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Currently choleretic drugs in the complex treatment and prevention of various diseases of the liver and gallbladder, they are widely used in the clinical practice of the therapist-gastroenterologist. This is due to the effects of choleretic drugs, which relieve pain attacks, facilitate the course of the disease, and also prevent the deterioration of the condition or the appearance new pathology, provoked by the decompensation of an existing disorder.
To understand why choleretic drugs are needed, you should know what bile is, what are it physiological functions and how it moves in the digestive system. Bile is biological fluid produced by liver cells and accumulates in gallbladder... The liquid has a bitter taste, a specific odor and, depending on the age of production, can be colored yellow, brown or greenish. Bile performs the following physiological functions in the human body:
- Emulsification and digestion of fats from food;
- Activation of enzymes of the small intestine and pancreas necessary for complete digestion of food;
- Provides full 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 elimination 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 temporary storage of bile from the moment it is produced until the food lump enters the duodenum.
Classification of choleretic drugs
Currently, an anatomical-therapeutic-chemical classification of choleretic agents is used, which takes into account both the chemical structure of the drug used and its therapeutic effects, and the anatomical structures affected by the drug. Such an integrated approach makes it possible 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 the production of bile by liver cells):
True choleretics that increase the production of bile due to the active synthesis of bile acids:
- Choleretics containing bile acids and made on the basis of plant or animal raw materials (for example, animal bile, plant extracts, etc.);
- Synthetic choleretics, which are chemicals obtained by organic synthesis and having the property of increasing the production of bile;
- Medicinal herbs with choleretic effect (used in the form of infusions, decoctions, etc.).
2. Cholekinetics(means that improve the outflow of bile by increasing the tone of the gallbladder and at the same time relaxing the bile ducts).
3. Cholespasmolytics (means that improve the outflow of bile by relaxing the muscles of the gallbladder and biliary tract):
- Anticholinergics;
- Synthetic antispasmodics;
- Plant-based antispasmodics.
- Preparations containing bile acids - ursodeoxycholic or chenodeoxycholic;
- Preparations containing highly active solvents of organic compounds of a lipid nature, for example, methyl tertiary butyl ether.
Synthetic choleretics are drugs in which as active substances only compounds obtained in the course of organic synthesis are included. Drugs of this group, in addition to choleretic action, 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 (suppress the inflammation present 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 phenomena of dyspepsia.
Medicinal herbs with choleretic action improve liver function, increase the secretion of bile, while reducing its viscosity. Also herbs 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 are also capable of anti-inflammatory, antimicrobial and diuretic effects. Due to the content of only various herbs as active substances, the preparations of this group are often called herbal choleretic agents.
Hydrocholeretics increase the volume of bile due to its dilution and decrease in viscosity, achieved by increasing the content of the fraction of water in it. In such a situation, the excretion of bile is facilitated and the formation of stones is prevented.
Cholekinetics are agents that increase the tone of the gallbladder and at the same time relax the muscles of the bile duct. To understand the significance of the cholekinetic effect, it is necessary to know that the gallbladder is connected to the duodenum by the bile duct, through which bile flows from one organ to another. Accordingly, at increased tone it narrows in the bile duct, which interferes with the movement of bile. And with a low tone of the gallbladder, it simply does not "push" bile into the duct. Thus, an increase in the tone of the gallbladder and relaxation of the duct create ideal conditions for the outflow of bile, since the former contracts intensively, pushing out the contents from itself and preventing it from stagnating, and the latter has a sufficiently wide 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, as a result of which digestion is improved and stagnation is eliminated.
Cholespasmolytics are subdivided into several groups depending on the characteristics of their pharmacological action, however, the resulting effects are the same for everyone. Cholespasmolytics eliminate spasm and widen the biliary tract, facilitating the excretion of bile into the intestine. These drugs are usually used in short courses to relieve pain in various diseases gallbladder and biliary tract.
Preparations to reduce the lithogenicity of bile, strictly speaking, are intended to dissolve existing stones in the gallbladder and prevent the formation of new ones. Since these drugs have a choleretic effect, they are, with some degree of convention, referred to the group of choleretic drugs.
Each group and subgroup includes certain drugs that have a number of properties and clinical effects used in different options pathology of the biliary tract and liver. In the next section, we present a list of choleretic drugs belonging to each group and subgroup.
Choleretic drugs - lists
Below, for the convenience of orientation and selection, we present a list of choleretic drugs by classification groups. 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 produced.True choleretics
True choleretics containing bile components include the following drugs: - Preparations containing components of natural animal bile - Allochol, Cholenzym, Vigeratin, Liobil;
- Dehydrocholic acid - Hologon;
- Sodium salt of dehydrocholic acid - Decholin, Biliton, Suprakol, Cholamin, Holomin.
