Objectives: To study the structure and functions of the liver and biliary tract. Study the most common diseases. Through a survey, identify the most frequent illnesses liver and bile ducts, causes that led to diseases. Develop recommendations for the prevention of these diseases.
General concepts about the liver The liver (hepar) is the largest digestive gland. It is located directly under the diaphragm in the upper abdominal cavity, mainly in the right hypochondrium. It has top and bottom surfaces, front and rear edges. The liver is also divided into two lobes: the right (larger) and the left (smaller).
Functions of the liver: Completion of the digestion process Storage of energy compounds necessary for the life of the body and their release into the blood in the required quantities for everyone at this moment quantities Neutralization of compounds toxic to the body Synthesis and release into the blood of a number of protein bodies that play important role in blood coagulation processes Formation and excretion through the system biliary tract specific secretion – bile Production of a significant part of the energy necessary for the body’s functioning Can serve as a blood reservoir
General information about the gallbladder shape elongated pear-shaped, with one wide end and the other narrow end Length 8–14 cm width 3–5 cm capacity 40–70 cubic cm color dark green The gallbladder is a sac-like reservoir for bile produced in the liver
Bile Bile is a liquid of complex composition, pH, bitter taste, contains 90% water and 10% organic and mineral substances. It contains bile acids, pigments, cholesterol, bilirubin (dye, pigment), NaCl and KCl, Ca, Fe, Mg, a number of hormones and metabolic products.
Cholecystitis Cholecystitis is inflammation of the gallbladder. In most cases, cholecystitis develops in the presence of gallstones. Reasons: irregular diet combined with overeating sedentary lifestyle pregnancy infection ( coli, cocci and other pathogens penetrate from the intestines or are carried through the bloodstream). hereditary constitutional predisposition.
Gallstone disease Gallstone disease is associated with the formation of cameos in the gallbladder and/or bile ducts and is caused by stagnation of bile in them or metabolic disorders. Often, for a number of years, the patient feels heaviness in the right hypochondrium that occurs after eating, bitterness in the mouth, and bitter belching. These first symptoms of trouble in the body are a sufficient reason to consult a doctor.
Gallstone disease Causes: excessive nutrition and a sedentary lifestyle, stagnation of bile associated with anatomical changes in the gallbladder and bile ducts as a result of their inflammation (scars, adhesions) and disturbances in its motor function, irregular nutrition (long breaks between meals), overeating, bloating, constipation is a hereditary predisposition to cholelithiasis (the disease occurs in members of the same family in different generations).
Chronic hepatitis Morphological definition: chronic hepatitis is an inflammatory-dystrophic lesion of the liver with histiolymphocytic infiltration along the portal tract with hypertrophy of Kupffer cells, atrophic changes in the parenchyma and preservation of the lobular structure.
Chronic hepatitis Chronic hepatitis in% of cases is the outcome of acute viral hepatitis. The hepatitis virus belongs to the group of slow viruses. It is found in all body fluids, especially in the blood. It can even be found in human saliva. It is highly resilient and can survive for a long time in dried blood or on other surfaces. The hepatitis B virus is 100 times more virulent than the AIDS virus.
Chronic hepatitis The transition of acute to chronic hepatitis is facilitated by: late diagnosis, insufficient treatment, poor nutrition, diet, alcohol intake, early discharge, early onset physical activity after an illness due to gastrointestinal diseases. But even if all of the above factors are excluded, viral hepatitis becomes chronic in 5% of cases.
Research part I conducted a survey on the topic “Diseases of the liver and biliary tract, their causes.” The respondents were asked to answer 10 questions in writing. 50 people were interviewed of different ages and social status. The survey showed the following results:
The number of diseases depending on the gender of the respondents: If we compare the number of cases between men and women, then women get sick more often (6% - hepatitis, 30% - cholecystitis). While men get sick less often (5% - hepatitis, 5% - cholecystitis).
Dependence of diseases on the age of respondents: The dependence of diseases on age is clearly visible. If among those surveyed under 30 years of age, 22% of people are ill, and 23% of people older than 30 years of age, then over 50 years of age, this disease occurs in 55%.
