are changing the world together! © econet
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