Synthetic choleretics
The following drugs are synthetic choleretics:- Hydroxymethylnicotinamide (Nicodine, Bilamid, Bilizarin, Bilocid, Cholamid, Coloton, Felosan, Isochol, Niciform);
- Gimecromon (Odeston, Holonerton, Cholestil);
- Osalmid (Oxafenamide, Osalmid, Auxobil, Drenamid, Driol, Enidran, Salmidochol);
- Tsikvalon (Tsiklovalon, Benevo, Cyclovalone, Divanil, Divanone, Flavugal, Vanilone).
Choleretics based on medicinal herbs
Herbal choleretics are as follows:- Helichrysum flower extract (Flamin);
- Corn silk extract (Peridol, Insadol);
- Tansy extract (Tanacehol, Tanaflon, Sibektan, Solar);
- Turmeric extract (Konvaflavin, Febichol);
- Scumpia leaf extract (Flacumin);
- Barberry leaf and root extract (Berberine sulfate, Berberis-Gomaccord, Berberis plus);
- Rosehip fruit extract (Holosas, Holemax, Holos);
- Datiskan hemp extract (Datiskan);
- Bupless extract (Pequokrin);
- Artichoke extract (Hofitol, Holebil);
- Preparations containing a complex of herbs with a choleretic effect (Holagol, Holagogum, Travohol, choleretic fees No. 2 and 3, Urolesan, Phytohepatol No. 2 and 3).
Hydrocholeretics
The following drugs are hydrocholeretic:- Alkaline mineral waters (Naftusya, Borjomi, Narzan, Essentuki 17, Essentuki 4, Arzni, Smirnovskaya, Slavyanovskaya, Izhevskaya, Jermuk, etc.);
- Salicylates (sodium salicylate);
- Valerian preparations ( alcoholic infusion valerian, valerian tablets, Valerianachel, etc.).
Cholekinetics
The following drugs are cholekinetic: - Magnesium sulfate (Magnesia, Kormagnesin);
- Sorbitol (Sorbitol);
- Mannitol (Mannitol, Mannitol);
- Xylitol;
- Barberry leaf and root extract (Berberine sulfate, Berberis-Gomaccord, Berberis plus);
- Helichrysum flower extract (Flamin);
- Rosehip fruit extract (Holosas, Holemax, Holos).
Cholespasmolytics
Cholespasmolytics are the following choleretic drugs:1. Anticholinergics:
- Bellalgin;
- Belloid;
- Besalol;
- Metacin;
- Platyphyllin;
- Spasmolitin;
- Fubromegan.
- Papaverine (Papaverine, Papaverine Buffus, Papazol);
- Drotaverin (Bioshpa, Nora-Drotaverin, Droverin, No-Shpa, Nosh-Bra, Ple-Spa, Spazmol, Spazmonet, Spazoverin, Spakovin);
- Aminophylline (Aminophyllin-Eskom, Euphyllin);
- Mebeverin (Duspatalin).
- Arnica tincture;
- Valerian tincture;
- Elecampane tincture;
- Tincture of St. John's wort;
- Mint tincture;
- Lemon balm tincture;
- Tincture of calendula flowers;
- Convaflavin (turmeric root);
- Holagol (extracts of various herbs).
Choleretic with litholytic action
Choleretic with litholytic action are as follows:1. Ursodeoxycholic or chenodeoxycholic acids - Livodex, Urdoksa, Urso 100, Ursodez, Ursodex, Uroliv, Ursolit, Ursorom S, Ursosan, Ursofalk, Choludexan, Exhol;
2. Methyl tert-butyl ether.
Choleretic herbal preparations
Choleretic herbal preparations are represented by finished dosage forms (tablets, tinctures or powders for preparing a solution for oral administration) or dried crushed parts of plants with the necessary properties.
Currently on the domestic pharmaceutical market there are the following choleretic herbal preparations in finished forms:
- Berberis-Homaccord;
- Berberis plus;
- Berberine sulfate;
- Datiscan;
- Insadol;
- Peridol;
- Convaflavin;
- Pequokrin;
- Sibektan;
- Solar;
- Tanaflon;
- Tanacekhol;
- Travohol;
- Urolesan;
- Febichol;
- Phytohepatol No. 2 and 3;
- Flacumin;
- Flamin;
- Holagogum;
- Holagol;
- Hollebil;
- Cholemax;
- Holos;
- Holosas;
- Hofitol.