Bowel diseases
Dyskinesia. Impaired motor function (dyskinesia) of the biliary tract and gallbladder occurs very often. Dyskinesia leads to changes in the ratio of bile pressure and different departments biliary system and impaired delivery of bile to the intestines. Impaired motor function can occur without visible preconditions, although dyskinesia is accompanied by all diseases of the biliary system (cholelithiasis, tumors, scars after removal of the gallbladder, etc.). Pregnancy, allergic conditions, and many diseases of the stomach, intestines and pancreas predispose to the development of dyskinesia of the biliary system. Finally, dyskinesia may be a consequence of neuroses.
Biliary dyskinesia is characterized by a feeling of heaviness and Blunt pain in the upper right abdomen, usually occurring 1.5-2 hours after eating. The pain is often accompanied by nausea and sometimes vomiting. Primary, i.e. not caused by any other disease, dyskinesia occurs without complications. Drug therapy usually prescribed by a doctor. The patient can try to take one or more medications to relieve pain that relieve spastic contraction of smooth muscles and are sold over the counter in pharmacies, for example papaverine, papalul, vitamin P (nicotinic acid). It is best to take these medications immediately before meals. If pain has already arisen, nitroglycerin (1 tablet under the tongue or Votchal drops (6-8 drops applied to a small piece of sugar) often helps to relieve it.
For neuroticism (anxiety, restlessness, fears, insomnia), drugs used to treat neuroses, in particular valerian root infusion, and various non-medicinal methods are used to eliminate dyskinesia. Heat on the liver area can only be used for primary dyskinesia, after consulting with a doctor.
The diet should, if possible, contain a large amount of vegetable fats that have a choleretic effect. Useful before or during meals of plants or animals choleretic drugs, for example, extract of corn silk, allohol, cholenzyme, cholagon, etc. In pharmacies you can buy sandy immortelle flowers and choleretic tea containing them (1 tablespoon of immortelle flowers or choleretic tea is brewed with 2 cups of boiling water, left for 20 minutes, filtered; take half a glass each 3 times a day). Trefoil leaves and peppermint(1 tablespoon of dry leaves is brewed with a glass of boiling water, left for 15-20 minutes, filtered; take 2 tablespoons of infusion 3 times a day).
Cholelithiasis. The formation of stones in the gall bladder and bile ducts is a very common pathological condition. Stones made from the bile pigment bilirubin bile acids, cholesterol and calcium salts, can be found in the bile ducts and gallbladder in approximately 10% of adults, mainly women who are prone to being overweight or obese. Often stones do not cause any painful manifestations throughout life; This is the so-called stone-carrying. Often, however, the stone clogs the bile ducts and damages the walls of the gallbladder and bile ducts, contributing to their inflammation. Exact reasons for formation gallstones unknown. A connection between cholelithiasis and pregnancy has been noted. Stagnation of bile, for example with biliary dyskinesia, as well as disorders of cholesterol and calcium metabolism predispose to the formation of stones. Inflammation of the gallbladder and bile ducts also contributes to the formation of stones, although the opposite relationships are also possible: damage to the walls of the biliary system by stones leads to inflammation.
The classic manifestation of cholelithiasis is the so-called biliary, or hepatic, colic, associated with jamming of a stone in the neck of the gallbladder or the mouth of a large bile duct. Pain during biliary colic, often extremely severe, is usually localized in the pit of the stomach or in the right hypochondrium and radiates to the right and back. Pain occurs an hour or a little later after eating a heavy, especially fatty, meal, and often also shortly after going to bed. The pain is often accompanied by nausea, vomiting, and fever. Many patients, outside of an attack, experience discomfort or heaviness in the liver area, swelling of fried, smoked foods, eggs, and vegetables from the cabbage family. “Occlusion of the common bile duct is accompanied by discoloration of stool, the color of which is generally determined mainly by the content of bile pigments in it. Many patients, after an attack of biliary colic, develop jaundice, usually lasting no more than 2-3 days, and their mood deteriorates (“bilious character”). Attacks can pass on their own within a few hours, as the stone is pushed from the site of wedging back into the cavity of the gallbladder, or forward into the intestine. Gallstone disease is often complicated by inflammation of the gallbladder (cholecystitis) or bile ducts (cholangitis).Acute cholecystitis or exacerbation of chronic cholecystitis against the background renal colic require emergency surgical treatment.
