Lecturer: Gorishna Ivanna Lubomyrivna 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 Methods of examinations Treatment of the different kinds of biliary dyskinesia Definition of the chronic hepatitis Hepatitis classification Treatment of the different kinds of hepatitis

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

Classification hypertonic-hyperkinetic dyskinesia hypotonic-hypokinetic 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 Pain syndrome Dyspeptic syndrome Hepatomegaly Gallbladder symptoms are positive

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

Stool test: Norma Biliary dyskinesia indigested muscular fibers non-digestable cellulose digestable cellulose fatty acids mucous epithelium leucocytes erythrocytes 1-2-3 + + + + ++ 1-2 1-2-3 0-1 ++++

Duodenal intubation

Duodenal intubation A I 10-20 Golden-yellow 0.2-1.4 8-22 II 2-6 - III Portion phase Duration (min) Color Speed of bile excretion Total volume, ml A I 10-20 Golden-yellow 0.2-1.4 8-22 II 2-6 - III 3-5 yellow 0.6-1.8

Duodenal intubation B IV 20-30 Brown 1.1-2.5 15-30 C V Golden-yellow Portion phase Duration (min) Color Speed of bile excretion Total volume, ml B IV 20-30 Brown 1.1-2.5 15-30 C V Golden-yellow 0.2-1.0 Constant

Duodenal intubation A Golden yellow ↑ 7 5-10 - -+ B Brown C Portion Colour pH Epithelium Leucocyte Lamblia Mu-cus A Golden yellow ↑ 7 5-10 - -+ B Brown C Bright yellow

Duodenal intubation A Yellow-green 6.2 5-6 - B Brown-green 5.5 3-5 3-6 Portion Color pH Epithelium Leucocytes Lamblia Mu-cus A Yellow-green 6.2 5-6 - B Brown-green 5.5 3-5 3-6 C yellow 7.2 4-6 2-4

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 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 Diet N 5 Spasmolitics: platyphyllini hydrotartratis (amp. 0.2 % 1 ml) papaverini hydrochloridum (tab. 0.01, amp. 2 % 2 ml) no-spa (tab. 0.04 or amp. 2 % 2 ml) Choleretic: cholagon allocholum cholenzynum galstena hepabene

Blind Duodenal intubation with magnesii sulfatis 33 % xylitol or sorbitol 10 %

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

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

Duodenal intubation Portion Color pH Epithelium Leucocytes Lamblia mucus A green 6.2 8-10 6-8 + B Brown-green 4.5 40-50 55-60 - C yellow 7.2 10-16 9-16

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

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 Active period: а) mild activity (elevation of ALT < 3 times); б) moderate activity (elevation of ALT < 10 times); в) severe activity (elevation of ALT >10 times). Inactive period

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

Clinical manifestation Pain syndrome Dyspeptic syndrome Intoxication syndrome

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) Palmar erythema Clubbing fingers

Jaundice

Jaundice

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

Hepato-spleno-megaly

Collateral circulation in case of biliary cirrhosis

Plan examination Fool blood count Biochemical test of blood Stool test 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 ELISA test PCR examination Quantitative PCR Viral genotyping

HBV serum markers HBsAg HBsAb (recovering) HBeAg HBeAb HBcAb Ig M HBc Ab Ig G (recovering) HBV DNA

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