Thank you
Currently choleretic drugs in the complex treatment and prevention of various diseases of the liver and gallbladder, they are used quite widely in the clinical practice of a gastroenterologist. This is due to the effects of choleretic drugs, which relieve painful attacks, alleviate the course of the disease, and also prevent the deterioration of the condition or the appearance of new pathology, provoked by decompensation of an existing disorder.
To understand why choleretic drugs are needed, you should know what bile is, what its physiological functions and how it moves through the digestive system. Bile represents biological fluid, produced by liver cells and accumulated in gallbladder. The liquid has a bitter taste, a specific odor and, depending on how long it was produced, can be yellow, brown or greenish in color. Bile performs the following physiological functions in the human body:
- Emulsification and digestion of fats received from food;
- Activation of enzymes of the small intestine and pancreas necessary for complete digestion of food;
- Ensures complete absorption of fat-soluble vitamins, calcium and cholesterol.
Emulsification of fats is carried out by bile acids contained in bile, which in addition improve intestinal motility, stimulate the formation of protective mucus and prevent the attachment of bacteria and proteins to the mucous membrane. Thanks to these effects, bile prevents constipation and intestinal infections. In addition, bile is necessary for the excretion of substances such as cholesterol, bilirubin, glutathione and steroid hormones from the human body along with feces.
Bile is synthesized by liver cells and enters the gallbladder through special ducts. Then from the gallbladder, also through the duct system, it enters duodenum where it performs its physiological functions. That is, the gallbladder is a kind of reservoir for the temporary storage of bile from the moment of its production until the food bolus enters the duodenum.
Classification of choleretic drugs
Currently, an anatomical, therapeutic and chemical classification of choleretic drugs is used, which takes into account both the chemical structure of the drug used and its therapeutic effects, and anatomical structures affected by the drug. This integrated approach allows us to create the most complete classification, reflecting various aspects of application, therapeutic effects and characteristics of absorption, distribution and excretion of drugs from the human body.So, today choleretic drugs are classified into the following groups and subgroups:
1. Choleretics(drugs that increase bile production by liver cells):
True choleretics, increasing bile production due to the active synthesis of bile acids:
- Choleretics containing bile acids and made from plant or animal raw materials (for example, animal bile, plant extracts, etc.);
- Synthetic choleretics, which are chemical substances obtained by organic synthesis and having the property of increasing bile production;
- Medicinal herbs that have a choleretic effect (used in the form of infusions, decoctions, etc.).
2. Cholekinetics(drugs that improve the flow of bile by increasing the tone of the gallbladder and simultaneous relaxation of the bile ducts).
3. Cholespasmolytics (drugs that improve the flow of bile by relaxing the muscles of the gallbladder and biliary tract):
- Anticholinergics;
- Synthetic antispasmodics;
- Antispasmodics made from plant materials.
- Preparations containing bile acids – ursodeoxycholic or chenodeoxycholic;
- Preparations containing highly active solvents of organic compounds of lipid nature, for example, methyl tert-butyl ether.
Synthetic choleretics are drugs that contain active substances includes only compounds obtained through organic synthesis. In addition to the choleretic effect, drugs in this group also have the following therapeutic effects: antispasmodic (reduce pain in diseases of the biliary tract and gallbladder), hypolipidemic (reduce the concentration of cholesterol in the blood), antibacterial (destroy pathogenic bacteria, provoking inflammatory diseases of the biliary tract) and anti-inflammatory (reduce inflammation existing in the biliary tract). In addition, synthetic choleretics suppress the processes of putrefaction and fermentation in the intestines, thereby eliminating bloating, stool instability and other symptoms of dyspepsia.
Medicinal herbs with choleretic effects improve liver function, increase bile secretion, while simultaneously reducing its viscosity. Herbs also increase the concentration of cholates in bile. Along with the choleretic effect, medicinal herbs also have a cholekinetic effect, that is, on the one hand, they increase the secretion of bile, and on the other, they improve its excretion, thereby achieving a complex therapeutic effect on the human body. Herbal preparations can also have anti-inflammatory, antimicrobial and diuretic effects. Due to the content of only various herbs as active substances, drugs in this group are often called herbal choleretic agents.
Hydrocholeretics increase the volume of bile due to its dilution and reduction of viscosity, achieved by increasing the content of the water fraction in it. In this situation, the excretion of bile is facilitated and the formation of stones is prevented.
Cholekinetics are agents that enhance the tone of the gallbladder and at the same time relax the muscles of the bile duct. To understand the significance of the effect of cholekinetics, you need to know that the gallbladder is connected to the duodenum by the bile duct, through which bile flows from one organ to another. Accordingly, when increased tone the bile duct narrows, which interferes with the movement of bile. And with low tone of the gallbladder, it simply does not “push” bile into the duct. Thus, increasing the tone of the gallbladder and relaxing the duct create ideal conditions for the outflow of bile, since the first contracts intensively, pushing out the contents and preventing it from stagnating, and the second has a wide enough lumen to allow the entire volume to pass through within a short period of time. The resulting effect of cholekinetics is the release of the gallbladder and the flow of bile into the duodenum, resulting in improved digestion and elimination of congestion.
Cholespasmolytics are divided into several groups depending on the characteristics of their pharmacological action, however, the resulting effects are the same for everyone. Cholespasmolytics eliminate spasms and expand the bile ducts, facilitating the excretion of bile into the intestine. These drugs are usually used in short courses to relieve pain in various diseases gallbladder and bile ducts.
Drugs to reduce bile lithogenicity, strictly speaking, are intended to dissolve existing gallstones and prevent the formation of new ones. Since these drugs have a choleretic effect, they are, with some degree of convention, classified in the group of choleretic drugs.
Each group and subgroup includes certain drugs that have a number of properties and clinical effects used in various options pathologies of the biliary tract and liver. In the next section we provide a list of choleretic drugs belonging to each group and subgroup.
Choleretic drugs - lists
Below, for ease of orientation and selection, we provide a list of choleretic drugs by classification group. In this case, we will first indicate the international name active substance, and next to or in brackets a number of commercial names under which the drug may be marketed.True choleretics
True choleretics containing bile components include the following drugs: - Preparations containing components of natural animal bile - Allohol, Cholenzym, Vigeratin, Lyobil;
- Dehydrocholic acid – Hologon;
- Sodium salt of dehydrocholic acid - Decholin, Biliton, Suprakol, Kholamine, Kholomin.