To treat biliary colic, the same drugs are used as for biliary dyskinesia. At very severe pain necessary medical assistance. Diet plays an important role in preventing colic and the progression of stone formation. It should be low in calories and contain enough vitamins, especially those found in fats (vitamins A, E and K). If necessary, vitamins-1p,1 are used in the form of ready-made preparations. In the daily diet, the amount of animal fats (lard, fatty meat and fatty poultry, butter, cream, sour cream) is significantly limited. The content of animal and plant proteins should be as high as possible - about 100 g per day. Carbon dioxide-alkali mineral water and a number of choleretic agents ( olive oil, corn silk extract, allohol, holagon, holosas, immortelle flowers, trefoil and peppermint leaves) improve the outflow of bile without causing spasm of the bile ducts, which helps push the stone into the intestinal cavity. It should, however, be borne in mind that substances that enhance the excretion of bile into the intestines, activating the motor function of the bile ducts and gallbladder (such as animal fat, egg yolk), can cause spastic contraction of the walls of the biliary system, stone jamming and an attack of biliary colic. It is often also provoked by body shaking and vibration associated with driving certain types of transport, especially bad roads, as well as running, jumping, etc.
For severe gallstone disease, surgical treatment may be necessary. IN last years Methods for destroying stones are being successfully developed that do not require “major” operations and are based, in particular, on the use of ultrasound or a laser beam. No means have yet been created for the resorption of gall bladder and bile duct stones.
There are no specific measures to prevent gallstone disease. Preventing obesity, following a diet that meets the calorie needs of the body, and limiting the content of animal fats in the diet reduce the risk of developing gallstone disease.
Acute cholecystitis. Acute inflammation of the gallbladder, or acute cholecystitis, is most often a complication of cholelithiasis associated with the retention of bile in the gallbladder due to prolonged spastic contraction of the cervical muscles or its blockage with a stone, as well as damage to the walls of the bladder due to stones in it. Occasionally, acute cholecystitis develops in complete well-being, without any visible connection with any diseases.
Acute cholecystitis usually begins with severe biliary colic (see above), an increase in temperature to 38-39 ° C and even higher. Soon a sharp tension in the abdominal muscles appears, first in the right hypochondrium, and then over the entire abdominal cavity; Light tapping with your fingertips on the right along the edge of the ribs and slightly below causes a sharp increase in pain.
Acute cholecystitis requires urgent hospitalization and often surgical treatment. At the same time, sometimes the symptoms of the disease are not clearly expressed, and the doctor has doubts: whether these signs are associated with cholecystitis or with biliary colic without inflammation of the bladder. In such cases, the patient is often left at home, having been prescribed antibacterial agents and drugs that relieve spasm of smooth muscles. On the first day of illness, fasting is necessary, but the amount of fluid should be sufficient. In the future, they gradually switch to the diet recommended for gallstone disease. During the acute period of illness, bed rest must be observed. Increasing symptoms require emergency hospitalization.
Prevention consists of preventing and timely treatment gallstone disease.
Chronic cholecystitis.Chronic inflammation gallbladder, or chronic cholecystitis, most often develops in patients with cholelithiasis; This form of the disease is called chronic calculous cholecystitis. In its course it is very similar to cholelithiasis, but after colic it usually persists for several days elevated temperature. Occasionally, there are no stones in the inflamed gall bladder (chronic acalculous cholecystitis). This form of the disease is not accompanied by biliary colic. Outside of exacerbation, the patient experiences heaviness and discomfort in the right hypochondrium; Often there are other signs of biliary dyskinesia (see above). During the period of exacerbation of acalculous cholecystitis, manifested by an increase in temperature, the appearance of aching pain in the right hypochondrium, nausea, loss of appetite, the doctor prescribes antibacterial agents. At calculous cholecystitis The same diet is recommended as for cholelithiasis, and for non-calculous disease - as for biliary dyskinesia. It is advisable to use choleretic drugs (see “Biliary dyskinesia”, “Cholelithiasis”).
To improve the outflow of bile, a course of sounding is sometimes performed duodenum with the introduction of various choleretic agents into its cavity; to this end medical workers use a thin rubber probe with a smooth oval metal tip. Moreover, this procedure is unpleasant, and for some patients even painful. In most cases, it can be completely replaced by blind probing performed by the patient himself without a probe. It is carried out like this. The patient takes a glass of weak (1 teaspoon per glass of water) solution of magnesium sulfate or bitter salt every day on an empty stomach, after which he lies on his right side for half an hour, applying a heating pad to the liver area (placed on right side belly so that it top edge was slightly above the lower edge of the ribs).
