Functional and organic diseases of liver and bile ducts. Etiology, pathogenesis, clinical features,...

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Transcript of Functional and organic diseases of liver and bile ducts. Etiology, pathogenesis, clinical features,...

  • Slide 1
  • Functional and organic diseases of liver and bile ducts. Etiology, pathogenesis, clinical features, diagnostics, treatment and prophylactic Lecturer: Gorishna Ivanna Lubomyrivna
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  • Plan of the lecture Definition of biliary dyskinesia Definition of biliary dyskinesia Biliary dyskinesia Biliary dyskinesia classification Clinical manifestation Methods of examinations biliary dyskinesia Treatment of the different kinds of biliary dyskinesia Definition of the chronic hepatitis Definition of the chronic hepatitis Hepatitis classification Clinical manifestation Methods of examinations Treatment of the different kinds of hepatitis
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  • Definition of the Biliary Dyskinesia is a disorder of the sphincter tonus and kinetics of the gall-bladder and bile ducts. is a disorder of the sphincter tonus and kinetics of the gall-bladder and bile ducts.
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  • Classification hypertonic-hyperkinetic dyskinesia hypertonic-hyperkinetic dyskinesia hypotonic-hypokinetic dyskinesia hypotonic-hypokinetic dyskinesia
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  • Clinical manifestation of hypertonic-hyperkinetic dyskinesia Duration of the disease up to 1 yr. Duration of the disease up to 1 yr. Pain syndrome Pain syndrome Dyspeptic syndrome Dyspeptic syndrome Manifestations of vegetative dysfunction, neurotic symptoms Manifestations of vegetative dysfunction, neurotic symptoms
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  • Clinical manifestation of hypotonic-hypokinetic dyskinesia Pain syndrome Pain syndrome Dyspeptic syndrome Dyspeptic syndrome Hepatomegaly Hepatomegaly Gallbladder symptoms are positive Gallbladder symptoms are positive
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  • Plan of examination Fool blood count Fool blood count Biochemical test of blood Biochemical test of blood Serum aminotransferase Serum aminotransferase Serum bilirubin (predominantly the direct reacting fraction) Serum bilirubin (predominantly the direct reacting fraction) Serum alkaline phosphatase Serum alkaline phosphatase Albumin and globulin level Albumin and globulin level Stool test Stool test USE of the abdominal cavity + cholekynetics for functional investigations USE of the abdominal cavity + cholekynetics for functional investigations
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  • Stool test:Norma Biliary dyskinesia indigested muscular fibers non-digestable cellulose digestable cellulose fatty acids mucous epithelium leucocytes erythrocytes 1-2-3 + + + + ++ 1-2 1-2-3 0-1++++
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  • Duodenal intubation PortionphaseDuration (min) ColorSpeed of bile excretion Total volume, ml AI10-20 Golden- yellow 0.2-1.48-22 II2-6--- III3-5yellow0.6-1.83-5
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  • Duodenal intubation PortionphaseDuration (min) ColorSpeed of bile excretion Total volume, ml BIV20-30 Brown 1.1-2.515-30 CV20-30Golden -yellow 0.2-1.0 Constant
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  • Duodenal intubation Portion ColourpHEpitheliumLeucocyteLambliaMu- cus AGolden yellow 75-10 --+ BBrown 75-10 -- CBright yellow 75-10 --
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  • Duodenal intubation PortionColorpHEpitheliumLeucocytesLambliaMu- cus AYellow -green 6.25-6 -- BBrown -green 5.53-53-6-- Cyellow7.24-62-4--
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  • 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 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 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 hypotonic dyskinesia - contraction of the gallbladder less than 1/2 of the previous volume
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  • 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. 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 Foods boiled, steamed and baked are recommended; food taking 5 times daily