Synthetic choleretics
The following drugs are synthetic choleretics:- Hydroxymethylnicotinamide (Nicodin, Bilamid, Bilizarin, Bilocid, Cholamid, Coloton, Felosan, Isochol, Niciform);
- Gimecromon (Odeston, Holonerton, Holestil);
- Osalmid (Oxafenamide, Osalmid, Auxobil, Drenamid, Driol, Enidran, Salmidochol);
- Cyclovalon (Cyclovalon, Benevo, Cyclovalone, Divanil, Divanone, Flavugal, Vanilone).
Choleretics based on medicinal herbs
Choleretics based on medicinal herbs are as follows:- Immortelle flower extract (Flamin);
- Corn silk extract (Peridol, Insadol);
- Tansy extract (Tanacehol, Tanaflon, Sibektan, Solaren);
- Turmeric extract (Convaflavin, Febichol);
- Mackerel leaf extract (Flacumin);
- Extract of leaves and roots of barberry (Berberine sulfate, Berberis-Homaccord, Berberis plus);
- Rose hip extract (Holosas, Holemaks, Holos);
- Datiscanna hemp extract (Datiscan);
- Voludushka extract (Pequocrine);
- Artichoke extract (Hofitol, Holebil);
- Preparations containing a complex of herbs that have a choleretic effect (Holagol, Holagogum, Travochol, choleretic fees No. 2 and 3, Urolesan, Phytohepatol No. 2 and 3).
Hydrocholeretics
The following drugs are hydrocholeretics:- Alkaline mineral waters (Naftusya, Borjomi, Narzan, Essentuki 17, Essentuki 4, Arzni, Smirnovskaya, Slavyanovskaya, Izhevskaya, Jermuk, etc.);
- Salicylates (sodium salicylate);
- Valerian preparations ( alcohol infusion valerian, valerian tablets, Valerianahel, etc.).
Cholekinetics
The following drugs are cholekinetics: - Magnesium sulfate (Magnesia, Cormagnesin);
- Sorbitol (Sorbitol);
- Mannitol (Mannitol, Mannitol);
- Xylitol;
- Extract of leaves and roots of barberry (Berberine sulfate, Berberis-Homaccord, Berberis plus);
- Immortelle flower extract (Flamin);
- Rose hip extract (Holosas, Holemaks, Holos).
Cholespasmolytics
The following choleretic drugs are cholespasmolytics:1. Anticholinergics:
- Bellalgin;
- Belloid;
- Besalol;
- Metacin;
- Platyfillin;
- Spasmolitin;
- Fubromegan.
- Papaverine (Papaverine, Papaverine bufus, Papazole);
- Drotaverine (Bioshpa, Nora-Drotaverine, Droverin, No-Shpa, Nosh-Bra, Ple-Spa, Spazmol, Spazmonet, Spazoverin, Spakovin);
- Aminophylline (Aminophylline-Eskom, Eufillin);
- Mebeverine (Duspatalin).
- Arnica tincture;
- Valerian tincture;
- Tincture of elecampane;
- St. John's wort tincture;
- Mint tincture;
- Melissa tincture;
- Tincture of calendula flowers;
- Convaflavin (turmeric root);
- Cholagol (extracts of various herbs).
Choleretic with litholytic action
Choleretic drugs with litholytic action are as follows:1. Ursodeoxycholic or chenodeoxycholic acids - Livodexa, Urdoxa, Urso 100, Ursodez, Ursodex, Uroliv, Ursolit, Ursorom S, Ursosan, Ursofalk, Choludexan, Exchol;
2. Methyl tert-butyl ether.
Choleretic herbal preparations
Choleretic herbal preparations are presented in ready-made dosage forms (tablets, tinctures or powders for preparing a solution for oral administration) or dried crushed parts of plants that have the necessary properties.
Currently on the domestic pharmaceutical market The following choleretic herbal preparations are available in ready-made forms:
- Berberis-Homaccord;
- Berberis plus;
- Berberine sulfate;
- Datiscan;
- Insadol;
- Peridol;
- Convaflavin;
- Pequocrine;
- Sibektan;
- Solaren;
- Tanaflon;
- Tanacehol;
- Travochol;
- Urolesan;
- Febichol;
- Phytohepatol No. 2 and 3;
- Flacumin;
- Flamin;
- Holagogum;
- Holagol;
- Holebil;
- Holemaks;
- Holos;
- Holosas;
- Hofitol.
In addition, the following medicinal herbs have a choleretic effect:
- Birch buds;
- Turmeric root;
- Calamus rhizome;
- Barberry roots and leaves;
- Burdock roots;
- Dandelion roots;
- Chicory root;
- Corn silk;
- Artichoke leaves;
- Volodushka leaves;
- Nettle leaves;
- Peppermint leaves and oil;
- Orthosiphon leaves;
- Parsley leaves;
- Mackerel leaves;
- Tansy leaves and flowers;
- Fir oil;
- Terpene oil Rose hips;
- Coriander fruit;
- Rowan fruits;
- Carrot seeds;
- Horseradish root juice;
- Knotweed herb;
- Danish grass;
- Oregano herb;
- Centaury grass;
- Lily of the valley herb;
- Artemisia grass;
- Immortelle flowers;
- Cornflower flowers;
- Tatar flowers.
Have a cholekinetic effect following products and medicinal herbs:
- Calamus rhizomes;
- Dandelion roots;
- Rhubarb roots;
- Barberry leaves;
- Lingonberry leaves;
- Watch leaves;
- Coriander oil;
- Juniper oil;
- Cumin oil;
- Olive oil;
- Coriander fruit;
- Juniper fruits;
- Cumin fruits;
- Fennel fruit;
- Dog-rose fruit;
- Sunflower oil;
- Lingonberry juice;
- Knotweed herb;
- Oregano herb;
- Shepherd's purse grass;
- Thyme herb;
- Yarrow herb;
- Immortelle flowers;
- Cornflower flowers;
- Calendula flowers;
- Chamomile flowers.