With calculous cholecystitis, emergency surgical care is sometimes necessary.
Cholangitis. Cholangitis, or angiocholitis, i.e. inflammation of the small and minute bile ducts is much less common than other diseases of the biliary system. Cholangitis is caused by various microorganisms. In the vast majority of cases, inflammation occurs due to difficulty in the outflow of bile (with cholelithiasis, after operations on the biliary tract). Characterized by jaundice, chills, sweating, sudden changes temperature during the day, severity or It's a dull pain in the liver area. Cholangitis occurs in acute and subacute form and demands compulsory treatment in a hospital, as it is often complicated by inflammation of the liver (hepatitis), the formation of ulcers in it, and sometimes blood poisoning. After discharge from the hospital, the same regimen and diet are prescribed as for chronic hepatitis (see below), until full recovery, the conclusion about which is given by the doctor.
LIVER DISEASES
Acute hepatitis. Hepatitis (from the Latin perag - liver) is an inflammation of the liver tissue, which can be caused by microorganisms (bacteria, viruses, protozoa), a number of drugs, if they are taken in very large doses or if the patient has a congenital intolerance to them (which is extremely rare) , as well as many toxic toxic substances. Hepatitis not associated with the action of microorganisms is called aseptic, or abacterial. Most often, acute hepatitis is caused by two types of viruses: type A (epidemic hepatitis virus, or Botkin's disease) and type B (serum hepatitis virus). Isolated cases of viral hepatitis are observed everywhere, especially in warm time of the year; occasionally, mainly in autumn, outbreaks or small epidemics of the disease occur. Infection is caused by consuming food and water contaminated with the feces of patients or virus carriers. The hepatitis B virus is unable to enter the blood from the intestines, and infection occurs only if the virus is introduced into the blood, for example, through a blood transfusion from a virus-carrying donor, or insufficient sterilization of medical instruments (this is why drug addicts who use the same syringe often get sick with it). Bacterial and amoebic hepatitis are rare, usually occurring in the tropics and subtropics. Malarial hepatitis was common in mid-latitudes; nowadays it is hardly observed.
Chemicals that most often cause acute hepatitis include hydrocarbons containing fluorine, chlorine, bromine or iodine (especially carbon tetrachloride), substances containing arsenic, salts heavy metals. Hepatitis can be caused by some medications, especially those used in psychiatry in very high doses (aminazine, amitriptyline); much less frequently, it develops under the influence of drugs used in moderate or even small doses for the treatment of internal diseases, for example, when taking sulfonamides (sulfadimezine, sulfamonomethoxine, sulfadimethoxine, etc.), delagil, plaquenil. Unfortunately, it is impossible to predict the individual tolerance of these and other medicines So far it hasn't been possible. But if the patient has ever previously taken a medicine that the doctor intends to prescribe for him, and at the same time noted any side effects, he must inform the doctor about this. Acute hepatitis can be a consequence of poisoning with plant poisons, for example those contained in fly agaric mushrooms.
The full picture of acute viral hepatitis is preceded by a period of warning signs that lasts about a week. The patient feels weak, his appetite and health deteriorate. Then a feeling of weakness, nausea, vomiting, and aversion to food appear. Feces often become mushy, sometimes liquid. Many people feel fullness, pressure or heaviness in the right hypochondrium associated with an enlarged liver; There is usually no real pain. The temperature does not always rise and rarely exceeds 38°C. After another 4-6 days, slight or moderate jaundice appears. The yellowish tint is primarily acquired by the whites of the eyes and the palate. After about 10 days from the beginning of the acute period, the severity of all symptoms begins to decrease, although liver function may remain impaired for several months. Sometimes hepatitis becomes chronic.
