1. 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

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

10. Duodenal intubation

11. 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
8-22 II
2-6 -
III
3-5
yellow

12. 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
15-30 C V
Golden-yellow
Constant

13. 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

14. 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

15. 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

16. 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

17. 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 or amp. 2 % 2 ml)
Choleretic:
cholagon
allocholum
cholenzynum
galstena
hepabene

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

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

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

21. 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

22. 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

24. 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

25. 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

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

31. Clinical manifestation
Pain syndrome
Dyspeptic syndrome
Intoxication syndrome

32. 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

33. Jaundice

34. Jaundice

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

36. Hepato-spleno-megaly

37. Collateral circulation in case of biliary cirrhosis

38. 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

40. Tests in case viral hepatitis
ELISA test
PCR examination
Quantitative PCR
Viral genotyping

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

42. 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 mg once per day