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O.L.Williams, K.D.Vellacot // Surg. Endosc. - 2002. -Vol.16. - №3. - P.465-467.
English version: CLINICAL FEATURES OF CALCULOSUS CHOLECYSTITIS REACTIVE HEPATITIS AND METHODS OF TREATMENT*
Dudchenko M. A.
Higher State educational if Ukraine "Ukrainian Medical Dental Academy", Poltava
The research were made on 42 patients with calculous cholecystitis. It were defined by the research that 73,8% of patients that were receiving treatment, had development of nonspecific reactive hepatitis as a natural pathological process. Timely surgical and conservative treatment of patients with calculous cholecystitis combined with reactive hepatitis, owing to the regenerative features of hepatocytes, creates the real possibility of recovery from this diseases.
Keywords: cholecystitis, hepatitis, treatment.
The liver and gallbladder are a uniform system of bile flow and bile from the body [4]. If the liver in physiological terms is a "biochemical laboratory" where there are metabolic and neutralizing processes, which is the end product of bile, ensuring the normal functioning of the body, the gallbladder, as the body of the reservoir, its rhythmic activity provides the intestine bile that is involved in digestion [1 2]. They are inter-related and interdependent feature of the genetic and self-regulation.
Cholestasis and biliary stones in the system lead to infection or aseptic inflammatory process in the gallbladder [3]. Products of inflammation, toxins, infection in violation of the outflow of bile into the duodenum easily penetrate on bile ducts in the liver lobules moves, damaging hepatocytes. Degenerating cells become autoantigens and the subsequent development of autoimmune inflammation, forming a non-specific reactive hepatitis [3, 6].
Since reactive hepatitis in patients with calculous cholecystitis occurs in secret, and the manifestations of both acute and chronic calculous cholecystitis in the acute stage are expressed, the attention of the patient and the doctor, usually in connection with the pain, focus on the pathology of the gall bladder, the treatment is completed generally accepted surgical technique - chole-cystectomy [5]. Latenotno current reactive hepatitis and progresses only when already joined tsirroliticheskie changes with clinical manifestations of the patient has to go to the doctor. During this period, the treatment of such patients is very difficult.
The issue of calculous cholecystitis and reactive hepatitis is considered very small value, at the same time the population cholelithiasis and cholecystitis with her and reactive hepatitis, cirrhosis of the liver in passing, are progressing. There is a growing incapacity, disability and mortality.
Purpose - to examine the clinical features of calculous cholecystitis with reactive hepatitis and justify their treatment.
Material and methods
The study was conducted on 42 patients aged 28 to 60 years, with disease duration of 7 years. Men was 16, women - 26. Almost all patients taken to surgery clinic number 1 YMCA ambulance with a diagnosis of "acute abdomen". Patients in full a clinical, laboratory, biochemical and instrumental examination. Established acute calculous cholecystitis in 21 people., Chronic calculous cholecystitis in the acute stage at 14 people., In remission - in 7 people. All patients underwent preoperative preparation with cholecystectomy.
Treatment nonspecific reactive hepatitis performed pomoschyu developed world and received a patent for consideration "method for treating liver cirrhosis," comprising a mixture of D-fruktazy, riboksina, essentsiale, mexidol, prednisolone intravenous and oral Gepon laser irradiation of blood.
Results and discussion
All patients described a history of the group and in the survey, there were no signs and symptoms of the presence and migrated in the past viral hepatitis. Most often, acute and chronic cholecystitis, followed by their nonspecific reactive hepatitis (in 73.8% of patients) was observed in the age of 40-60 years. The more frequently recurred chronic cholecystitis, the more attacks the liver. In 89.6% of patients had other diseases of the digestive system: chronic gastro in 61.9% of patients, chronic colitis - at 54.7%, duodenal ulcer - in 14.3%, chronic pancreatitis - in 27.6% of patients, Some patients had 2-3 comorbidities.
The most pain was constant. All patients had pain in the right upper quadrant. At % of patients, along with pain in the right upper quadrant were epigastric pain. Half of the patients the pain radiate to the right side of the chest. The pain was often dull, aching, almost constant. A feeling of heaviness and fullness in the right upper quadrant had 94.1% of patients. Acute pain resembling biliary colic, had half of the patients with acute cholecystitis. In one third of patients with chronic cholecystitis in the acute stage. The cause of the gain or pain in the right upper quadrant, as dyspepsia, in most cases, a violation of diet
* To cite this English version: Dudchenko M. A. Clinical features of calculosus cholecystitis reactive hepatitis and methods of treatment / / Problemy ekologii ta medytsyny. - 2013. - Vol 17, № 1-2. - P. 67 -68.
TOM 17. N 1-2 2013 P.
and errors in diet. Quite often (39.6%) led to greater pain was stress.
Many patients complained of discomfort in the area of the heart (49.6%), and other various kinds of pain (28.6%), and sometimes on rhythm disturbance of the heart.