The clinical picture of toxic and drug-induced hepatitis depends on the type and amount of the pathogenic factor that has entered the body and the sensitivity of the body to it. Some poisons directly destroy liver tissue, which subsequently degenerates, others first cause disturbances in intrahepatic blood flow, and in the action of others, allergies or individual intolerance (idiosyncrasy) play a leading role. The overall result is a violation of all liver functions: digestive (a decrease in bile production leads to diarrhea), metabolic (inhibition of the synthesis and metabolism of proteins, fats, carbohydrates and vitamins in the liver), barrier (loss of the ability to fully neutralize harmful substances absorbed in the intestines). Due to swelling of the walls of small bile ducts, the outflow of bile from the liver is disrupted and jaundice may develop. Nausea, vomiting, aversion to food, characteristic of acute hepatitis, as well as sometimes observed cardiac or vascular insufficiency associated with suppression of metabolic and barrier functions liver.
The course of moderate acute hepatitis was described above. Often, however, the disease progresses in very mild form, remaining unnoticed by either the patient himself or others. And on the contrary, under the influence of unfavorable factors (congenital or acquired as a result of alcohol abuse “weakness” of the liver tissue, excessive dose of a damaging agent, individual hypersensitivity to it), acute hepatitis can turn into chronic and even cirrhosis of the liver (see below).
Treatment of all forms of acute hepatitis is a matter for specialists. The patient himself and those around him must firmly know that the basis of treatment is still the regimen and diet. The first 1.5-2 weeks. the patient is on bed rest. He is allowed to eat in a semi-sitting position and sit down for a short time to perform natural needs. The purpose of this regime is to reduce the metabolic rate as much as possible, i.e. avoid overloading the affected liver. As symptoms subside, the regimen is gradually expanded. In recent years, most countries of the world have abandoned the use of a very strict diet with the complete exclusion of proteins and fats from the diet as nutrients that place the greatest burden on the liver, although some doctors believe that such a diet is necessary in the first days of illness. The difficulty is that, on the one hand, eating proteins and fats requires intense work of the liver, and on the other hand, the lack of these substances prevents the restoration of the vital activity of liver cells. It seems most reasonable to limit the amount of protein to 30 g and fat to 20 g per day (see Table 6). When the patient's condition begins to improve, he is prescribed a diet containing about 50 g of protein and fat per day. Culinary processing of protein products should make them gentle (soufflé from meat, poultry, fish, egg white omelette, cottage cheese). Sufficient temperature treatment improves the digestibility of animal proteins. Easily digestible fats include butter and vegetable oil, egg yolks; lard and margarine are much less digestible. It is important that food contains enough vitamins. If this is not possible for one reason or another, the patient is given multivitamin preparations. You should not eat foods that increase the secretion of bile (smoked meats, chocolate, cocoa, coffee).
The consumption of any alcoholic beverages, including weak ones, is strictly prohibited: alcohol during hepatitis is deadly and, even if it does not lead to the death of the patient, contributes to the transition of acute hepatitis to chronic and to cirrhosis of the liver.
Hygiene procedures in the first days of illness are limited to wiping the skin, for which you can use, for example, a mixture of equal quantities of vodka and 2-3% vinegar. With the beginning of improvement, the patient can take a warm shower, and from the third week of illness - a warm bath.
Prevention of acute epidemic hepatitis (type A) consists of sanitary and hygienic measures: thorough washing of hands, fruits and vegetables used for food raw, use for drinking only boiled water, sufficient time and intensity of heat treatment of food. All these measures must be observed especially strictly when caring for or contacting a patient, as well as during an outbreak or epidemic of the disease. During this period, it is generally not recommended to eat raw fruits and vegetables. In addition, if there is a sick person in the room, you need to disinfect the restroom (toilet, tank, seat, walls) and bedpan with a saturated solution of bleach or 2-3% chloramine solution. Prevention of serum hepatitis directly depends on the results of the fight against drug addiction. Case or outbreak of serum hepatitis B medical institution are regarded as an emergency.
The possibility of preventing toxic hepatitis is determined by the awareness of the population and, in particular, the availability of this information. Local public and state environmental organizations should not allow the existence of environmental secrets (pollution of water bodies with substances toxic to the liver, etc.).
Secondary prevention, aimed at preventing the transition of acute hepatitis to chronic and liver cirrhosis,
includes diet, complete abstinence from alcohol, elimination of any factors, including medications, that may have an adverse effect on the liver, restriction physical activity. It should be carried out for at least six months until it is finally determined that the liver functions have been fully restored and the disease has not become chronic.
