CHOLAGOGUE MEANS - the pharmaceuticals activating vneshnesekretorny function of a liver and increasing biliation in a duodenum
. pages conditionally divide on holeretichesky — strengthening biliary secretion hepatocytes (Choleretica, Cholesecretica), and holekinetichesky — promoting biliation in intestines (Cholagoga, Cholekinetica); some. pages at the same time strengthen education and biliation.
Holereticheskiye Zh. pages increase amount of bile of hl. obr. due to increase in contents of water in it (hydrocholeretics) or thanks to increase in maintenance of the dense rest (true choleretics). True choleretics influence preferential the secretory mechanism of bilification. They strengthen synthesis of salts bilious to - t (dressing gowns) in a liver.
As a result of increase in content in bile of dressing gowns its holato-cholesteric coefficient increases that, apparently, prevents loss of cholesterol of bile in a deposit and possible formation of stones. Treat holeretichesky means: bile acids (see); the drugs containing bile acids — dehydrocholic acid (see), dekholin (see), Cholenzymum (see), Allocholum (the tablet containing dry bile of animals, dry extract of garlic, dry extract of a nettle and active coal), Cholecinum (the tablet containing holeinat sodium and lecithin); synthetic. page — tritio-n-metoksifenilpropan (sulfarly, p-propenyl anisole-trithione), Nicodinum (see), oksafenamid (see), Cycvalonum (see), 1-metoksi-4-naftoilpropionovaya to - that (ikterit), 1-fenilpropanol (felikur); vegetable. the pages containing flavones, vitamins and essential oils — berberine (see), Cholosasum (see), Cholagolum (contains colorant of a root of a turmeric, oemodin from a buckthorn, salicylate of magnesium, essential oils, alcohol, luccu oil), drugs of an immortelle sandy (broth, liquid extract and a dry concentrate — Flaminum), a thorough-wax, tansies, corn stigmas.
Bilious to - you both at enteral, and at parenteral administration render expressed, but short (1 — 3 hour) cholagogue action. They strengthen release of cholesterol, dressing gowns and a bromsulfalein with bile. The Holeretichesky effect bilious to - t is caused by strengthening of functional activity of hepatocytes and decrease in a reabsorption of compound components of bile in biliary tract. Increase in excretion of dressing gowns happens, apparently, hl. obr. at the expense of an enterogepatichesky cycle since the general allocation bilious to - t is less than the sum entered to - you and spontaneously allocated. Dehydrocholic to - that has the most expressed cholagogue effect, is least toxic in comparison with other connections of this group.
Synthetic. pages considerably increase bilious secretion, surpass in activity of salt bilious to - t, malotoksichna; duration of their action 2 — 6 hour. Cycvalonum also ikterit render as well holekinetichesky action. Sulfarl, apparently, thanks to existence in its molecule of sulfur increases an ureapoiesis in a liver and increases the content of glutathione in blood; Nicodinum has bactericidal property. From the specified synthetic drugs in the USSR are allowed for use Nicodinum, oksafenamid, Cycvalonum.
Holekineticheskiye Zh. pages strengthen biliation of hl. obr. thanks to specific irritation of a mucous membrane of a duodenum therefore there is an allocation in blood of hormone cholecystokinin (see) which causes reduction of a gall bladder and sphincteri incontinence of the general bilious channel (Oddi's sphincter). Thanks to continuous outflow of bile its stagnation in channels is eliminated, absorption in blood decreases and development of an infection and formation of stones is prevented, intensity of inflammatory process decreases. K Zh. pages of this group belong magnesium sulfate (see. Magnesium ), Pituitrinum (see), polyatomic alcohols — xylitol (see), mannitol (see) and sorbite (see), vegetable oils, egg yolks. Biliation is promoted also antispasmodics (see) and cholinolytic means (see), eliminating a spasm of sphincters of bilious channels
. pages appoint at various diseases of a liver, gall bladder and bilious ways (hron, hepatitises, cholecystitis, a cholangitis, etc.) hl. obr. for the purpose of improvement of a passage of zhelchevydelitelny system.
At infectious processes in a liver or bilious ways. the page is appointed in combination with antiseptic agents or chemotherapeutic means (antibiotics, streptocides). the pages containing to - you, apply also at long drainage (see) bilious ways or in the presence of a fistula on a gall bladder. They contribute to normalization of digestion, strengthen bile secretion, preventing development of an infection. The drugs containing bile and bilious to - you, can serve as means of replacement therapy at endogenous insufficiency bilious to - t (cirrhoses of a liver).
At obstruction of the general bilious channel small concrements sometimes use holeretichesky means (hl. obr. dekholin) in combination with magnesium sulfate and spasmolysants.
At diseases of a liver and bilious ways. pages quite often combine with laxatives for the purpose of elimination of locks and the related intensive return absorption in blood of components of bile and various toxicants from intestines. Some choleretics, especially dekholin and dehydrocholic to - that, have the expressed diuretic effect. It is reasonable to appoint them at the cirrhosis and other diseases which are followed by ascites.
Holekinetiki is applied by hl. obr. at duodenal sounding (see). For elimination of spasms (attacks of bilious colic) or at the treatment of diseases of a liver and bilious ways which are followed by pains appoint spasmolysants and cholinolytics.
Use of holeretichesky means is contraindicated at the acute inflammatory and sharply expressed dystrophic processes in a liver, and also at the diseases of a liver which are followed by a cholemic syndrome since they create additional load of cells of a liver and can strengthen jaundice. However at long mechanical jaundice purpose of small doses of Allocholum or Cholenzymum is reasonable since they provide absorption of fat-soluble vitamins (especially And yes To) in intestines.
Kliniko-pharmakol. characteristic of the main. the pages applied in medical practice it is given in the table.
Table. Kliniko-pharmakologichesky characteristic of the fixed cholagogue assets
Bibliography: Mashkovsky M. D. Pharmaceuticals, p.1, page 455, M., 1977; Racer N. P. and Gubergrits A. Ya. Pharmakoterapiya of diseases of a liver and bilious ways, page 107, Kiev, 1971.