In addition, the following medicinal herbs have a choleretic effect (choleretic):
- Birch buds;
- Turmeric root;
- Calamus rhizome;
- Roots and leaves of barberry;
- Burdock roots;
- Dandelion roots;
- Chicory root;
- Corn silk;
- Artichoke leaves;
- Bupleur leaves;
- Nettle leaves;
- Peppermint leaves and oil;
- Orthosiphon leaves;
- Parsley leaves;
- Scumpia leaves;
- Leaves and flowers of tansy;
- Fir oil;
- Terpene oil Rosehip;
- Coriander fruit;
- Rowan fruits;
- Carrot seeds;
- Horseradish root juice;
- Highlander's grass;
- Datiski grass;
- Oregano herb;
- Centaury grass;
- Lily of the valley herb;
- Wormwood herb;
- 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;
- Caraway fruits;
- Fennel fruit;
- Dog-rose fruit;
- Sunflower oil;
- Lingonberry juice;
- Highlander's grass;
- Oregano herb;
- Shepherd's purse herb;
- 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 remedies. Synthetic choleretics include drugs containing nicodine, gimecromone, osalmide or tsikvalone as active substances. Compared to natural choleretics (for example, Allochol, Cholenzym, Lyobil, etc.), they are better tolerated, do not cause unstable stools, and also have a number of additional positive therapeutic effects, such as antispasmodic, lipid-lowering, antibacterial and anti-inflammatory.In addition, modern choleretic drugs include dehydrocholic acid (Hologon, Decholin) and ursodeoxycholic acid (Livodexa, Urdoksa, Urso 100, Ursodez, Ursodex, Uroliv, Ursorom, Ursorom S, Ursosan, Ursofalk, Ekholudexan). Also modern drug is the cholespasmolytic Duspatalin.
Among the choleretic herbal and animal preparations, modern ones include the following:
- Berberis-Homaccord;
- Vigeratin;
- Insadol;
- Convaflavin;
- Pequokrin;
- Peridol;
- Sibektan;
- Solar;
- Tanacekhol;
- Tanaflon;
- Urolesan N;
- Febichol;
- Holagogum;
- Holagol;
- Holaflux;
- Holosas.
Choleretic drugs - indications for use
A common indication for the use of choleretic drugs is pathology of the gallbladder, biliary tract or liver. However, in order to select the optimal drug, it is necessary to know the indications for the use of each group of choleretic agents. Within the groups, there are slight differences between 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 the 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, Nikodin, Oxafenamide, etc.), and preparations containing components of natural bile (for example, Allochol, Lyobil, Decholin, Cholenzym, Hologon, etc.), and remedies based on medicinal herbs (for example, Konvaflavin, Holosas, Flakumin, 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 provoked by a violation of the outflow of bile.
In addition, with insufficient bile secretion, choleretics containing components of natural bile of animals can be used as substitution therapy drugs.
Among choleretics, the most "harsh" are preparations 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 spectrum 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 excretion from the body) expressed in osalmide;
- Antibacterial effect expressed in Nikodin;
- Anti-inflammatory effect expressed in tsikvalon;
- Suppression of decay and fermentation in the intestine - the effect is expressed 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 of the gallbladder, ducts and liver, due to which their very high efficiency is achieved. That is why, at the present time, in the absence of allergies or intolerance to the components of herbs, 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, the drugs of this group are almost never used independently. Usually they are 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 congestion of bile 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: - Dyskinesia of the biliary tract of the hyperkinetic form;
- 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 gallbladder and preventing the formation of new ones;
- Dissolution of stone fragments formed after the ultrasonic crushing procedure;
- Complex treatment of gallstone disease;
- Reflux gastritis or reflux esophagitis, provoked by the reflux of bile acids into the stomach or esophagus;
- Acute hepatitis;
- Toxic liver damage from poisons, alcohol, drugs, etc.;
- Compensated biliary cirrhosis of the liver;
- Primary cholangitis;
- Intrahepatic atresia biliary tract;
- Stagnation of bile against the background of 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 - 5 receptions, depending on how many times a day a person eats. It is recommended to take choleretic drugs before every meal. Preparations must be taken with a drink enough water and be sure to eat something half an hour after taking it. If a person does not eat anything after taking a choleretic drug, then he will experience nausea, diarrhea and overall health will worsen.Usually, choleretic drugs are taken in long (up to 3 - 8 weeks) courses 2 - 4 times a year, making intervals between them at least 1 - 2 months. Such courses of the use of choleretic drugs are prophylactic and should be carried out during the entire period of time while the disease persists. With exacerbation of diseases of the biliary tract, liver and gallbladder, choleretic drugs are used as part of complex therapy in large doses.
Ursodeoxycholic acid preparations for the treatment of reflux gastritis and reflux esophagitis, as well as 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 - Nikodin, Oxafenamid, Osalmid;
- Choleretics containing medicinal herbs - Flamin, Febichol, Holosas, Cholemax, Holos, Hofitol;
- Cholekinetics - Valerian, Valerianakhel, Magnesia, Kormagnesin, magnesium sulfate;
- Anticholinergics (cholespasmolytics) - Atropine, Metacin, Platyphyllin, Papaverine, Papazol, Drotaverin, No-Shpa, Bioshpa, Nora-Drotaverin, Nosh-Bra, Ple-Spa, Spazmol, Spazmonet, Spazoverin, Spakovin Euphyllin.