Modern choleretic drugs
Modern choleretic drugs are represented by a group of synthetic choleretics and combined herbal and animal agents. Synthetic choleretics include drugs containing nicodine, hymecromone, osalmide or cyclone as active substances. Synthetic choleretics compared to natural ones (for example, Allohol, Cholenzym, Lyobil, etc.) are better tolerated, do not cause unstable stool, and also have a number of additional positive therapeutic effects, such as antispasmodic, hypolipidemic, antibacterial and anti-inflammatory.In addition, modern choleretic drugs include dehydrocholic acid (Hologon, Decholin) and ursodeoxycholic acid (Livodexa, Urdoxa, Urso 100, Ursodez, Ursodex, Uroliv, Ursorom, Ursorom S, Ursosan, Ursofalk, Choludexan, Exchol). Also modern drug Duspatalin is a cholespasmolytic.
Among the modern choleretic plant and animal preparations are the following:
- Berberis-Homaccord;
- Vigeratin;
- Insadol;
- Convaflavin;
- Pequocrine;
- Peridol;
- Sibektan;
- Solaren;
- Tanacehol;
- Tanaflon;
- Urolesan N;
- Febichol;
- Holagogum;
- Holagol;
- Holaflux;
- Holosas.
Choleretic drugs - indications for use
A general indication for the use of choleretic drugs is pathology of the gallbladder, biliary tract or liver. However, to select the optimal drug, it is necessary to know the indications for use of each group of choleretic drugs. Within the groups there are slight differences between the drugs, which, however, do not affect their indications for use, which remain the same. Thus, for clinical orientation in choleretic drugs, it is necessary to know the indications for use of each classification group, which we will consider below.Choleretics
Indications for the use of choleretics are the same for all three subgroups of this group of choleretic drugs. This means that synthetic choleretics (for example, Tsikvalon, Nicodin, Oksafenamide, etc.), and drugs containing components of natural bile (for example, Allohol, Lyobil, Decholin, Cholenzym, Hologon, etc.), and herbal products (for example, Convaflavin, Holosas, Flacumin, etc.) have the same indications for use. So, choleretics are indicated for use in the following conditions or diseases: - Chronic inflammatory liver diseases (for example, hepatitis, steatosis, etc.);
- Chronic inflammatory diseases of the biliary tract (cholangitis, cholecystitis, etc.);
- Habitual constipation caused by impaired bile flow.
In addition, in case of insufficient bile secretion, choleretics containing components of natural animal bile can be used as replacement therapy drugs.
Among choleretics, the most “harsh” are drugs containing bile components, so they are the worst tolerated and often provoke stool disorders. Synthetic choleretics have a milder effect, but in terms of the range of positive therapeutic effects they are significantly inferior to drugs containing bile components. In addition, synthetic choleretics do not improve the properties of bile, like natural preparations and products containing medicinal herbs. But synthetic choleretics, in addition to choleretic, have the following therapeutic effects:
- Antispasmodic effect (eliminate spasm and pain in the biliary tract) is expressed in osalmide and hymecromone;
- Lipid-lowering effect (reduce the concentration of cholesterol in the blood due to its removal from the body) expressed in osalmide;
- Antibacterial effect expressed in nicodine;
- Anti-inflammatory effect expressed in cyclone;
- Suppression of rotting and fermentation in the intestines - the effect is pronounced in nicodine.
Plant choleretics have a milder effect compared to synthetic and natural preparations containing bile components. In addition, they have a complex positive effect on the organs gall bladder, ducts and liver, due to which their very high efficiency is achieved. That is why at present, in the absence of allergies or intolerance to herbal components, it is recommended to use preparations containing herbal components as choleretics.
Hydrocholeretics
Indications for the use of hydrocholeretics, in principle, do not differ from those for choleretics. However, drugs in this group are almost never used independently. They are usually used in combination with other choleretic agents, mainly choleretics and cholekinetics, to enhance the therapeutic effect.Cholekinetics
Indications for the use of cholekinetics are as follows:- Hypotonic biliary dyskinesia;
- Atony of the gallbladder with stagnation of bile in combination with dyskinesia;
- Chronic cholecystitis;
- Chronic hepatitis;
- Gastritis with low or zero acidity (hypoacid or anacid) of gastric juice;
- Preparation for duodenal intubation.
Cholespasmolytics
Indications for the use of cholespasmolytics are as follows: - Hyperkinetic biliary dyskinesia;
- Moderate pain syndrome accompanying diseases of the biliary tract and gallbladder.
Indications for the use of choleretic drugs with litholytic action
Indications for the use of choleretic drugs with litholytic action are as follows:- Dissolving small stones in the gall bladder and preventing the formation of new ones;
- Dissolution of stone fragments formed after the ultrasonic crushing procedure;
- Complex treatment of cholelithiasis;
- Reflux gastritis or reflux esophagitis, provoked by the reflux of bile acids into the stomach or esophagus;
- Acute hepatitis;
- Toxic damage to the liver from poisons, alcohol, drugs, etc.;
- Compensated biliary cirrhosis of the liver;
- Primary cholangitis;
- Atresia intrahepatic biliary tract;
- Stagnation of bile due to parenteral nutrition;
- Biliary dyskinesia;
- Complex treatment of chronic opisthorchiasis;
- Prevention of liver damage during the use of cytostatics or oral contraceptives.
Taking choleretic drugs - brief instructions
All choleretic drugs, regardless of the form of release, must be taken 20 - 30 minutes before meals. Moreover, the total daily dosage is divided equally into 3 to 5 doses, depending on how many times a day a person eats. It is recommended to take choleretic drugs before each meal. Medicines must be taken with sufficient quantity water and be sure to eat something half an hour after taking it. If a person does not eat something after taking a choleretic drug, he will experience nausea, diarrhea and general health will worsen.Typically, choleretic drugs are taken in long-term (up to 3-8 weeks) courses 2-4 times a year, with intervals of at least 1-2 months between them. Such courses of use of choleretic drugs are preventive and should be carried out for the entire period of time while the disease persists. In case of exacerbation of diseases of the biliary tract, liver and gallbladder, choleretic drugs are used as part of complex therapy in large dosages.
Ursodeoxycholic acid preparations for the treatment of reflux gastritis and reflux esophagitis, as well as the dissolution of gallstones, must be taken continuously for 6 to 8 months.
