Holestatichesky hepatitis is a disease in which development key value has difficulty of current of bile, and also accumulation of the components making it in a liver. Clinically the disease is shown by an itch, discomfort in a zone of the right podreberye, intensive jaundice, dyspepsia, increase in a liver and emergence on skin. In diagnostics all-clinical and biochemical blood tests with definition of hepatic tests, ultrasonography of a liver and a gall bladder, a sonografiya of a pancreas, MRT of abdominal organs have major importance. Therapy is directed to improvement of outflow of bile and normalization of function of body.
Holestatichesky hepatitis represents rather rare pathology of which pathogenesis is the cornerstone intra hepatic with deterioration in excretory function of cages and damage of channels. Frequency of detection of a disease does not exceed 10% among all hepatitises with a chronic current. Holestatichesky hepatitis mainly occurs at people of advanced age. Despite rather low prevalence, a disease will badly respond to treatment because not always perhaps accurately to establish its reason. The gastroenterology is engaged in studying of an etiology and pathogenesis, and also development of new methods of therapy of holestatichesky hepatitis. Diagnostics and treatment of a disease are carried out by the gastroenterologist together with the hepatologist and the surgeon.
Reasons of holestatichesky hepatitis
This pathology can be caused by intra hepatic or extra hepatic stagnation of bile. In the first case violation of outflow of bile is possible both at the level of cells of a liver, and at the level of intra hepatic channels. Often transition of acute viral hepatitis B, C or other types to a chronic form is the reason of stagnation of bile at the level of a liver. Also in some cases lead damages of a liver to an intra hepatic holestaz viruses Ebshteyna-Barra, herpes, a cytomegalovirus, a mikoplazmenny infection. Reception of various medicines, such as aminazine, some diuretics, antibiotics, anabolic steroids, contraceptives can become the reason of holestatichesky hepatitis. Emergence of an intra hepatic holestaz is preceded sometimes by influence of toxins, alcohol, poisons. Holestatichesky hepatitis develops also against the background of endocrine diseases.
Extra hepatic can be a consequence of obstruction of large channels. In this case as its possible reasons serve obstruction by a stone of the general bilious channel, chronic kalkulezny cholecystitis, chronic pancreatitis, cancer of a head of a pancreas and a tumor of other bodies of gepatobiliarny system. Against the background of a holestaz in a liver there is a destruction of hepatocytes to the subsequent malfunction of body. In certain cases it is not possible to establish the reason of development of a disease that it is treated as idiopathic holestatichesky hepatitis.
Symptoms of holestatichesky hepatitis
The symptomatology of holestatichesky hepatitis is similar to displays of other chronic diseases of a liver. Distinctive features are more expressed jaundice and a skin itch which often acts as the first display of a disease. The itch in this case is caused by hit in blood of bilious acids owing to stagnation of bile in a liver. Also patients with a holestatichesky form of hepatitis often have ksantoma which have an appearance of yellow spots. At the same time color a calla, as a rule, becomes lighter, and urine darkens. Palpatorno is defined increase in the sizes and increase in density of a liver without splenomegaliya. In the period of an aggravation temperature increase and soft symptoms of intoxication is possible. Weight of a clinical picture depends on expressiveness of a holestaz.
Diagnosis of holestatichesky hepatitis
In diagnosis of a disease an important role is played by laboratory and tool methods of a research. From laboratory techniques the basic for diagnosis of a holestaz consider biochemical blood test. At a biochemical research increase in level of bilirubin at the expense of direct fraction, increase in level , alkaline phosphatase (more than by 5 times), gamma glutaminetransferase and cholesterol is noted. It is also possible to define the increased quantity in blood of phospholipids, V-lipoproteidov and bilious acids. For confirmation of a virus etiology of a disease the research of specific markers is conducted by the IFA and PTsR methods. A characteristic serological marker of an intra hepatic holestaz is definition of anti-mitochondrial antibodies.
From tool methods performing ultrasonography of a liver and gall bladder is obligatory. At ultrasonography symptoms of chronic hepatitis come to light. Ultrasonography of bilious ways, a gall bladder and a pancreas allows to confirm or exclude extra hepatic . With difficulties in diagnostics of a holestaz the retrograde holangiopankreatografiya, a chreskozhny chrespechenochny holangiografiya or the cholecystography which allow to find stones in bilious ways when they are not visible on ultrasonography is carried out. By modern noninvasive methods of identification of the reasons of holestatichesky hepatitis are MR-pankreatokholangiografiya and MRT of a gepatobiliarny zone. For studying of morphological changes the punktsionny biopsy of a liver can be carried out though it also does not play a crucial role in diagnostics of a holestaz.
Treatment of holestatichesky hepatitis
Treatment of chronic hepatitis with a holestatichesky syndrome has to be based on elimination of the reason which led to a holestaz. If influence of toxic factors or medicamentous medicines is a cause of illness, then it is necessary to stop their receipt in an organism. All patients are recommended to adhere to a diet No. 5 which provides an exception of spicy, greasy and fried food. It is obligatory to minimize alcohol intake which negatively influences cells of a liver. Good nutrition with sufficient protein content is also recommended. At any stage of a disease reception of fat-soluble vitamins A, E, and also B12 is desirable. For improvement of function of hepatocytes gepatoprotektor, essentsialny phospholipids and lipoic acid can be appointed.
In the presence of an intra hepatic holestaz with high activity of inflammatory process purpose of small doses of Prednisolonum for reduction of expressiveness of pathological changes is shown. If the patient is disturbed by a severe itch, use of medicines is necessary for neutralization of bilious acids, such as or a lignin. The most effective remedy for treatment of an intra hepatic holestaz ursodezoksikholevy acid which improves bile outflow is considered. Medicine is recommended to all patients with holestatichesky hepatitis. If hepatitis is caused by an extra hepatic holestaz, it is necessary to remove its cause. Various operational methods, such as a laparoscopic or open holetsistektomiya, a pancreas head resection, extraction of concrements of bilious channels at RPHG are for this purpose used, endoscopic balloon dilatation of a sphincter of Oddi and so on.
Prevention of a disease comes down to the termination of receipt in an organism of alcohol and other hepatotoxic substances, and also to timely treatment of pathology of a liver. At the correct treatment and elimination of the reason of a holestaz the forecast at holestatichesky hepatitis in general favorable.