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  • Treatment of hypertonic- hyperkinetic dyskinesia 1. Diet N 5 2. Spasmolitics: platyphyllini hydrotartratis (amp. 0.2 % 1 ml) papaverini hydrochloridum (tab. 0.01, amp. 2 % 2 ml) no-spa (tab. 0.04 or amp. 2 % 2 ml) 3. Choleretic: cholagon allocholum cholenzynum galstena hepabene
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  • Treatment of hypotonic- hypokinetic dyskinesia 1. Diet N 5 Prokinetic: motilium, domperidone (tabl. 0.01 g) 1 mg/kg/day Prokinetic: motilium, domperidone (tabl. 0.01 g) 1 mg/kg/day 3. Choleretic and cholekinetic drugs: cholagon allocholum cholenzynum galstena hepabene chophytol
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  • Hepatoprotectors Essentiale (cap., amp.) 1-2 cap. 3 times a day Essentiale (cap., amp.) 1-2 cap. 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Thiotriazolinum 1 tabl. 3 times a day Thiotriazolinum 1 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day
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  • Antioxidants (aevitum, tocopheroli acetatis) Antioxidants (aevitum, tocopheroli acetatis) Enterosortion (enterosgel) Enterosortion (enterosgel) Probiotics (linex, bifiform, bactisuptil) Probiotics (linex, bifiform, bactisuptil)
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  • Blind Duodenal intubation with magnesii sulfatis 33 % with magnesii sulfatis 33 % xylitol or sorbitol 10 % xylitol or sorbitol 10 %
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  • Chronic cholecystitis and cholecystocholangitis Chronic recurrent inflammatory process of gallbladder and intrahepatic bile ducts, accompanied with bile ducts motor disorders Chronic recurrent inflammatory process of gallbladder and intrahepatic bile ducts, accompanied with bile ducts motor disorders
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  • Clinical manifestation Pain syndrome Pain syndrome Dyspeptic syndrome Dyspeptic syndrome Intoxication syndrome Intoxication syndrome Cholestasis Cholestasis Inflammatory syndrome Inflammatory syndrome Dyscholia Dyscholia Ph of bile is acidic Ph of bile is acidic USE USE
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  • Duodenal intubation Portion ColorpHEpitheliumLeucocytesLambliamu cus Agreen6.28-106-8++ BBrown- green 4.540-5055-60-- Cyellow7.210-169-16--
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  • Treatment of hypotonic- hypokinetic dyskinesia 1. Diet N 5 2. Prokinetic: motilium, domperidone (tabl. 0.01 g) 1 mg/kg/day 3. Choleretic and cholekinetic drugs: cholagon allocholum cholenzynum galstena hepabene chophytol
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  • Hepatoprotectors Essentiale (cap., amp.) 1-2 cap. 3 times a day Essentiale (cap., amp.) 1-2 cap. 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Carsil (dragee) 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Hepabene 1-2 dragee 3 times a day Thiotriazolinum 1 tabl. 3 times a day Thiotriazolinum 1 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day Chophytol 1-2 tabl. 3 times a day
  • Slide 26
  • Treatment of lambliasis, girardiasis Furasolidone 8-10 mg/kg 4 times a day- 10 days (tabl. 0.05) Furasolidone 8-10 mg/kg 4 times a day- 10 days (tabl. 0.05) Tinidazole 50-60 mg/kg/day (tab. 0.5, 0.15) Tinidazole 50-60 mg/kg/day (tab. 0.5, 0.15) Metronidazolum 15-20 mg/kg for 5 days (tabl. 0.5) Metronidazolum 15-20 mg/kg for 5 days (tabl. 0.5)
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  • Blind Duodenal intubation with magnesii sulfatis 33 % with magnesii sulfatis 33 % xylitol or sorbitol 10 % xylitol or sorbitol 10 %
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  • 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 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
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  • Chronic hepatitis can be caused by persistent viral infection, drugs, and autoimmune or unknown factors. Approximately 1520 % of cases are associated with hepatitis B infection; in this group of patients, unusually severe disease may be caused by superimposed infection with hepatitis D (a defective RNA virus that is dependent on replicating hepatitis B virus). More than 90 % of infants infected during the 1st year of life experience chronic hepatitis B infection compared with a rate of 510 % among older children and adults. Chronic hepatitis may also follow 3050 % of hepatitis C virus infections. Patients receiving blood products or who have had massive transfusions are at increased risk. Hepatitis A virus does not cause chronic hepatitis. Drugs comm