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Functional and organic diseases of liver and bile ducts. Etiology, pathogenesis, clinical features, diagnostics, treatment and prophylactic. Lecturer: Gorishna Ivanna Lubomyrivna. Plan of the lecture. Definition of biliary dyskinesia Biliary dyskinesia classification Clinical manifestation

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

Lecturer:

GorishnaIvannaLubomyrivna

plan of the lecture
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
definition of the biliary dyskinesia
Definition of the Biliary Dyskinesia

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

classification
Classification

hypertonic-hyperkinetic dyskinesia

hypotonic-hypokinetic dyskinesia

clinical manifestation of hypertonic hyperkinetic dyskinesia
Clinical manifestation of hypertonic-hyperkinetic dyskinesia

Duration of the disease up to 1 yr.

Pain syndrome

Dyspeptic syndrome

Manifestations of vegetative dysfunction, neurotic symptoms

clinical manifestation of hypotonic hypokinetic dyskinesia
Clinical manifestation of hypotonic-hypokinetic dyskinesia

Pain syndrome

Dyspeptic syndrome

Hepatomegaly

Gallbladder symptoms are positive

plan of examination
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
use of the abdominal cavity cholekinetics for functional investigations
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

diet 5
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

treatment of hypertonic hyperkinetic dyskinesia
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
treatment of hypotonic hypokinetic dyskinesia
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
hepatoprotectors
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

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Antioxidants (aevitum, tocopheroliacetatis)

Enterosortion (enterosgel)

Probiotics (linex, bifiform, bactisuptil)

blind duodenal intubation
Blind Duodenal intubation

with magnesiisulfatis 33 %

xylitol or sorbitol 10 %

chronic cholecystitis and cholecystocholangitis
Chronic cholecystitis and cholecystocholangitis

Chronic recurrent inflammatory process of gallbladder and intrahepatic bile ducts, accompanied with bile ducts motor disorders

clinical manifestation
Clinical manifestation

Pain syndrome

Dyspeptic syndrome

Intoxication syndrome

Cholestasis

Inflammatory syndrome

Dyscholia

Ph of bile is acidic

USE

treatment of hypotonic hypokinetic dyskinesia1
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
hepatoprotectors1
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

treatment of lambliasis girardiasis
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)

blind duodenal intubation1
Blind Duodenal intubation

with magnesiisulfatis 33 %

xylitol or sorbitol 10 %

definition of the chronic hepatitis
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
slide30
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.
classification of the hepatitis
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

the activity of the chronic hepatitis
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
stages of chronic hepatitis
Stages of chronic hepatitis

0- fibrosis is absent;

1- mild fibrosis;

2- moderate fibrosis;

3- severe fibrosis;

4- cirrhosis.

example of the diagnosis
Example of the diagnosis
  • Chronic viral hepatitis B, active period, mild activity, without fibrosis
clinical manifestation1
Clinical manifestation
  • Pain syndrome
  • Dyspeptic syndrome
  • Intoxication syndrome
objective examination shows
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
objective examination shows1
Objective examination shows
  • Hepatic smell
  • Hepatomegaly
  • Symptoms of portal hypertension
    • Splenomegaly
    • Ascites
    • Collateral circulation
  • Splenism
  • Hemorrhagic syndrome
  • Encephalopathy
plan examination
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
tests in case viral hepatitis
Tests in case viral hepatitis
  • ELISA test
  • PCR examination
  • Quantitative PCR
  • Viral genotyping
hbv serum markers
HBV serum markers
  • HBsAg
  • HBsAb (recovering)
  • HBeAg
  • HBeAb
  • HBcAb Ig M
  • HBc Ab Ig G (recovering)
  • HBV DNA
hcv serum markers
HCV serum markers
  • HCV Ab Ig G
  • HCV Ab Ig M
  • HCV RNA
hdv serum markers
HDV serum markers
  • HDV Ab Ig G
  • HDV Ab Ig M
  • HDV RNA
  • HBsAg
autoimmune hepatitis
Autoimmune hepatitis
  • Hypergammaglobulinemia.
  • Serum IgG levels usually exceed 16 g/L.
  • Serum antiactin (smooth muscle), antinuclear, and antimitochondrial antibodies.
  • Additional less common autoantibodies include rheumatoid factor, anti-parietal cell antibodies, and antithyroid antibodies.
  • A Coombs-positive hemolytic anemia may be present.
treatment of the viral hepatitis
Treatment of the viral hepatitis
  • Regime
  • Diet 5
  • Interferon-therapy: (α-Interferon).
diet 51
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
interferon therapy
Interferon-therapy:
  • Intron А (α2b-Interferon),

Form of production - vial with 3 and 5 М units

  • Viferon (α2- Interferon+ vit. E and C)

Form of production rectal suppository

Viferon 1 - 150000 units

Viferon 2 - 500000 units

Viferon 3 – 1000000 units

Viferon 4 – 2000000 units.

  • Pegasis (peginterferonα-2а)

Form of production syrette with 135 mcgand 180 mcg

modern treatment of viral hepatitis
Modern treatment of viral hepatitis
  • HBV: Interferon+Lamivudine.

the doses of Lamivudine is 3 mg/kg (up to 100 mg) once per day

  • HСV: Interferon+Ribavirin

the doses of Ribavirin is 1000-1200 mg once per day

autoimmune hepatitis1
Autoimmune hepatitis
  • Prednisone is given at an initial dose of 1–2 mg/kg/day and continued until aminotransferase values return to less than twice the upper limit of normal.
  • The dose should then be lowered in 5-mg decrements over a 4- to 6-wk period, until a maintenance dose of less than 20 mg/day is achieved.
  • In patients who respond poorly, who experience severe side effects, or who cannot be maintained on low-dose steroids, azathioprine (1.5 mg/kg/day, up to 100 mg/day) may be added, with frequent monitoring for bone marrow suppression.
hepatoprotectors2
Hepatoprotectors
  • Heptral (tabl.- 0.4 g, amp.- 0.4 g) 1-2 tabl. 3 times a day (20-25 mg/kg/day)
  • Ursophalk (cap. 250 mg) 8-10 mg/kg/day
  • 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
slide70
Antioxidants (aevitum, tocopheroli acetatis)
  • Enterosortion (enterosgel)
  • Probiotics (linex, bifiform, bactisuptil)