Chronic hepatitis. Chronic inflammation of the liver is most often observed in those who have suffered acute (especially viral) hepatitis. The factors contributing to the transition of acute to chronic hepatitis were discussed above. But hepatitis can also be primary chronic course, i.e. develop gradually. This form of the disease is possible with prolonged exposure to small quantities of those toxic substances that in large doses cause acute hepatitis. Another cause of primary chronic hepatitis is prolonged stagnation of bile in the bile ducts, for example, with cholelithiasis. In the liver with chronic hepatitis, along with sluggish inflammation, tissue degeneration (dystrophy) and proliferation of connective tissue occur, which can lead to cirrhosis (see below).
Manifestations different forms chronic hepatitis are varied and mostly nonspecific. The patient is concerned about weakness, apathy, loss of appetite, weight loss; Yellowness of the white membrane of the eyes and sometimes the skin may periodically occur, often a feeling of heaviness or discomfort in the right hypochondrium. Pain in the liver area is noted when the root cause of hepatitis is stagnation of bile. As with other liver diseases, in this case it is necessary to strictly adhere to a diet containing a sufficient amount (60-80 g per day) of proteins, half of which should be of animal origin, and up to 400 g of carbohydrates (see Table 6). Fats are added to food only in quantities that make it palatable. If food is low in vitamins, it is recommended to take a multivitamin.
Chronic hepatitis is often accompanied by suppression of gastric juice production, which makes it difficult to digest and absorb proteins. In these cases, it is advisable, after consulting a doctor, to use diluted hydrochloric acid with pepsin or gastric juice, as in chronic gastritis with reduced secretion (see above).
Doctor focusing on functional state liver, determines the level of physical activity that is reasonable for each patient.
Prevention of the appearance of chronic hepatitis, as well as its progression, is based, first of all, on measures for the prevention and treatment of acute hepatitis, as well as cholelithiasis.
Ivanovo College of Pharmacy |
Coursework |
Means for the treatment of the liver and biliary tract. |
Discipline: Medicines. |
Completed by: Dimitrieva N. A. Student of group 31 – M. Supervisor: Rozhdestvenskaya N. V. Teacher of special disciplines |
Rating: _____Signature: ____________ |
2012 – 2013 academic year |
Contents:Introduction………………………………………………………………………………..1
Chapter 1: a brief description of major liver diseases…………………………..2
1.1. Hepatitis………………………………………………………………………………..2
1.2. Cirrhosis……………………………………………………………………………….4
Chapter 2: Brief description of the main diseases of the biliary tract………………………………………………………. ……………………………………...5
1.1. Cholecystitis………………………………………………………………………………………..6
1.2. Gallstone disease……………………………………………………………..8
Chapter 3: Drugs for the treatment of diseases of the liver and biliary tract.................................................................. ........................................................ ....................10
Chapter 4: Medicinal plants used for diseases of the liver and biliary tract………………………………………………………………………………………22
Conclusion…………………………………………………………………………………30
References………………………………………………………………………………………..31
Introduction.
Relevance of the chosen topic. In the last decade, the importance of treating diseases of the liver and biliary tract has increased significantly. This is due to the fact that many biologically active substances of plant origin are successfully used in combination with other drugs.
Goal course work- study the principles of treatment of diseases of the liver and biliary tract with drugs and medicinal plants. When completing the course work, the following tasks were set:
1. characterize the most common diseases of the liver and biliary tract;
2. study the composition and effect of drugs and plants used for the treatment of these diseases;
3. draw conclusions on the use of official medicines and plants in the treatment of diseases of the liver and biliary tract.
The material for writing this coursework was educational and reference literature, as well as articles from modern medical journals and Internet resources.
Reference literature was used to characterize the drugs and medicinal plants. Educational literature and journal articles served as the basis for a brief description of liver and biliary tract diseases. Electronic sources reveal many aspects of the problem under study.
The first chapter addresses the problems associated with the characteristics of the main liver diseases; the second chapter discusses brief characteristics of biliary tract diseases.
The main part consists of chapters three and four, which are directly devoted to the description of drugs and medicinal plants used to treat diseases of the liver and biliary tract.
In conclusion, conclusions are drawn based on the analysis of the course material discussed in the course.
Chapter 1: Brief description of the main liver diseases.