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 old, since the prepared infusions and decoctions contain a wide range of active substances and it is simply impossible to predict the reaction of the child's body to all of them.
Choleretic drugs during pregnancy
Pregnant women can take only those choleretic drugs that do not provoke uterine contractile activity and do not penetrate the placenta to the fetus, and also do not cause a pronounced deterioration of the condition. The following choleretic drugs are completely safe during pregnancy: - Cholenzyme;
- Holosas;
- Cholemax;
- Holos;
- Valerian;
- Magnesia (magnesium sulfate);
- Feed magnesin;
- Atropine;
- Metacin;
- Papaverine (Papazol);
- Drotaverin (No-Shpa, Bioshpa, Nora-Drotaverin, Nosh-Bra, Ple-Spa, Spazmol, Spazmonet, Spazoverin, Spakovin).
- Odeston;
- Holonerton;
- Cholestil;
- Flamin;
- Febichol;
- Berberis-Gommacord;
- Hofitol;
- Euphyllin.
Dosages, rules of admission 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 (BDT)
The selection of drugs depends on the form of biliary dyskinesia. So, for hypertensive type biliary dyskinesia
(ZHVP) the following choleretic drugs are shown: - Cholespasmolytics of any type (for example, No-Shpa, Papaverin, Platifillin, Metacin, Duspatalin, Odeston, etc.), which reduce pain syndrome;
- Cholekinetics (for example, Magnesia, Kormagnesin, Berberine-Gommacord, Cholosas, Cholemax, Cholos, Sorbitol, Mannitol, Flamin, etc.).
With hypotonic dyskinesia of the gastrointestinal tract the following choleretic drugs are shown:
- Any choleretics (for example, Allohol, Liobil, Nikodin, Tsikvalon, Holagogum, Holagol, Flakumin, Konvaflavin, Febichol, Sibektan, Tanacehol, etc.);
- Hydrocholeretics (alkaline mineral waters, etc.);
- Myotropic antispasmodics (Duspatalin, Odeston).
Choleretic drugs for stagnation of bile
In this case, to eliminate stagnation, the most effective and optimal are their choleretic groups of cholekinetics, for example, Kormagnesin, Berberine-Gommacord, Holosas, Mannitol, Flamin, etc.Cholecystitis
Choleretic drugs with cholecystitis, they are used at any stage of the disease. In the presence of stones in the gallbladder with cholecystitis, only drugs containing ursodeoxycholic acid as an active substance can be used as choleretic drugs (for example, Livodexa, Urdoksa, Urso 100, Ursodez, Ursodex, Uroliv, Ursolit, Ursorom S, Ursosan, Ursanofalk, , Exhol). With non-calculi cholecystitis, it is necessary to take choleretics from any group. Among synthetic choleretics, choleretic drugs containing oxafenamide and gimecromone or cyclovalon are optimal. When using oxaphenamide or gimecromone, you do not need to additionally take cholespasmolytics (No-Shpa, Papaverine, etc.), since these synthetic choleretics have an antispasmodic effect. And against the background of the use of Cyclovalon, you do not need to additionally take antibacterial drugs, since this choleretic has a pronounced antimicrobial effect. When using choleretics containing bile components or medicinal herbs (for example, Allochol, Liobil, Sibektan, Tanacekhol, etc.), it is necessary to additionally take cholespasmolytics or antibacterial drugs.
In addition to any choleretics with non-stone cholecystitis, it is necessary to take cholekinetics (Magnesia, Kormagnesin, Berberine-Gommacord, Holosas, Cholemax, Holos, Sorbitol, Mannitol, Flamin, etc.), which will facilitate the secretion 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 about 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 medicine.
Choleretic drugs - prices
Prices for choleretic drugs are very variable and range from 50 to 500 rubles per package. 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 natural bile components and medicinal herbs. The most expensive are synthetic choleretics, cholespasmolytics and ursodeoxycholic acid preparations. That is, there are groups of drugs that are relatively expensive and cheap. However, since in each specific case choleretic drugs from a certain group are shown, it is impossible to replace them with funds from another, cheaper classification subgroup. You can only choose the cheapest drug from the same group. This principle of substitutability should always be used when choosing a choleretic drug.Cooking cholagogue Marco Polo salad - video
Before use, you must consult a specialist.Choleretic drugs
Substances that increase the output of bile into the duodenum are called choleretic. An increase in bile output may be due to the following reasons:
1) an increase in the formation of bile in the liver and an increase in its enzymatic activity. This is how essential oils, allocholus, corn stigmas, immortelle flowers act. These funds have a stimulating effect on the liver cells and neurohumoral regulation bile formation;
2) restoration of the tone of the bile ducts and gallbladder, in connection with which the excretion of bile into the intestine is enhanced. This is how antispasmodics act (atropine, papaverine, etc.), Karlovy Vary salt, magnesium sulfate. The influence of substances of this type is reduced to mechanical facilitation of the movement of bile along the excretory pathways;
3) anti-inflammatory action of chemotherapeutic and antiseptic agents, which also contribute to the restoration of the liver and bile ducts and increased bile secretion.