Choleretic drugs for children
The following choleretic drugs can be used in children:- Choleretics containing components of natural bile - Allochol;
- Synthetic choleretics - Nicodin, Oksafenamide, Osalmid;
- Choleretics containing medicinal herbs - Flamin, Febichol, Holosas, Holemaks, Holos, Chofitol;
- Cholekinetics - Valerian, Valerianahel, Magnesia, Cormagnesin, magnesium sulfate;
- Anticholinergics (cholespasmolytics) - Atropine, Metacin, Platiphylline, Papaverine, Papazol, Drotaverine, No-Shpa, Bioshpa, Nora-Drotaverine, Nosh-Bra, Ple-Spa, Spasmol, Spasmonet, Spazoverine, Spakovin Eufillin.
In addition, children can drink alkaline mineral water(Borjomi, Essentuki 17, Essentuki 4, Jermuk, Slavyanovskaya, etc.) as natural hydrocholeretics. It is recommended not to use medicinal herbs with a choleretic effect in children under 12 years of age, since the prepared infusions and decoctions contain a wide range of active substances and it is simply impossible to predict the child’s body’s reaction to all of them.
Choleretic drugs during pregnancy
Pregnant women can take only those choleretic drugs that do not provoke contractile activity of the uterus and do not penetrate through the placenta to the fetus, and also do not cause a significant deterioration in the condition. The following choleretic drugs are completely safe during pregnancy: - Holenzyme;
- Holosas;
- Holemaks;
- Holos;
- Valerian;
- Magnesia (magnesium sulfate);
- Cormagnesin;
- Atropine;
- Metacin;
- Papaverine (Papazole);
- Drotaverine (No-Shpa, Bioshpa, Nora-Drotaverine, Nosh-Bra, Ple-Spa, Spazmol, Spazmonet, Spazoverin, Spakovin).
- Odeston;
- Holonerton;
- Cholestil;
- Flamin;
- Febichol;
- Berberis-Gommacord;
- Chophytol;
- Eufillin.
Dosages, rules of administration and duration of therapy with choleretic drugs in pregnant women are exactly the same as usual.
The use of choleretic drugs for certain diseases
Biliary dyskinesia (BID)
The selection of drugs depends on the form of biliary dyskinesia. Yes, when hypertensive type biliary dyskinesia
(ZhVP) the following choleretic drugs are indicated: - Cholespasmolytics of any type (for example, No-Shpa, Papaverine, Platyfillin, Metacin, Duspatalin, Odeston, etc.), which reduce pain;
- Cholekinetics (for example, Magnesia, Cormagnesin, Berberine-Gommacord, Holosas, Holemaks, Holos, Sorbitol, Mannitol, Flamin, etc.).
With dyskinesia of the gallbladder of the hypotonic type The following choleretic drugs are indicated:
- Any choleretics (for example, Allohol, Lyobil, Nikodin, Tsikvalon, Holagogum, Holagol, Flacumin, Convaflavin, Febichol, Sibektan, Tanacechol, etc.);
- Hydrocholeretics (alkaline mineral waters, etc.);
- Antispasmodics of myotropic action (Duspatalin, Odeston).
Choleretic drugs for bile stagnation
In this case, to eliminate congestion, the most effective and optimal are the choleretic group of cholekinetics, for example, Cormagnesin, Berberine-Gommacord, Holosas, Mannitol, Flamin, etc.Cholecystitis
Choleretic drugs for cholecystitis they are used at any stage of the disease. In the presence of gallstones in cholecystitis, only products containing ursodeoxycholic acid as an active substance can be used as choleretic drugs (for example, Livodex, Urdox, Urso 100, Ursodez, Ursodex, Uroliv, Ursolite, Ursorom S, Ursosan, Ursofalk, Choludexan , Exhol). For non-stone cholecystitis, it is necessary to take choleretics from any group. Among synthetic choleretics, the optimal ones are choleretic ones containing oxafenamide and hymecromone or cyclovalone as active substances. When using oxafenamide or hymecromone, there is no need to additionally take cholespasmolytics (No-Shpa, Papaverine, etc.), since these synthetic choleretics have an antispasmodic effect. And while using cyclovalone, you do not need to take additional antibacterial drugs, since this choleretic has a pronounced antimicrobial effect. When using choleretics containing bile components or medicinal herbs (for example, Allochol, Liobil, Sibektan, Tanacechol, etc.), it is necessary to additionally take cholespasmolytics or antibacterial drugs.
In addition to any choleretics for non-stone cholecystitis, it is necessary to take cholekinetics (Magnesia, Cormagnesin, Berberine-Gommacord, Holosas, Holemaks, Holos, Sorbitol, Mannitol, Flamin, etc.), which will facilitate the release of bile into the duodenum from the gallbladder.
There are very few negative reviews about choleretic drugs and they are usually due to the ineffectiveness of a particular drug in this particular case. The lack of a clinical effect causes disappointment in a person, from which he concludes that the drug is ineffective and leaves it negative feedback.
However, choleretic drugs are very effective if taken correctly and as directed, taking into account the properties of each drug. Therefore, a negative review of a drug is not a reflection of its ineffectiveness, but of the wrong choice of drug.
Choleretic drugs - prices
Prices for choleretic drugs are very variable and range from 50 to 500 rubles per pack. The cost of the drug depends on the manufacturer (imported drugs are more expensive than domestic ones) and its composition. The cheapest are preparations containing components of natural bile and medicinal herbs. The most expensive are synthetic choleretics, cholespasmolytics and ursodeoxycholic acid preparations. That is, there are groups of drugs with relatively expensive and cheap prices. However, since in each specific case choleretic drugs from a certain group are indicated, it is impossible to replace them with drugs from another, cheaper classification subgroup. You can only choose the cheapest drug from the same group. This principle of replaceability should always be used when choosing a choleretic drug.Preparation of choleretic Marco Polo salad - video
Before use, you should consult a specialist.Choleretic Agents
Substances that help increase the release of bile into the duodenum are called choleretic. An increase in bile output may be due to the following reasons:
1) increasing the formation of bile in the liver and increasing its enzymatic activity. This is how essential oils, allohol, corn silk, and immortelle flowers work. These drugs have a stimulating effect on liver cells and neurohumoral regulation bile formation;
2) restoration of the tone of the bile ducts and gallbladder, and therefore the excretion of bile into the intestines increases. This is how antispasmodics (atropine, papaverine, etc.), Carlsbad salt, and magnesium sulfate act. The effect of substances of this type is reduced to mechanical facilitation of the movement of bile along the excretory tract;
3) the anti-inflammatory effect of chemotherapeutic and antiseptic agents, which also help restore the functioning of the liver and bile ducts and increase bile secretion.