In all patients with ultrasound, computed tomography and magnetic resonance imaging revealed the presence of stones in the gallbladder.
Most important in the diagnosis of chronic nonspecific reactive hepatitis patients is cholecystitis by palpation and percussion of the liver. All patients with acute and acute exacerbation of chronic calculous cholecystitis revealed mild hepatomegaly in patients with chronic calcu-lous cholecystitis in remission moderate increase in liver was detected in one third of cases.
In two thirds of patients with liver appeared right hy-pochondrium. Almost always marked her severe pain on palpation. In 36.9% of the patients body was sealed. Plotnovata more consistency and soreness of the liver often determined in the projection of the gall bladder with positive symptoms of his disease.
In a laboratory study, constantly revealed signs of inflammatory disease in the body. In 82.4% of patients experienced moderate neutrophilic leukocytosis with a left shift and increased erythrocyte sedimentation rate in two thirds of patients. Almost half of the patients was determined by the observed hyperproteinemia (more than 86 g / l). The average protein concentration in the serum was 87 ± 6,8 g / l. At 62.7% of patients studied fibrinogen concentration was 4.1 g / l and was 5,8 ± 1,8 g / l. In 84.9% of the patients has a positive one or the other sediment samples (thymol, etc.) confirming Dysproteine-mia them. The signs of the integrity of the hepatocyte membrane to improve the activity of aminotransferases (at 57.8%) and aspartate aminotransferase (at 39.2%). Increased activity of these enzymes were usually mild. About cholestasis indicate the activity of alkaline phos-phatase, which was at 83.2% of patients above 6 IU and was 6,8 ± 1,8 units. Mild transient hyperbilirubinemia was at 32.3% of patients, more due to the direct or related reactions.
Ultrasonography and computed tomography revealed diffuse changes in the liver, confirming their inflammatory nature.
The detected changes in the liver in acute and chronic calculous cholecystitis repeat pathology in patients with chronic calculous cholecystitis in remission but with less activity and severity.
Therefore, acute and chronic calculous cholecystitis involve in the pathological process of the liver with the development of non-specific reactive hepatitis.
As a result of cholecystectomy and conservative treatment on the third day condition of the patients im-
proved significantly. No pain and dyspeptic symptoms, the temperature returned to normal, recovered appetite, improved health, physical activity. By the 7th day of the patients felt almost healthy, returned to normal blood disease, liver returned to normal performance in more than half of the patients. By the 10th day all lechivshiesya discharged from the hospital with the assessment of significant improvements and recommendation: sparing diet (diet 5), the internal reception shpy, Loseke, pangrola, Valium, triovita, prednisolone (5 mg). In the future, a spa treatment.
Thus, cholelithiasis with calculous cholecystitis in most cases accompanied by a non-specific reactive hepatitis. The longer cholelithiasis and severe manifestation of it, the greater the damage to the liver occurs that requires early surgical treatment and a focused conservative therapy.
Findings
1. In patients with calculous cholecystitis development of non-specific reactive hepatitis is a natural disease process that should always be kept in mind when treating such patients.
2. With timely surgical and conservative treatment of patients with calculous and acalculous cholecystitis in combination with reactive hepatitis, the regenerative properties of hepatocytes are a real possibility of recovery from the disease.
The prospect of further research. Given the professional opportunities and regenerative properties of hepa-tocytes, it is possible to develop more effective methods of surgical and conservative treatment of patients with cholelithiasis and cholecystitis, combined with nonspecific reactive hepatitis.
References
1. Digtyareva I. I., Skrypnik I. N. Klinicheskaya gastroen-terologiya / I. I. Degtyareva, I. M. Skripnik. - M.: MIL, 2004. - 613 s.
2. Dudchenko M.O. Ziroz pechinki / M.O.Dudchenko. - Poltava, «Divosvit», 2004. - 130s.
3. Dudchenko M.A. Cholezistit / M.A.Dudchenko. - Poltava, «Poltavs'kiy literator», 2011. - 147s.
4. Genrich Liir. Vazhnaya triada: pechen', zhelchnye puti, podzheludochnaya. Perevod s nemezkogo T.F.Korchaginoy / Genrich Liir. - M., «Unikum press», 2003 - 468 s.
5. Nechitaylo M.E. Minimal'no invazivnaya chirurgiya pa-tologii zhelchnych protokov / M.E.Nechitaylo, V.V.Grubnik, P.V.Ogorodnikov. - K., «Zdorov'ya», 2005. - 442s.
6. Williams O.L., Vellacot K.D. Selective operative cholangiography and perioperative emlo-hopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy 1 viable option for choledocholithiasis / O.L.Williams, K.D.Vellacot // Surg. Endosc. - 2002. -Vol.16. - №3. - P.465-467.
Marepian Ha/t'MLUOB qo pe/taKLiii25.10.2012 p.
