Lecturer: Gorishna Ivanna Lubomyrivna

1. Functional and organic diseases of liver and bile ducts. Etiology, pathogenesis, clinical features, diagnostics, treatment and prophylactic Lecturer: GorishnaIvannaLubomyrivna

2. Plan of the lecture • Definition of biliary dyskinesia • Biliary dyskinesia classification • Clinical manifestation • Methods of examinations • Treatment of the different kinds of biliary dyskinesia • Definition of the chronic hepatitis • Hepatitis classification • Clinical manifestation • Methods of examinations • Treatment of the different kinds of hepatitis

3. Definition of the Biliary Dyskinesia is a disorder of the sphincter’ tonus and kinetics of the gall-bladder and bile ducts.

4. Classification hypertonic-hyperkinetic dyskinesia hypotonic-hypokinetic dyskinesia

5. Clinical manifestation of hypertonic-hyperkinetic dyskinesia Duration of the disease up to 1 yr. Pain syndrome Dyspeptic syndrome Manifestations of vegetative dysfunction, neurotic symptoms

6. Clinical manifestation of hypotonic-hypokinetic dyskinesia Pain syndrome Dyspeptic syndrome Hepatomegaly Gallbladder symptoms are positive

7. Plan of examination • Fool blood count • Biochemical test of blood • Serum aminotransferase • Serum bilirubin (predominantly the direct reacting fraction) • Serum alkaline phosphatase • Albumin and globulin level • Stool test • USE of the abdominal cavity + cholekynetics for functional investigations

8. Stool test:

10. Duodenal intubation

11. Duodenal intubation

12. Duodenal intubation

13. Duodenal intubation

14. USE of the abdominal cavity + cholekinetics for functional investigations cholekinetics lead to a contraction of the gallbladder for 1/2-2/3 of the previous volume hypertonic dyskinesia - contraction of the gallbladder more than 2/3 of the previous volume hypotonic dyskinesia - contraction of the gallbladder less than 1/2 of the previous volume

15. Diet 5 Exclude heavy fats (like pork), spices, fried foods, "fast food"”; avoid stimulators of gastrointestinal secretions, the diet must be rich by metionine, lecithin, and choline to stimulate synthesis of proteins and enzymes in the liver. Diet with normal value of proteins and vitamins, with restriction of fats and carbohydrates is administered, also restrict salt. Foods boiled, steamed and baked are recommended; food taking 5 times daily

16. Treatment of hypertonic-hyperkinetic dyskinesia • Diet N 5 • Spasmolitics: • platyphyllinihydrotartratis (amp. 0.2 % 1 ml) • papaverinihydrochloridum (tab. 0.01, amp. 2 % 2 ml) • no-spa (tab. 0.04 or amp. 2 % 2 ml) • Choleretic: • cholagon • allocholum • cholenzynum • galstena • hepabene

17. Treatment of hypotonic-hypokinetic dyskinesia • Diet N 5 • Prokinetic: motilium, domperidone (tabl. 0.01 g) 1 mg/kg/day • Choleretic and cholekinetic drugs: • cholagon • allocholum • cholenzynum • galstena • hepabene • chophytol

18. Hepatoprotectors Essentiale (cap., amp.) 1-2 cap. 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Thiotriazolinum 1 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day

19. Antioxidants (aevitum, tocopheroliacetatis) Enterosortion (enterosgel) Probiotics (linex, bifiform, bactisuptil)

20. Blind Duodenal intubation with magnesiisulfatis 33 % xylitol or sorbitol 10 %

21. Chronic cholecystitis and cholecystocholangitis Chronic recurrent inflammatory process of gallbladder and intrahepatic bile ducts, accompanied with bile ducts motor disorders

22. Clinical manifestation Pain syndrome Dyspeptic syndrome Intoxication syndrome Cholestasis Inflammatory syndrome Dyscholia Ph of bile is acidic USE

23. Duodenal intubation

24. Treatment of hypotonic-hypokinetic dyskinesia • Diet N 5 • Prokinetic: motilium, domperidone (tabl. 0.01 g) 1 mg/kg/day • Choleretic and cholekinetic drugs: • cholagon • allocholum • cholenzynum • galstena • hepabene • chophytol

25. Hepatoprotectors Essentiale (cap., amp.) 1-2 cap. 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Thiotriazolinum 1 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day

26. Treatment of lambliasis, girardiasis Furasolidone 8-10 mg/kg 4 times a day-10 days (tabl. 0.05) Tinidazole 50-60 mg/kg/day (tab. 0.5, 0.15) Metronidazolum 15-20 mg/kg for 5 days (tabl. 0.5)

27. Blind Duodenal intubation with magnesiisulfatis 33 % xylitol or sorbitol 10 %

28. Definition of the chronic hepatitis • a continuing hepatic inflammatory process manifested by elevated hepatic transaminase level, lasting 6 mo or more and accompanied with pain, dyspeptic, intoxication and cholestatic syndromes

30. Chronic hepatitis can be caused by persistent viral infection, drugs, and autoimmune or unknown factors. Approximately 15–20 % of cases are associated with hepatitis B infection; in this group of patients, unusually severe disease may be caused by superimposed infection with hepatitis D (a defective RNA virus that is dependent on replicating hepatitis B virus). More than 90 % of infants infected during the 1st year of life experience chronic hepatitis B infection compared with a rate of 5–10 % among older children and adults. Chronic hepatitis may also follow 30–50 % of hepatitis C virus infections. Patients receiving blood products or who have had massive transfusions are at increased risk. Hepatitis A virus does not cause chronic hepatitis. Drugs commonly used in children that may cause chronic liver injury include isoniazid, methyldopa, nitrofurantoin, dantrolene, and the sulfonamides.

35. Classification of the hepatitis Forms of chronic hepatitis: 1. Chronic viral hepatitis(В, С, D) 2. Autoimmune hepatitis 3. Drug-induced hepatitis 4. Toxic hepatitis 5. Cryptogenic

36. The activity of the chronic hepatitis • Active period: а) mild activity (elevationof ALT<3 times); б) moderate activity (elevationof ALT< 10times); в) severe activity (elevationof ALT>10times). • Inactive period

37. Stages of chronic hepatitis 0- fibrosis is absent; 1- mild fibrosis; 2- moderate fibrosis; 3- severe fibrosis; 4- cirrhosis.

42. Example of the diagnosis • Chronic viral hepatitis B, active period, mild activity, without fibrosis

43. Clinical manifestation • Pain syndrome • Dyspeptic syndrome • Intoxication syndrome

44. Objective examination shows • Inadequate weight gain or failure to thrive • Sexual delay • Jaundice • Pruritus • Hyperpigmentation or hypopigmentation of the skin • Symptoms of hypovitaminosis • Telangiectasias (spider angiomas) • Palmarerythema • Clubbing fingers

45. Jaundice

46. Jaundice

47. Objective examination shows • Hepatic smell • Hepatomegaly • Symptoms of portal hypertension • Splenomegaly • Ascites • Collateral circulation • Splenism • Hemorrhagic syndrome • Encephalopathy

48. Hepato-spleno-megaly

49. Collateral circulation in case of biliary cirrhosis

50. Plan examination • Fool blood count • Biochemical test of blood • Serum aminotransferare • Serum bilirubin (predominantly the direct reacting fraction) • Serum alkaline phosphatase • Serum γ-globulin levels • Albumin and globulin level • The prothrombin time • serum iron and serum ferritin • Stool test • USE of the abdominal cavity