Холестаз – что это за болезнь? Cholestasis (from others-Greek. Chole-bile, stasis-standing) is a pathological process, characterized by reduction or cessation of bile in the lumen of the duodenum as a result of the breach of its synthesis, shedding or excretion.
It may be associated with pathological processes on any stretch of hepatocytes to duodenal papilla.
Холестаз – Причины возникновения
Holetsaticeski syndrome may have many causes, However, they can be divided into two groups: the first, pathological processes, violate synthesis of bile, vnutripechjonochnye often causes, and, Secondly, violations of excretion and bile allocation. The first include the following:
- · вирусные поражения печени (gepatitы);
- · алкогольные поражения печени;
- · токсические поражения печени (heavy metal poisoning, Poisons);
- · врождённые метаболические нарушения (mukovystsydoz, galactosemia, Alpha1-antitrypsin deficiency, tyrosinemia);
- · медикаментозное поражение печени (with some gepatotoksicnah medicines);
- · первичный билиарный цирроз;
- · септические состояния;
- · застойная сердечная недостаточность;
- · холестаз беременных;
- · хромосомные нарушения (Trisomy 17, 18, 13and chromosomes);
- · эндокринная патология (gipopituitarizm, gipotireoz);
- · семейные синдромы (eg, Alagille Syndrome, etc.).
To vnepechjonochnym reasons include the following:
- · склерозирующий холангит (primary and secondary);
- · болезнь Кароли (congenital dilatation of the bile duct vnutripechjonochnyh);
- · желчекаменная болезнь;
- · стриктуры желчных протоков;
- · злокачественные новообразования поджелудочной железы или холедоха;
- · билиарная атрезия и др.
Холестаз – Симптомы
- · skin itching, growing at night, diminishing day (for a long time may be the only symptom of cholestasis);
- · ксантелазмы (small size education yellowish-brownish color on eyelids, often symmetrically located);
- · ксантомы (education of type ksantelazm-small yellowish education, but located on the back, Breast, elbows);
- · мацерация кожных покровов, as well as pustular rash secondary infection raschjosov);
- · гиперпигментация кожи;
- · может возникать боль в эпигастрии, the right hypochondrium;
- · nausea, vomiting, loss of appetite;
- · может отмечаться повышение температуры тела;
- · желтушность кожи, mucous membranes and sclera;
- · потеря массы тела;
- · изменения цвета мочи и кала (dark urine, discoloration of the faecal masses);
- · стеаторея (the high fat content in feces);
- · гиповитаминозы (Vitamin a deficiency-dry skin, night blindness, dryness of mucous membranes and sclera; vitamin e-infertility, muscular weakness; Vitamin D deficiency-osteoporosis, pathological fractures);
- · повышенная кровоточивость (decrease of absorbability of vitamin k);
- · холелитиаз (formation of stones in the biliary duct and bladder).
Холестаз – Диагностика
- severe conditions (anemia, leukocytosis);
- physical examination (is determined by the increase of the level of direct bilirubin, bile acids, activity of alkaline phosphatase, cholesterol, lejcinaminopeptidazy activity, GGT, 5-nukleozidazy);
- · анализ мочи (detected bile pigments, urobilinogen);
- examination of feces for the presence of helminths and protozoa (enlargement of the liver, resizing of the gallbladder, expansion of bile duct obstruction above);
- · ретроградная панкреатохолангиография (evaluated State of bile ducts);
- · компьютерная и магнитно-резонансная томографии органов брюшной полости;
- · чрескожная чрезпечёночная холангиография (endoscopy of the bile ducts with contrast);
- · биопсия печени с гистологическим исследованием (rarely used).
Холестаз – Виды заболевания
Cholestasis can be vnutripechjonochnym and vnepechjonochnym. Vnutripechjonochnyj can be divided into the following subspecies:
- · функциональный холестаз (decreases the level of bile kanal'cevogo current, bilirubin and bile acids, Fasciola excretion of water);
- · морфологический (accumulation in hepatocytes and bile duct components of bile);
- · клинический холестаз (delay of bile components in blood).
Depending on the presence or absence of jaundice secrete icteric and bezzheltushnyj cholestasis.
Downstream of the pathological process emit the acute and chronic cholestasis.
On the mechanism of development of cholestasis sometimes partial (decreases the volume allocated to the bile), dissociativnym (delay selection of some components of bile) and pervasive (breach allocation of bile into the duodenum).
Cholestasis can also occur with or without cytolysis.
Холестаз – Действия пациента
When identifying the above symptoms should consult a physician-gastroenterologist for examination and further treatment.
Холестаз – Лечение
Treatment of cholestatic syndrome is to eliminate its causes, that is, treatment of the underlying disease (treatment of tumors, removing stones, deworming, etc.). It is also possible use of Ursodeoxycholic acid (ursosan), holestiramina, plasmapheresis and etc.. Is assigned a special diet with reduced content of neutral fats.
Холестаз – Осложнения
Cholestasis can be complicated by bleeding, Osteoporosis, formation of gallstones with development of cholangitis, gemerolopiej, cirrhosis and hepatic insufficiency.
Холестаз – Профилактика
Refraining from the consumption of alcoholic beverages, reducing the number of acute, greasy and fried foods in the diet, timely treatment of diseases, leading to holestazu.