The role of the liver in the body is great. She performs a number of very important functions one of which is bile formation, and bile takes part in digestion, especially in the processing and absorption of fats. Bile enhances the contraction of intestinal muscles (peristalsis), which contributes to the normal movement of food and the remains of undigested food products. Bile helps reduce fermentation and putrefactive processes in the intestines. All nutrients absorbed in the intestines must pass through the liver. Regulation of bile secretion, as well as other processes occurring in the liver, is carried out by the central nervous system and endocrine glands.
Diseases of this organ develop in humans for several reasons. Among the most common among them, experts identify an infectious factor (we are talking about hepatitis viruses), diabetes mellitus...
Methods for examining patients with liver and gallbladder diseases
Introduction 3
1. Laboratory and instrumental methods studies of patients with gallbladder diseases 4
2. Diagnosis of patients with gallbladder diseases 7
3.Diagnostic methods for liver disease 10
3.1.Hepatitis 10
3.2.Chronic hepatitis 12
3.2.Liver cirrhosis 15
3.3. Fatty liver degeneration 17
Conclusion 21
References 22
Introduction
Pathology of the biliary tract is a topical problem for modern medicine. In the last decade, both in Russia and abroad, despite certain successes in therapy associated with the appearance on the pharmacological market of new effective drugs for the correction of functional disorders of the digestive system, there has been a clear tendency towards an increase in the incidence of the biliary system. Moreover, this trend is characterized by stability. Thus, according to scientific forecasting data, the incidence of diseases digestive system in the next 15-20 years will increase in the world by at least 30-50% due to an increase in the number of diseases based on stress, dyskinetic, and metabolic mechanisms. These trends are also characteristic of the pathology of the biliary system. According to the literature, the prevalence of diseases of the gallbladder and bile ducts in Moscow among the adult population over the past 10 years has become almost 2 times higher than in Russia. Gallstone disease has become significantly “younger” and occurs not only in young, but also in early childhood. The disease began to appear quite often not only in women, but also in men. Currently, the prevalence rates of biliary tract diseases range from 26.6 to 45.5 per 1000 population.
The above facts suggest the relevance of the topic under consideration.
The purpose of this work is to study diagnostic methods for diseases of the liver and biliary tract.
To achieve this goal, the following tasks were set:
Consider laboratory and instrumental methods for studying patients with gallbladder diseases;
Describe diagnostic methods for liver disease.
Laboratory and instrumental methods for studying patients with gallbladder diseases
For biliary dyskinesias, cholecystitis (not exacerbation), cholelithiasis in the interictal period general state The patient most often remains satisfactory. At acute cholecystitis, exacerbation of chronic cholecystitis, prolonged attack of hepatic colic with cholelithiasis, the patient’s condition can be moderate or severe.
The patient's position with GIVP and cholecystitis outside of exacerbation is usually active. The forced position of the patient is observed during an attack of hepatic colic (cholelithiasis, calculous cholecystitis). Patients are restless, tossing about in bed, trying (to no avail) to take a position in which the pain is less noticeable.
The appearance of the patient in most cases is not changed. The asthenic constitution and associated connective tissue dysplasia are often the cause of the presence in these patients of the gallbladder of the hourglass type, the presence of constrictions, membranes, kinks, diverticula in the gallbladder, which leads to the formation of biliary dyskinesia, and subsequently to organic pathology - cholecystitis, cholelithiasis; a hypersthenic constitution is often observed in persons suffering from cholelithiasis, mainly women, as well as in persons with biliary dyskinesia of the hypokinetic type. 1
The skin has a normal color in case of diarrhea and chronic cholecystitis outside of exacerbation, as well as in case of cholelithiasis during the interictal period. During an attack of hepatic colic, patients may develop subicteric sclera, and with the development of obstructive jaundice, the skin becomes green-yellow in color. Cholesterol deposition due to impaired cholesterol metabolism in patients with cholelithiasis and calculous cholecystitis is accompanied by the appearance of xanthoma and xanthelasma on the skin.
When performing percussion of the abdomen, it is necessary to pay attention to the size of the liver according to Kurlov, which is not changed in patients with ADHD, cholelithiasis, cholecystitis without exacerbation (along the right midclavicular line - 9 cm, along the anterior midline - 8 cm, along the left costal arch - 7 cm). An increase in the size of the liver can occur after hepatic colic in a patient with cholelithiasis, during an exacerbation of cholecystitis. Using very quiet percussion, you can determine the size of the gallbladder if it is significantly enlarged (distension of the gallbladder with its hypokinesia, cholelithiasis).
