Cholestasis is a disorder of bile excretion as a result of insufficient formation of it in the hepatic cells or cessation of outflow along the bile ducts.
There are cholestasis intrahepatic andextrahepatic. Intrahepatic cholestasis develops with damage to hepatic cells by a viral infection, medication and toxic damage to the liver, including alcohol. Medication of liver damage is observed with prolonged use of antibiotics, including anti-tuberculosis, as well as anti-inflammatory, hormonal and psychotropic drugs. Toxic liver damage causes salts of heavy metals, benzene and its derivatives, hydrocarbons with chlorine. In some cases, the causes of intrahepatic cholestasis are unknown. This also applies to the state of cholestasis during pregnancy.
As a result of damage to the liver cells, secretion of bile, reabsorption and secretion of fluid in the bile duct are disturbed.
Extrahepatic cholestasis occurs as a result ofthe presence of a mechanical barrier to the outflow of bile. This occurs with calculous cholecystitis, acute pancreatitis, swelling of the head of the pancreas and bile ducts.
In addition to these diseases, cholestasis symptoms can be observed in allergic diseases, systemic lesions of the connective tissue, and some endocrine diseases.
The clinical picture of cholestasis
The subjective symptoms of cholestasis are determined bytime of conversation with the patient. The patient complains of dryness and bitterness in the mouth, especially in the morning, pain or a feeling of heaviness in the right hypochondrium. On examination of the patient revealed jaundice staining of the skin and mucous membranes, which is accompanied by intense skin itching. The appearance of itching is associated with the irritating effect of bilirubin, the level of which increases sharply with cholestasis. The patient's tongue is covered with a yellowish bloom, tooth prints appear on the edge of the tongue, a so-called scalloped tongue is formed. On palpation, the liver is painful, protrudes from the edge of the costal arch. The positive symptom of Ortner (painful tapping along the right costal arch), Kerr symptom (pain on palpation at the site of projection of the gall bladder) is determined. A characteristic feature is discolored feces and dark urine.
The clinical symptoms of cholestasis are fairly typical. They are complemented by laboratory data.
Симптомы холестаза в биохимическом анализе крови - an increase in the content of direct bilirubin, the content of bile acids and cholesterol, high activity of alkaline phosphatase. In the general analysis of urine bile acids, high level of urobilin are determined.
Cholestasis treatment
Since cholestasis is just a symptom, the presence of which is possible in many diseases, treatment should be carried out only after determining the diagnosis of the underlying disease.
If cholestasis has developed, treatment should begin with the appointment of a diet. Patients are shown diet number 5. The purpose of the diet is aimed at maximally limiting the irritating effects on the liver.
Drug therapy is the appointmenthepatoprotectors, choleretic drugs, antispasmodics. Effectively prescribing herbal medicine. When cholestasis can be used decoction of the immortelle sandy, corn stigmas, rosehips. To prevent the development of cholestasis, the normalization of bile outflow, blind sensing is used, the use of which is prohibited in the presence of large stones in the gallbladder.
Prevention of cholestasis is the timely diagnosis and treatment of diseases of the liver and biliary tract.