Bile production is regulated by the central nervous system and autonomic innervation. Substances that stimulate the central nervous system and parasympathetic innervation, increase bile formation, and substances that depress the central nervous system and excite sympathetic innervation, reduce the secretion of bile. Cholinolytic substances inhibit bile formation, but by relaxing the muscle tone of the biliary tract and sphincter, facilitate the excretion of bile. Substances that relax smooth muscle spasms also act: magnesium sulfate, Karlovy Vary salt. Sulfates, entering the duodenum, irritate its receptors and cause the so-called gallbladder 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 thin bile are used: sodium bicarbonate, sabur, alkaline mineral waters. Many choleretic agents act in combination. Choleretic is used for diseases of the liver and biliary tract.
Allochol - Allocholum... Tablets containing dry 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 biliary tract, revitalizes the secretion and intestinal motility, acts as an anti-fermentation and anti-rot in the gastrointestinal canal.
It is used for chronic inflammation of the liver, biliary tract and gallbladder.
Doses inside: dogs - 1-2 tablets, cats - 0.25-0.5 tablets. Assign 3 times a day after feeding.
Dehydrocholic acid - Acidum dehydrocholicum. White crystalline powder of bitter taste. Let's hardly dissolve in water, we will dissolve in alcohol. Available in tablets of 0.2 g.
Action. It belongs to the group of bile acids that stimulate the production of bile by the hepatic cells.
Apply when chronic inflammation liver, bile ducts and gallbladder. Use is contraindicated in acute and subacute liver dystrophies.
Doses inside (g): horses - 3-6, pigs - 1-3, dogs - 0.2-2.0. Assign 3 times a day.
Corn silk - Stigmata Maydis... Corn stubs with stigmas harvested during the ripening period of the corn cobs. Stigma contains stigmasterol, systosterol, essential oil, vitamins C and K.
Action. Corn stigma increases the secretion of bile, decreases its viscosity, stimulates contractions of the gallbladder, enhances blood clotting and acts as a diuretic.
Used as a choleretic and diuretic for inflammation of the liver, gallbladder, bile ducts. As a choleretic, diuretic and lactic eater, it is good to use corn silage for large and small animals, harvested during the milky ripeness of corn cobs. Dried corn stigmas are used in the form of infusion 1:10 or 1:20.
Doses inside (g): horses - 30-60, sheep and pigs - 20-40, dogs - 10-20. Assign 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 animals (1 part each).
It acts and is used as a choleretic agent for inflammation of the liver, biliary tract and gallbladder. It is 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-growing immortelle (cmin) collected before the blooming of the flowers contain flavonoids, glycosides, essential oil, vitamins K and C, carotene.
Action. They stimulate the liver, increase bile formation, increase the tone of the gallbladder and bile ducts, increase the secretory function of the stomach and pancreas.
It is used as a choleretic agent for diseases of the liver, gallbladder 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. Assign 2-3 times a day.
Hepatitis is an inflammation of the liver of a diffuse nature, accompanied by hyperemia, cell infiltration, dystrophy, necrosis and lysis of hepatocytes and other structural elements, pronounced 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, dog plague, parvovirus enteritis, leptospirosis, listeriosis, colibacillosis, salmonellosis, panleukopenia, infectious anemia cats, etc.
Chronic hepatitis is more often the result of acute hepatitis.
Symptoms Hepatitis mainly occurs after any infectious or invasive disease, therefore, its symptoms consist of signs of the underlying disease.
Common symptoms include: depression, decrease or loss of appetite, thirst, vomiting, an increase in body temperature up to 40 ... 42C, an increase in the volume of the liver, its soreness on palpation. The syndrome of parenchymal jaundice is clearly manifested: dyspeptic disorders, itching of the skin, scratching, intense yellow coloration of the mucous membranes and unpigmented areas of the skin, an increase in the level of bilirubin (free) in the blood.
There is a syndrome liver failure, manifested by a violation of the most important functions of the body - digestive upset, poor absorption of fat, increased bleeding, general intoxication, severe depression, loss of fatness, exhaustion. Hepatitis is accompanied by an enlargement of the spleen.
