CHOLESTASIA (cholestasis; Greek chole bile - f-stasis standing) — the insufficiency of biliation caused by disturbance of its development by hepatic cells (a vnutripeche-nochny cholestasia) or the termination of current of bile on bilious channels (an extrahepatic cholestasia).
Damages of hepatic cells by a virus are the main reasons for a vnutripe-chenochny cholestasia at a viral hepatitis (see a viral hepatitis), alcohol at alcoholic hepatitis (see the Liver, diseases) and cirrhosis (see), chemical connections and toxicants at toksiko-allergiche-skom hepatitis (see Hepatitis), and also dysfunction of hepatocytes of an unknown etiology at pregnant women or at primary biliary cirrhosis. The pathogeny of an intra-hepatic cholestasia still remains not absolutely clear. Its development is connected first of all with damage of the secretory device of hepatic cells and bilious tubules. At the same time there is a disturbance of secretion of fractions of bile, and also a reabsorption and secretion of liquid and electrolytes in bilious tubules.
The extrahepatic cholestasia develops in connection with existence of a mechanical obstacle at cholelithiasis (see), cancer of a head of a pancreas (see), cancer of bile-excreting channels, acute or hron. the sclerosing pancreatitis (see) sclerosing fathers illite at a peptic ulcer with post-bulbar localization of an ulcer (see. A peptic ulcer), a polypose of a duodenum, a diverticulum of a duodenum in the field of a faterov of a nipple (a big nipple of a duodenum), p erikho the l e died and flax lymphadenitis, cancer of a faterov of a nipple (see), an inborn malformation of bilious ways (with m D in e } t and d of c and t and p ER with t of N and I to and sh to and, ate with h N and e p r about t about to and).
The pathoanatomical picture at a cholestasia is characterized by accumulation of granules of a bilious pigment in cytoplasm of hepatocytes, is preferential in the center of a hepatic segment, development of dystrophic and necrotic changes of hepatocytes, a reactive inflammation and change in the bilious courses up to their destruction.
Clinically the cholestasia is shown by jaundice (see), a skin itch (see the Itch skin), decolouration a calla of different degree of manifestation. In blood increase in direct bilirubin (see), cholesterol (see), bile acids (see) and activities of an alkaline phosphatase is observed (see).
To define character of a cholestasia on the basis a wedge, pictures and data a lab. researches it is extremely difficult. The intra hepatic cholestasia meets at women more often. Shegren's syndrome (see Shegren with and and d r about m), r ev m and / p oidny arthritis (see), endocrine disturbances, an allergy (see) to drugs and foodstuff can accompany it. Jaundice develops against the background of reception of hepatotoxic medicines. The long time precedes jaundice a skin itch. A cholangitis (see) and the attacks of pains characteristic of bilious colic or pancreatitis, no. The splenomegaly (see), ksan volumes that z is noted (see). Process progresses rather slowly.
The Vneiyechenochny cholestasia meets identical frequency at men and women. The diseases accompanying a vnut-rinechenochny cholestasia usually are absent. In the anamnesis frequent attacks of bilious colic (see Cholelithiasis) and pancreatitis, manifestation of a holaigit. Bystry, almost simultaneous emergence of a skin itch and jaundice, absence of a splenomegaly, bystry progressing of process is characteristic.
The most informative at differential diagnosis of a vnut-ripechenochny and vneiyechenochny cholestasia are tool methods of a research. At the same time apply an ekhografiya (see. Ultrasonic diagnosis), rentgenol. a research of a stomach and duodenum, gastroscopy (see) and a duodenoskopiya (see), a holegrafiya (see), to-ruyu carry out at the level of bilirubin
no more than 2 mg / 100 by ml (34,2 µmol! k), scanning of a liver and pancreas (see Scanning), a radionuclide holangiografiya with HIDA — 99shts, a computer tomography (see the Tomography computer), an endoscopic retrograde pankreatokholangiografiya (see Pankreatokholangiograf) iya retrograde), a laparoscopy (see Pe-ritoneoskopiya). In some cases there is a need in diagnostic a laparotompa and an operational holangiografiya.
At a cholestasia recommend the food rich with protein, fats limit up to 40 g a day because of disturbance of their absorption connected with insufficient intake of bile. At an intra hepatic cholestasia a symptomatic treatment. Appoint holestiramin, Biligninum, intravenous injections of 5% of solution of glucose and Haemodesum apply. At decrease in level of a prothrombin appoint Vikasolum intramusculary. At primary biliary cirrhosis, cholestatic hepatitis apply Prednisolonum. Hemosorption (see t. 10, Don. materials) the short-term effect gives. At an extrahepatic cholestasia treatment operational.
The forecast depends on a basic disease.
Prevention comes down to the prevention and treatment of diseases of a liver and the bilious ways which are followed by development of a cholestasia. Bibliography: Diseases of the digestive system, under the editorship of A.S. Loginov, page 3, M., 1977; Klemashev I. C. Differential diagnosis and therapy of cholestasias, in book: Aktualn. probl. sovr. clinics, under the editorship of I. A. Novikov, etc., page 8, M., 1982; Diseases of the liver, ed.
by L. Schiff a. E. R. Schiff, Philadelphia,
1982. I. S. Klemashev.