Cholestasis is called a condition in which the intake of bile into the duodenum is broken.
Causes of cholestasis
The emergence of cholestasis is associated with two fundamentally different types of causes:
- Decrease in the formation of bile in the liver;
- A violation of the excretion of bile from the liver into the intestine, which, in turn, can be divided into the intrahepatic excision block and extrahepatic block.
Disturbances in the formation of bile are due to liver diseases - viral, bacterial, toxic (including alcoholic and medicinal) hepatitis, cholestatic pregnancy, benign recurrent cholestasis.
Disruption of bile outflow may be due to tumorous processes, cholecystitis, cholangitis, tuberculosis, sarcoidosis, lymphogranulomatosis and other diseases, in which an obstruction occurs during the course of bile flow.
Depending on the causes causing the pathological process, the severity and duration of the disease are distinguished:
- Acute and chronic cholestasis;
- Cholestasis, which occurs with signs of jaundice or without them.
Clinical manifestations of cholestasis
The main manifestations of cholestasis include jaundice, itching of the skin and manifestations of inappropriate absorption of fat in the intestine, but none of these symptoms are early - all of them appear at a fairly late stage of the disease.
At the earliest stages, attention should be paid to the symptoms of the underlying disease, whose manifestations may begin long before the onset of cholestasis.
Pure cholestasis, unlike most diseases affecting the liver to cause weakness and fatigue, all symptoms of intoxication are very specific in nature, since due to the accumulation of fatty acids and bilirubin.
The bile acids, probably, cause itching, is very concerned with the person with cholestasis. The mechanism of this phenomenon is associated with irritating fatty acids on the nerve endings of the dermis and epidermis.
Because the bile acids do not reach the intestine, there are problems with the chair - violated the absorption of fat, which appears unchanged in the feces (steatorrhea).
This pathological condition is accompanied by weight loss and a decrease in the blood of fat-soluble vitamins (A, D, K, E). The first is reduced vitamin E, which causes prolongation of the time of blood coagulation and can appear for a long time, do not stop bleeding. Prolonged cholestasis leads to malabsorption of vitamins to the development of other "night blindness" osteodystrophy and development of other diseases associated with hypovitaminosis.
Cholestasis can be the cause of a violation of the exchange of copper in the body, as in normal, most of this element is removed precisely with bile. Copper accumulates in the liver and other organs, causing severe, often prognostically unfavorable conditions.
Chronic cholestasis has its own characteristics - xanthoma - soft, flat or slightly raised education around the eyes, palmar creases, neck, chest, back or under the breasts; Xanthos in the form of nodules are located on the surface of the joints, on the buttocks and places subjected to compression.
Diagnosis of cholestasis
Diagnosis of cholestasis is based on laboratory parameters: in the blood, elevated levels of bile acids, bilirubin (conjugated) and alkaline phosphatase. In chronic cholestasis, lipid levels (cholesterol, triglycerides, lipoproteins, phospholipids) may be elevated.
To clarify the nature of the disease, an ultrasound examination, an endoscopic retrograde chalangiogia and a transcutaneously-estrusal cholangiography are used.
Treatment of cholestasis
If the cause of the disease is known, then the treatment should be directed to it - education or stones that prevent the outflow of bile are removed, drugs are replaced, etc.
If the cause of cholestasis is unknown or known, but can not be removed, then the treatment is based on the diet and drug therapy. The diet implies a reduction in the amount of animal fats in food, consumption of products with triglycerides, medium chain length, and adequate vitamin therapy.
The drug of choice for non-obstructive cholestasis is ursodeoxycholic acid, which displaces toxic bile acids and provides tsitoprotektirovnoe action, beneficial effect on the function of the liver. To remove it, sedation is used.
Prevention of cholestasis reduces to the timely detection and treatment of diseases of the liver, gall bladder and biliary tract.