In the blood, the content of albumin decreases and the amount of alpha and beta globulins increases, the concentration of ammonia, cholesterol, transaminase activity, and cholinesterase activity decreases. The urine with hepatitis is dark in color. In young animals, frequent signs of infectious hepatitis are: conjunctivitis, rickets, diarrhea, enlarged tonsils. Keratitis is registered in one right or both eyes. Convulsions and paralysis of the limbs are not uncommon.
Diagnosis. Take into account the data of anamnesis, the results of clinical and laboratory studies. It is necessary to exclude liver cirrhosis, hepatosis, cholecystitis. In all cases, the possible etiological factor is taken into account. Liver cirrhosis is chronic without fever. Acute hepatitis differs from hepatosis in etiology, severity of the course, temperature reaction.
Treatment.
1. Eliminate primary cause... For invasive or infectious diseases carry out etiotropic therapy.
2. Prescribe dietary feeding. In this case, the age and breed characteristics of the animal are taken into account.
Exclude from the diet fatty foods and sugar. At the beginning of treatment, a fasting regimen for 24 hours with 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, Potentilla, yarrow, chamomile, licorice, St. John's wort, blueberries, bird cherry, etc. All these plants have different therapeutic effect on the liver and digestive organs. In addition to water, in the first days of treatment, it is useful for dogs and cats to prescribe meat and fish lean broths.
On the 2nd-4th day of treatment, small frequent portions of rice, oatmeal or semolina porridge, rice water. A small amount of boiled chicken or ground beef is added to the porridge (1-2 tablespoons per meal). If the animal after such feeding does not develop indigestion in the form of vomiting and diarrhea, then the dose of feed is gradually increased.
On the 3-5th day of treatment, fresh, warm in a small amount low-fat lactic acid products are added to the specified diet: kefir, yogurt, milk, cottage cheese, milk mixture, acidophilus or acidophilus milk.
On the 6-9th day, boiled finely chopped vegetables - carrots, cabbage, potatoes - are introduced into the diet. Starting from the 10th day successful treatment, animals are transferred to a normal diet.
3. To relieve the 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 drip method. In cats, these solutions are often injected subcutaneously. Ringer's, Ringer-Locke's, Acesol, Disol, Trisol, Chlosol, Sanasol, etc. solutions 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 rheopolyglucin, enterodesis, polyamine, hydrolysin, casein hydrolyzate, etc.
5. When pain syndrome, as well as to normalize body temperature, pain relievers and sedatives are prescribed. These are belladonna preparations (belladonna) - bacarbon, bellalgin, bellastezin, 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 are used - hepatoprotectors. These include: legalon, which is administered orally after eating 1 tablet 3 times a day, Liv-52 - 1-2 tablets 3 times a day, silibor 1-2 tablets 3 times a day, Essentiale forte - 3 times a day. 1-2 capsules per day, sirepar intramuscularly or intravenously, 2-3 ml once a day, as well as glucose and vitamins B1, B2, B6, B12, ascorbic and nicotinic (rec. 180) acids, vitohepat, lipoic acid, retinol and tocofer roll. Good medicinal property possesses 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 furacilin (1: 5000), put enemas with disinfectants or with decoctions of medicinal herbs.
8. As agents disinfecting the biliary tract, enhancing the secretion of bile, use hexamethylenetetramine (rec. 183) orally at 40 mg / kg or intravenously 20 mg / kg, and also prescribe cholagon (rec. 181) and decholin orally at 6 -12 mg / kg, corn silk 60-120 mg per 1 kg of body weight 3-4 times a day, sulfuric acid magnesia, 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 uithiol (rec. 786) is injected intramuscularly at the rate of 5 mg / kg of animal weight, intravenously - sodium thiosulfate 20-30 mg / kg in the form of a 30% solution.
11. The use of anti-inflammatory and immunosuppressive agents (hydrocortisone, prednisolone, delagin, diphenhydramine, pipolfen, immunoglobulin, etc.) is limited.
Prevention. General and special events to prevent the occurrence of infectious and invasive diseases, carry out their timely treatment.
It is necessary to prevent the feeding of animals with toxic, spoiled feed. Diets should be balanced in protein, carbohydrates, fats, vitamins and minerals. Unjustified use of medicinal substances that have a toxic effect on the liver should be avoided.
CIRRHOSIS OF THE LIVER
Chronic process, accompanied by structural changes organ, replacing its parenchymal elements with connective tissue. It is quite common in dogs.
Etiology. Primary cirrhosis for the most part are the result of a lack of pyridoxine, selenium and other trace elements, chronic intoxication the body with poisonous substances contained in the feed. Long-term hepatitis, hepatosis, cholangitis and cholecystitis can lead to cirrhosis.