Bile formation is regulated by the central nervous system and autonomic innervation. Substances that stimulate the central nervous system nervous system And parasympathetic innervation, increase bile formation, and substances that depress the central nervous system and stimulate sympathetic innervation reduce bile secretion. Anticholinergic substances inhibit bile formation, but by relaxing the muscle tone of the biliary tract and sphincter, they facilitate the excretion of bile. Substances that relax smooth muscle spasms also act: magnesium sulfate, Carlsbad salt. Sulfates entering the duodenum irritate its receptors and cause the so-called bladder reflex - contraction of the gallbladder and increased peristalsis of the biliary tract. Magnesium sulfate and sodium sulfate also increase bile formation.
Bile itself, bile acids and their salts, acting on the duodenum, reflexively enhance bile formation. Hydrochloric acid, many hormones and enzymes stimulate the formation of bile. To enhance the excretion of bile, substances that dilute bile are used: sodium bicarbonate, sabur, alkaline mineral waters. Many choleretic agents act in combination. Choleretic drugs are used for diseases of the liver and biliary tract.
Allohol - Allocholum. Tablets containing dried animal bile (0.08 g), dry garlic extract (0.04 g), dry nettle extract (0.005 g) and Activated carbon(0.025 g). Available in tablets of 0.3 g.
Action. Allochol stimulates the secretory activity of the liver, increases the tone of the bile ducts, revitalizes secretion and intestinal motility, and has an anti-fermentation and anti-putrefactive effect in the gastrointestinal canal.
Used for chronic inflammation of the liver, biliary tract and gallbladder.
Oral doses: dogs - 1-2 tablets, cats - 0.25-0.5 tablets. Prescribed 3 times a day after feeding.
Dehydrocholic acid - Acidum dehydrocholicum. White crystalline powder with a bitter taste. Slightly soluble in water, soluble in alcohol. Available in tablets of 0.2 g.
Action. Belongs to the group of bile acids that stimulate the production of bile by liver cells.
Used for chronic inflammation liver, bile ducts and gallbladder. Contraindicated for use in acute and subacute liver dystrophies.
Oral doses (g): horses - 3-6, pigs - 1-3, dogs - 0.2-2.0. Prescribed 3 times a day.
Corn Silk - Stigmata Maydis. Corn stalks with silks collected during the ripening period of corn cobs. Stigmas contain stigmasterol, systosterol, essential oil, vitamins C and K.
Action. Corn silk increases the secretion of bile, reduces its viscosity, stimulates contractions of the gallbladder, enhances blood clotting and has a diuretic effect.
Used as a choleretic and diuretic for inflammation of the liver, gall bladder, and bile ducts. As a choleretic, diuretic and lactic agent, it is good to use corn silage, harvested during the milky ripeness of corn cobs, for large and small animals. Dried corn silks are used in the form of an infusion of 1:10 or 1:20.
Oral doses (g): horses - 30-60, sheep and pigs - 20-40, dogs - 10-20. Prescribed 3 times a day in the form of infusion or collection with food.
Cholenzym - Cholenzymum. Tablets containing dry bile (1 part), dried powders of the pancreas and intestines of slaughter cattle (1 part each).
It acts and is used as a choleretic agent for inflammation of the liver, biliary tract and gall bladder. Also prescribed for inflammation of the stomach and intestines.
Dose: dogs - 0.5-1 tablet 2-3 times a day.
Sandy immortelle flowers - Flores Helichrysi arenarii. The baskets of wild immortelle (Cmina) collected before the flowers bloom contain flavonoids, glycosides, essential oil, vitamins K and C, and carotene.
Action. They stimulate the liver, increase bile formation, increase the tone of the gallbladder and bile ducts, and increase the secretory function of the stomach and pancreas.
Used as a choleretic agent for diseases of the liver, gall bladder and bile ducts. Prescribed in the form of collection, infusion and extract.
Doses (g): large cattle 15-40, pigs - 2-5, dogs 0.5-1. Prescribed 2-3 times a day.
Hepatitis is a diffuse inflammation of the liver, accompanied by hyperemia, cellular infiltration, dystrophy, necrosis and lysis of hepatocytes and other structural elements, and severe liver failure.
In dogs and cats, acute parenchymal hepatitis is more often observed, occurring with inflammation of the organ parenchyma.
To hepatitis infectious origin include viral hepatitis, canine distemper, parvovirus enteritis, leptospirosis, listeriosis, colibacillosis, salmonellosis, panleukopenia, infectious anemia cats, etc.
Chronic hepatitis is often a consequence of acute hepatitis.
Symptoms Hepatitis mainly occurs after any infectious or invasive disease, so its symptoms consist of signs of the underlying disease.
General symptoms include: depression, decreased or loss of appetite, thirst, vomiting, increased body temperature to 40...42C, increased liver volume, its pain on palpation. The syndrome of parenchymal jaundice is clearly manifested: dyspeptic disorders, itching of the skin, scratching, intense yellow discoloration of the mucous membranes and non-pigmented areas of the skin, increased levels of bilirubin (free) in the blood.
Syndrome is noted liver failure, manifested by a violation of the most important functions of the body - indigestion, poor absorption of fat, increased bleeding, general intoxication, severe depression, loss of fatness, exhaustion. Hepatitis is accompanied by an enlarged spleen.
The albumin content in the blood decreases and the amount of alpha and beta globulins, the concentration of ammonia, cholesterol, transaminase activity increases, and the activity of cholinesterase decreases. Urine with hepatitis is dark in color. In young animals, frequent signs of infectious hepatitis are: conjunctivitis, rickets, diarrhea, enlarged tonsils. Keratitis is recorded in one right or both eyes. Convulsions and paralysis of the limbs are common.
Diagnosis. Anamnesis data, results of clinical and laboratory tests are taken into account. It is necessary to exclude liver cirrhosis, hepatosis, cholecystitis. In all cases, the possible etiological factor is taken into account. Liver cirrhosis occurs chronically without fever. Acute hepatitis differs from hepatosis in etiology, severity, and temperature reaction.
Treatment.