Symptoms Developing gradually. For quite a long time, a change in appetite, the phenomenon of a catarrhal state of the stomach and intestines are noted. With a pronounced form of the disease, depression, inactivity is characteristic. Hemorrhages appear on the conjunctiva, mucous membrane of the mouth, nose. on the skin. Abdominal dropsy develops, in which the abdomen changes due to the accumulation of fluid in the abdominal cavity. In hypertrophic cirrhosis, the liver enlarges and is palpated on the right by the ice rib. With percussion, zones of dullness are revealed on both sides (Fig. 13).
Rice. 13. Displacement of the border of the liver with its cirrhosis in dogs
In atrophic cirrhosis, a pear-shaped abdomen is often observed due to accumulated transudate in the abdominal cavity.
With hypertrophic and atrophic cirrhosis, signs of poorly expressed mechanical or parenchymal jaundice are often noted: slight staining in yellow sclera, sometimes mucous membranes, urine; blood serum gives a direct reaction to bilirubin, the content of albumin and fibrinogen in the blood significantly decreases and the amount of globulins increases.
The course of the disease is long, up to several months or even years.
Diagnosis. It is based on a change in the boundaries of the liver and spleen, the presence of jaundice, hemorrhages, 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 directed at the underlying disease.
The diet should consist of easily digestible feed with a lot of proteins and vitamins. The patient is prescribed vegetable dishes, fruits, low-fat lactic acid foods, 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 later stages disease is ineffective.
1. Symptomatic treatment is aimed at prolonging the life of the animal and consists of the appointment of hepatoprotectors: bilignin, 5-10 g, legalon, 1 tablet 3 times a day; Liv-52, silibor, essential forte, sirepar, 1-3 ml 1 time per day intramuscularly or intravenously, panzinorma forte. These medicinal substances are used for a long time (for a month or more).
2. Choleretic agents are widely used, such as allochol, berberine bisulfate, immortelle flowers, zixorin, convaflavin, corn silk, nicodine, choleretic collection, flamin, cholagol, cholenzyme, cholosas and others according to the instruction.
3. With ascites, a needle is inserted into the abdominal cavity and fluid is released from it.
4. The appointment of diuretics is shown - diacarb, collection of a diuretic, bearberry decoction, furosemide, lasix, etc. and cardiotonic - cordiamine, corazole, camphor, sulfocamphokaine, 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 for the treatment of liver cirrhosis.
ABDOMINAL WATERFLASS (ASCITS)
Chronic secondary disease associated with difficulty in resorption of peritoneal fluid in 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. Outflow difficulties may depend on the state of the portal (hepatic) circulation, failure of the heart, kidneys, hydremia.
All liver diseases, during which its volume, capsule tension change, function is sharply disturbed, for example, cirrhosis, cancer, echinococcosis, can lead to stagnation of blood in the portal vein system and to a decrease in the absorption of fluid from the abdominal cavity. Similar consequences cause stagnation in big circle blood circulation arising from diseases of the heart, lungs, improper metabolism. Abdominal dropsy is often a local manifestation of edematous disease.
Symptoms On external examination, symmetrical bilateral protrusion of the lower and lateral parts is noticeable abdominal wall, labored breathing, fast fatiguability, emaciation, edema 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 symptom. When probing the abdominal walls, fluid fluctuation is felt. Bowel murmurs are often weakened. Dullness is established by percussion, and with a test puncture of the abdominal wall follows clear liquid straw yellow in color with a low protein content.
The course of ascites is chronic, severe, the disease lasts for months and even years. With the appearance of jaundice and edema, 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 in maintaining the strength of the body and alleviating the course of the underlying disease. Protein-rich feed is introduced into the diet, watering is limited and dacha is reduced table salt.
It is advisable to prescribe cardiac, mainly digitalis and May lily of the valley preparations, as well as diuretics. To reduce the permeability of the vascular walls, intravenous administration of calcium chloride and gluconate is indicated.
In parallel with drug therapy, 1 time in 3-4 days by puncturing the abdominal cavity, a transudate is released (in dogs, no more than 0.1-2 liters).
In some cases, the improvement of the general condition of the dog can be achieved surgery(hemming 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, profuse urination, weakness, pruritus, sexual dysfunction, decreased or increased appetite... The skin becomes dry, low elasticity. The animal is losing weight. Furunculosis appears. Possible enlargement of the liver, expansion of the borders of the heart to the left, deafness of tones, systolic murmur. Chronic gastritis and enteropathy develop.
Pathology of the urinary system is characterized by cystitis, pyelitis, pyelonephritis. Pathology of the organs of vision in dogs is manifested by iritis, iridocyclitis, cataracts and myopia.
In a laboratory study of blood, signs of anemia, hyperglycemia, hypoalbuminemia, hypergammaglobulinemia, hypercholesterolemia, sometimes an increase in the content of urea, creatinine are noted.
In urine - high density, glucosuria, often acetone, sometimes microhematuria, proteinuria, cylindruria.