1. Eliminate primary cause. For invasive or infectious diseases carry out etiotropic therapy.
2. Dietary feeding is prescribed. At the same time, the age and breed characteristics of the animal are taken into account.
excluded from the diet fatty foods and sugar. At the beginning of treatment, fasting for 24 hours is useful. free access to water or rehydration solutions. It is advisable to add decoctions and infusions of herbs to a bowl of water - marshmallow root, string, sage leaves, oregano, cinquefoil, yarrow, chamomile, licorice, St. John's wort, blueberries, bird cherry, etc. All of these plants have different therapeutic effects on the liver and digestive organs. In addition to water, in the first days of treatment, it is useful for dogs and cats to be prescribed meat and fish lean broths.
On the 2-4th day of treatment, rice, rolled oats or semolina porridge, rice water. Add a small amount of boiled chicken or ground beef to the porridge (1-2 tablespoons per serving). If the animal does not experience digestive upset in the form of vomiting and diarrhea after such feeding, then the dose of food is gradually increased.
On the 3-5th day of treatment, fresh warm low-fat lactic acid products are added to the specified diet in small quantities: kefir, yogurt, milk, cottage cheese, milk formula, acidophilus or acidophilus milk.
On the 6th-9th day, boiled finely chopped vegetables are introduced into the diet - carrots, cabbage, potatoes. Starting from the 10th day successful treatment, the animals are transferred to a normal diet.
3. To relieve intoxication of the body and improve the functioning of the liver, injections into the blood of antitoxic substances and liquids are useful - isotonic sodium chloride solution, 5-10% glucose solution or its mixture with 0.9% sodium chloride solution in an amount of 100-2000 ml by drop method. For cats, these solutions are often administered subcutaneously. Solutions of Ringer, Ringer-Locke, “acesol”, “disol”, “trisol”, “chlosol”, “sanasol”, etc. are also widely used.
4; To replenish protein and sugar in the patient's body and in case of blood loss, plasma substitutes are effective - hemodez, gelatinol, polyglucin and reopolyglucin, enterodes, polyamine, hydrolysin, casein hydrolysate, etc.
5. When pain syndrome, and to normalize body temperature, painkillers and sedatives are prescribed. These are belladonna (belladonna) preparations - becarbon, bellalgin, bellastesin, besalol, etc. For the same purpose, animals are given almagel, gastrofarm, 1-2% solutions of novocaine, salicylates and drugs from the analgin group.
6. To improve metabolism in liver cells, drugs - hepatoprotectors - are used. These include: legalon, which is administered orally after meals, 1 tablet 3 times a day, Liv-52 - 1-2 tablets 3 times a day, silybor 1-2 tablets 3 times a day, Essentiale forte - 3 times a day daily 1-2 capsules, sirepar intramuscularly or intravenously 2-3 ml 1 time per day, as well as glucose and vitamins B1, B2, B6, B12, ascorbic and nicotinic (rec. 180) acids, vitohepat, lipoic acid, retinol and tocopherol. good medicinal properties has panzinorm forte - 1 tablet 3 times a day during feeding. The course of treatment with vitamins and multivitamins is 15-30 days.
7. In case of toxic hepatitis with symptoms of gastroenteritis and intoxication, the stomach is washed warm water or water with the addition of potassium permanganate (1: 10000) or furatsilin (1: 5000), give enemas with disinfectants or with decoctions of medicinal herbs.
8. As a means of disinfecting the bile ducts, increasing the secretion of bile, hexa-methylenetetramine (rec. 183) is used orally at 40 mg/kg or intravenously 20 mg/kg, and cholagon (rec. 181) and decholine are prescribed orally at 6 doses -12 mg/kg, corn silk 60-120 mg per 1 kg of body weight 3-4 times a day, magnesia sulfuric acid, allochol (rec. 785), etc.
9. For hepatitis of infectious etiology, antibiotics and sulfonamides are prescribed. Their use is described in detail in the section “treatment of gastroenteritis”.
10. In case of poisoning with heavy metals, a 5% solution of uitiol (rec. 786) is administered intramuscularly at the rate of 5 mg/kg of animal weight, sodium thiosulfate 20-30 mg/kg in the form of a 30% solution is administered intravenously.
11. The use of anti-inflammatory and immunosuppressive drugs (hydrocortisone, prednisolone, delagin, diphenhydramine, pipolfen, immunoglobulin, etc.) is limited.
Prevention. Conduct general and special events to prevent the occurrence of infectious and invasive diseases, carry out their timely treatment.
It is necessary to prevent feeding toxic, spoiled feed to animals. Diets should be balanced in proteins, carbohydrates, fats, vitamins and minerals. Unreasonable use of drugs that have a toxic effect on the liver should be avoided.
CIRRHOSIS OF THE LIVER
A chronic process accompanied by structural changes organ, replacing its parenchymal elements with connective tissue. It occurs quite often in dogs.
Etiology. Primary cirrhosis for the most part are a consequence of a lack of pyridoxine, selenium and other trace elements, chronic intoxications body with toxic substances contained in food. Long-term hepatitis, hepatosis, cholangitis and cholecystitis can lead to cirrhosis.
Symptoms They develop gradually. For quite a long time, changes in appetite and catarrhal conditions in the stomach and intestines have been noted. In severe forms of the disease, depression and inactivity are characteristic. Hemorrhages appear on the conjunctiva, mucous membrane of the mouth, and nose. on the skin. Abdominal dropsy develops, in which the abdominal area changes due to the accumulation of fluid in the abdominal cavity. With hypertrophic cirrhosis, the liver becomes enlarged and can be palpated on the right side behind the left rib. Percussion reveals areas of dullness on both sides (Fig. 13).
Rice. 13. Displacement of the border of the liver during cirrhosis in dogs
With atrophic cirrhosis, a pear-shaped abdomen is often observed due to the accumulation of transudate in the abdominal cavity.
In hypertrophic and atrophic cirrhosis, signs of mild mechanical or parenchymal jaundice are quite often observed: slight staining yellow sclera, sometimes mucous membranes, urine; blood serum gives a direct reaction to bilirubin, the content of albumin and fibrinogen in the blood decreases significantly and the amount of globulins increases.
The course of the disease is long, up to several months and even years.
Diagnosis. It is based on changes in the boundaries of the liver and spleen, the presence of jaundice, hemorrhages, and the appearance of ascites. A constant sign is urobilinuria. The prognosis is unfavorable, since the disease is accompanied by irreversible processes.
Treatment. First of all, the causes that contributed to the appearance of cirrhosis are eliminated. In secondary cirrhosis, treatment is aimed at the underlying disease.
The diet should consist of easily digestible foods with plenty of proteins and vitamins. The patient is prescribed vegetable dishes, fruits, low-fat lactic acid products, lean meat, rice and oatmeal porridges, decoctions and infusions of medicinal herbs (peppermint, St. John's wort, sage, chamomile, rose hips, calendula, wormwood, etc.).
Drug therapy for late stages the disease is ineffective.
1. Symptomatic treatment is aimed at prolonging the life of the animal and consists of prescribing hepatoprotectors: bilignin 5-10 g, legalon 1 tablet 3 times a day; Liv-52, silybor, essentiale forte, sirepara 1-3 ml once a day intramuscularly or intravenously, panzinorm forte. These medicinal substances are used for a long time (a month or more).
2. Choleretic agents are widely used, such as allochol, berberine bisulfate, sandy immortelle flowers, zixorin, convaflavin, corn silk, nicodin, choleretic collection, flamin, holagol, cholenzym, holosas and others according to the instructions.
3. For ascites, a needle is inserted into the abdominal cavity and fluid is released from it.
4. The prescription of diuretics is indicated - diacarb, diuretic collection, bearberry decoction, furosemide, Lasix, etc. and cardiotonic drugs - cordiamine, corazol, camphor, sulfocamphocaine, etc. (see treatment of myocardosis).
5. In veterinary practice, vitamins A, D, E, groups B and C, as well as multivitamin preparations are always used to treat liver cirrhosis.
ABDOMINAL HYDROSE (ASCITES)
A chronic secondary disease associated with difficulty in resorption of peritoneal fluid into the blood and lymph circulation system and the accumulation of this fluid in the abdominal cavity.
Etiology. The reason for the accumulation of a large volume of transudate in the abdominal cavity is its weak outflow. Difficulties in outflow may depend on the state of the portal (hepatic) circulation, insufficiency of the heart, kidneys, and hydremia.
All liver diseases, during which its volume changes, the tension of the capsule, and the function is sharply upset, for example, cirrhosis, cancer, echinococcosis, can lead to stagnation of blood in the portal vein system and a decrease in the absorption of fluid from the abdominal cavity. Similar consequences are caused by stagnation in big circle blood circulation arising from diseases of the heart, lungs, and improper metabolism. Abdominal dropsy is often a local manifestation of edematous disease.
Symptoms Upon external examination, symmetrical bilateral protrusion of the lower and lateral parts is noticeable abdominal wall, labored breathing, fast fatiguability, emaciation, swelling of the lower parts of the body. Dogs are reluctant to change position, lie down or sit. Their body temperature is normal, the mucous membranes are pale. The appearance of jaundice is an unfavorable sign. When palpating the abdominal walls, fluid fluctuations are felt. Bowel sounds are often weakened. Dullness is determined by percussion, and with a test puncture of the abdominal wall it leaks clear liquid straw-yellow in color with a small protein content.
The course of ascites is chronic, severe, the disease lasts for months and even years. When jaundice and edema appear, the outcome of the disease is unfavorable.
The diagnosis is made on the basis of the chronic course of the disease at normal temperature, with the accumulation of fluid in the abdominal cavity with a density below 1.011-1.015, poor in protein (up to 2%).
Treatment. It consists of maintaining the body’s strength and alleviating the course of the underlying disease. Feeds rich in protein are introduced into the diet, watering is limited and the dacha is reduced table salt.
It is advisable to prescribe cardiac medications, mainly digitalis and lily of the valley preparations, as well as diuretics. To reduce the permeability of vascular walls, intravenous administration of calcium chloride and gluconate is indicated.
In parallel with drug therapy, transudate is released once every 3-4 days by puncturing the abdominal cavity (in dogs, no more than 0.1-2 liters).
In some cases, improvement in the general condition of the dog can be achieved surgery(suturing the omentum to the peritoneum).
DIABETES
The disease is caused by an absolute or relative deficiency of insulin and a violation of all types of metabolism, primarily carbohydrate.
Etiology. In recent years, scientists have identified several groups of factors that cause diabetes - genetic, viral infection (viral hepatitis, plague, parvovirus infection), autoimmune disorders, structural diseases of the pancreas (acute and chronic pancreatitis), cytotoxic substances.
Symptoms Clinical symptoms very diverse. These include the appearance of thirst, frequent, excessive urination, weakness, skin itching, sexual dysfunction, decreased or increased appetite. The skin becomes dry and less elastic. The animal is losing weight. Furunculosis appears. Possible enlargement of the liver, expansion of the borders of the heart to the left, dullness of tones, systolic murmur. Chronic gastritis and enteropathy develop.
Pathology of the urinary system is characterized by cystitis, pyelitis, pyelonephritis. Pathology of the visual organs in dogs is manifested by iritis, iridocyclitis, cataracts and myopia.
Laboratory blood tests show signs of anemia, hyperglycemia, hypoalbuminemia, hypergammaglobulinemia, hypercholesterolemia, and sometimes increased urea and creatinine levels.
In the urine - high density, glucosuria, often acetone, sometimes microhematuria, proteinuria, cylindruria.
Diagnosis on diabetes diagnosed on the basis of polyuria, polydipsia, bulimia, hyperglycemia and glycosuria with simultaneous exhaustion. The glucose content in the blood of diabetic patients reaches more than 100-150 mg per 100 g, in urine - up to 5-10% or more.
Treatment. 1. Diet therapy. Lean boiled meat (poultry, beef, horse meat), fish and meat broths, vitamins and multivitamins are prescribed. Sweets are excluded from the diet, White bread, confectionery and oatmeal. Limit the amount of fat in feed.
2. Drug therapy includes various pancreatic preparations and synthetic hypoglycemic drugs (antidiabetic drugs): Adebit, Bucarban, Glyurenorm, Glucophage, insulin 1-5 units/kg of animal weight subcutaneously, Maninil, Oranil, Predian, chlorpropamide.
3. To normalize lipid metabolism in the body - lipostabil forte 1-2 capsules 2 times a day, lipocaine.
4. If the acid-base state is disturbed, with acidosis of various etiologies, dimephosphone is used at the rate of 1 ml/5 kg of animal weight 3-4 times a day.