Diagnosis on diabetes is put on the basis of polyuria, polydipsia, bulimia, hyperglycemia and glucosuria with simultaneous depletion. The glucose content in the blood of diabetic patients reaches more than 100-150 mg per 100 g, in the urine — up to 5-10% or more.
Treatment. 1. Diet therapy. Prescribe lean boiled meat (poultry, beef, horse meat), fish and broths, vitamins and multivitamins. Sweets are excluded from the diet, White bread, confectionery and oatmeal. Limit the amount of fat in the feed.
2. Drug therapy includes various preparations of the pancreas and synthetic hypoglycemic drugs (antidiabetic agents): adebit, bukarban, glurenorm, 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. In case of violation of the acid-base state, with acidosis of various etiologies, dimephosphon is used at the rate of 1 ml / 5 kg of animal weight 3-4 times a day.
5. Pancreatin and panzinorm forte are widely prescribed to improve the function of the pancreas.
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 drugs they are used to treat diseases of the liver, gallbladder and biliary tract, in which exocrine function liver. This leads to a violation 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 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. Bile acids, which are a product of the combination of cholic acid with glycine and taurine, are of primary importance for the digestion processes. Bile is an indispensable component of normal digestion, which ensures 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 elimination of some exogenous drugs and some hormones (estrogens).
Bile released into the lumen of the duodenum is a normal stimulator of bile formation in the liver cells. Hydrochloric acid, ACTH, insulin and other hormones and enzymes also stimulate bile formation. The liver regulates the excretion 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 is carried out periodically, usually simultaneously with pancreatic juice. On its way, bile overcomes the barrier of Oddi's sphincter. With inflammation of the mucous membrane of the gallbladder and the common duct, in the presence of stones in them, the sphincter of Oddi contracts spasmodically and bile is not passed into the intestine. This leads to stagnation of bile in the gallbladder and bile ducts. In these cases, it is necessary to take means that cause relaxation of the muscles of the sphincter of Oddi, ducts and gallbladder.
Bile secretion is regulated by cholinergic and adrenergic nerves under the general influence of the central nervous system. Substances that stimulate the central nervous system (small doses), cholinomimetic agents increase bile formation; substances that depress the central nervous system, and adrenergic agonists reduce the secretion of bile.
Anticholinergics inhibit bile formation, but relax the 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 entering the duodenum from the bile ducts and gallbladder. 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, decholin, allochol, cholosas, cholenzym, corn stigmas, choleretic tea, essential oils, immortelle flowers, nicotinic acid, chloral hydrate, etc. The drugs that increase the amount of the liquid part of bile include subar, hydrochloric acid, salicylates, etc., and those that enhance the antimicrobial effect of bile are iodine, sulfonamides, antibiotics, etc .;
2) agents that promote the secretion of bile into the intestine. as a result of anti-inflammatory action. Such a division of choleretic agents 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 the production of bile and increases urine output.
Assign inside 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 function of the stomach and intestines, weakens the processes of fermentation and putrefaction.
It is used for acute and chronic diseases of the liver and bile ducts, for constipation caused by intestinal atony. Treatment course: several weeks.
Cholenzym tablets - White 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 in them.
Used as a choleretic agent for diseases gastrointestinal tract: gastritis, etc.
The approximate dose for calves inside is 1 tablet 1-2 times a day after feeding.
Nikodin. White crystalline powder, soluble in water. It has a choleretic and bactericidal effect, as well as the properties of vitamin PP. It has a positive effect on liver function. It is especially effective in combining inflammatory diseases. If necessary, it is prescribed together with antibiotics.
Herbal medicine and herbal choleretic agents in particular have proven themselves well as choleretic agents.
Sandy immortelle flowers. Collected and dried flower baskets with the upper (1-2 cm long) parts of wild-growing stems perennial plant sandy immortelle. The inflorescences of the plant contain flavones, tannins, essential oils, bitterness, vitamins K and E, etc.
It is used as a choleretic agent for acute and chronic diseases of the liver, gallbladder and biliary tract in the form of infusion, extract and collection. Infusion of flowers (1:20) is prescribed inside the calves by 1/3 cup 2-3 times a day 15-30 minutes before feeding.
Flamin. Dry concentrate of immortelle. Yellow powder, hardly soluble in cold water, easily in hot water. Calves are prescribed 1/2 tablet (0.025 g) 3 times a day 30 minutes before feeding. The course is 10-40 days.
Corn silk (corn sticks). The stigmas 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 a choleretic and diuretic effect. The infusion is used for cholecystitis, hepatitis, especially in cases of delayed bile secretion, kidney stones and edema of cardiac origin. In this case, there is an increase in the secretion of bile, a decrease in its viscosity and specific gravity, a decrease in the content of bilirubin, 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, inflorescences of tansy, inflorescences cat paw, holosas, holagol.
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