5. To improve pancreatic function, pancreatin and panzinorm forte are widely prescribed.
Medicinal substances of plant and synthetic origin that increase the secretion of bile and promote its release into the duodenum are called choleretic. In combination with others medicines they are used to treat diseases of the liver, gall bladder and biliary tract, in which exocrine function liver. This leads to disruption motor function alimentary canal, absorption of food and a number of medicinal substances, metabolism of proteins and phosphorus compounds. Stagnation of bile and inhibition of the synthesis of bile acids can lead to the precipitation of cholesterol and the subsequent formation of gallstones.
Bile contains a specific pigment, bilirubin, bile acids (glycocholic, tacrocholic, etc.), cholesterol, lecithin, mucin and inorganic salts. Of main importance for digestive processes are bile acids, which are the product of a combination of cholic acid with glycine and taurine. Bile is an essential component of normal digestion, ensuring the emulsification of fats and the absorption of lipophilic substances from the intestine into the blood. It is necessary for the absorption of fat-soluble vitamins and the excretion of some exogenous drugs and some hormones (estrogens).
Bile released into the lumen of the duodenum is a normal stimulator of bile formation in liver cells. Hydrochloric acid, ACTH, insulin and other hormones and enzymes also have a stimulating effect on bile formation. The liver regulates the removal of cholesterol from the blood and is one of the main organs for neutralizing various chemical agents and removing them from the blood along with bile.
The release of bile from the common bile duct and gallbladder into the lumen of the duodenum occurs periodically, usually simultaneously with pancreatic juice. On its way, bile overcomes the barrier of the sphincter of Oddi. When the mucous membrane of the gallbladder and common duct is inflamed, if there are stones in them, the sphincter of Oddi contracts spasmodically and bile is not allowed to pass into the intestines. This leads to stagnation of bile in the gallbladder and bile ducts. In these cases, it is necessary to take medications that cause relaxation of the sphincter of Oddi muscles, ducts and gallbladder.
Bile secretion is regulated by cholinergic and adrenergic nerves under the general influence of the central nervous system. Substances that excite the central nervous system (small doses), cholinomimetic agents increase bile formation; substances that depress the central nervous system and adrenergic agonists reduce bile secretion.
Anticholinergics inhibit bile formation, but relax muscle tone and the sphincter of Oddi and thereby facilitate the excretion of bile. Antispasmodics act similarly: magnesium sulfate and other substances. Lack of bile may be associated with a violation of its formation in liver cells or with difficulty in exiting the bile ducts and gallbladder into the duodenum. Therefore, from a practical point of view, two series of choleretic agents are of interest:
1) drugs that stimulate the formation of bile - choleretics. These include dihydrocholic acid, decholine, allochol, holosas, cholenzyme, corn silk, choleretic tea, essential oils, immortelle flowers, nicotinic acid, chloral hydrate, etc. Drugs that increase the amount of the liquid part of bile include subar, hydrochloric acid, salicylates, etc., and drugs that enhance the antimicrobial effect of bile include iodine, sulfonamides, antibiotics, etc.;
2) agents that promote the release of bile into the intestines Scholekinetics - berberine bisulfate, holagol, atropine sulfate, papaverine hydrochloride, Carlsbad salt, etc. This group also includes substances (choline, thioline, vikasol, vitamin K, etc.) that improve the release of bile as a result of anti-inflammatory action. Such a division of choleretic drugs is not always possible, since a number of drugs have choleretic, cholekinetic and cholespasmotic properties. Most choleretic agents act in combination, increasing the secretion of bile and facilitating its entry into the intestines.
Dehydrocholic acid. White or slightly yellowish light crystalline powder, odorless, bitter taste. Slightly soluble in water, but miscible with alcohol. Stimulates bile production and enhances diuresis.
Prescribed orally for cholangitis, chronic cholecystitis, hepatitis 3 times a day after feeding. The course of treatment is several days. Like other choleretic drugs, the drug is contraindicated in acute and subacute liver dystrophies, obstructive jaundice.
Allohol. Film-coated tablets containing bile and activated charcoal. Strengthens the secretory function of the liver, activates the secretory and motor functions of the stomach and intestines, weakens the processes of fermentation and putrefaction.
Used for acute and chronic diseases of the liver and bile ducts, for constipation caused by intestinal atony. Course of treatment: several weeks.
Cholenzym tablets are white film-coated tablets. Contains dried bile, pancreas and small intestinal mucosa. They have choleretic activity and improve digestion due to the presence of trypsin and amylase.
Used as a choleretic agent for diseases gastrointestinal tract: gastritis, etc.
For calves, the approximate dose orally is 1 tablet 1-2 times a day after feeding.
Nikodin. White crystalline powder, soluble in water. It has choleretic and bactericidal effects, as well as the properties of vitamin PP. Positively affects liver function. Particularly effective in combination with inflammatory diseases. If necessary, prescribed along with antibiotics.
Herbal medicine and herbal choleretic drugs in particular have proven themselves to be effective as choleretic agents.
Sandy immortelle flowers. Collected and dried flower baskets with the upper (1-2 cm long) parts of the stems of wild perennial plant sandy immortelle. The inflorescences of the plant contain flavones, tannins, essential oils, bitters, vitamins K and E, etc.
Used as a choleretic agent for acute and chronic diseases of the liver, gall bladder and bile ducts in the form of infusion, extract and collection. An infusion of flowers (1:20) is administered orally to calves 1/3 cup 2-3 times a day 15-30 minutes before feeding.
Flamin. Dry immortelle concentrate. Yellow powder, difficult to dissolve in cold water, easily soluble in hot water. Calves are prescribed 1/2 tablet (0.025 g) 3 times a day 30 minutes before feeding. Course 10-40 days.
Corn silks (corn stalks). The silks collected during the ripening period of corn cobs contain synestrol, stigmasterol, essential oil, bitter glycosidic substances, saponin, ascorbic and pantothenic acids, vitamin K, etc.
They have choleretic and diuretic effects. The infusion is used for cholecystitis, hepatitis, especially in cases of delayed bile secretion, for kidney stones and edema of cardiac origin. In this case, there is an increase in bile secretion, a decrease in its viscosity and specific gravity, a decrease in bilirubin content, and an increase in diuresis. At the same time, the content of prothrombin in the blood increases, which leads to an acceleration of blood clotting.
The group of choleretic drugs also includes tablets "Liobil", convaflavn, berberine bisulfate, tansy inflorescences, inflorescences cat's paw, holosas, holagol.
Loading...