With exacerbation of cholecystitis, characteristic symptoms may be identified:
Zakharyin's symptom - sharp pain when tapping with a finger or pressing in the area of the gallbladder projection;
Vasilenko's symptom - sharp pain when tapping a finger in the area of the gallbladder at the height of inspiration;
Obraztsov-Murphy symptom - sharp pain when inserting the hand into the right hypochondrium at the height of inspiration;
Ortner's symptom is pain when tapping the edge of the hand on the right costal arch.
Superficial palpation of the abdomen reveals:
Severe local pain in the projection area of the gallbladder in acute cholecystitis, biliary colic;
Mild to moderate pain at the point of the gallbladder in chronic cholecystitis, cholelithiasis during remission, and in diarrhea.
The gallbladder is usually accessible by palpation when it is enlarged (hypokinetic type GIB with gallbladder distension, cholelithiasis). 2
To examine patients with diseases of the biliary tract, the following laboratory and instrumental research methods are used:
Clinical blood test;
Biochemical blood test;
Fractional chromatic duodenal sounding;
Microscopic examination of bile;
Biochemical study of bile;
X-ray and radiological studies;
Ultrasound examination of the hepatopancreatoduodenal zone;
Endoscopic examination, etc.
Diagnosis of patients with gallbladder diseases
The diagnostic approach to a patient in whom the doctor suspects the existence of problems associated with the extrahepatic biliary tract or gallbladder should be based on clinical symptoms and the suspected nature of the pathology. Advances in diagnostic radiology and corrective endoscopy have made it possible to accurately identify the nature and location of the pathological process and provide the way for therapeutic intervention,
Abdominal radiography. Plain radiographs of the abdomen have limited value in the diagnosis of diseases associated with the presence of gallstones or jaundice. Only in 15-20% of patients can contrasted stones localized in the right upper quadrant of the abdomen be detected on plain radiographs. Air within the biliary tree may indicate the presence of a fistula connecting the gallbladder to the intestine.
Oral cholecystography. Oral cholecystography was introduced in 1924. The function of the gallbladder is assessed based on its absorptive capacity. X-ray contrast iodine dye, taken orally, is absorbed in the gastrointestinal tract and enters the liver, then excreted into the bile duct system and concentrated in the gallbladder. Stones seen as filling defects in a visualized, contrast-enhanced gallbladder or nonvisualization of the gallbladder may not indicate a “positive” result. False-positive non-imaging may occur in patients who do not follow the doctor's instructions for a prescribed test, or in those who are unable to swallow tablets, or in cases where tablets cannot be absorbed in the gastrointestinal tract or dye is not excreted into the biliary tract. tract due to liver dysfunction.
Abdominal ultrasonography. This method has replaced oral cholecystography as the method of choice when examining a patient for the presence of gallstones. The effectiveness of abdominal ultrasonography, or ultrasound, in the diagnosis of acute cholecystitis is not as significant as in the diagnosis of gallstones. Ultrasonography is used to identify intra- and extrahepatic biliary dilatation. 3
Computed tomography (CT). This test is not highly sensitive for detecting gallstones, but provides the surgeon with information related to the origin, size and location of biliary dilatation, as well as the presence of tumors located in and around the biliary tract and pancreas.
Biliary scintigraphy. Intravenous administration of a radioactive isotope, one of the iminodiacetic acid family, labeled technetium-99t, provides specific information relevant to the determination of cystic duct patency and serves as a sensitive method for the diagnosis of acute cholecystitis. In contrast to ultrasonography, which serves as an anatomical test, biliary scintigraphy is a functional test.
Percutaneous transhepatic cholangiography (PTC). Under fluoroscopic control and local anesthesia a small needle is inserted through abdominal wall into the bile duct. This method provides a cholangiogram and allows therapeutic adjustments if necessary based on the clinical situation. Used in patients with a complex of biliary problems, including strictures and tumors.
Endoscopic retrograde cholangiopancreatography (ERCP). Using a side-viewing endoscope, the biliary tract and pancreatic duct can be intubated and visualized. Advantages include direct visualization of the ampulla area and direct measurement distal segment bile duct. The use of this method brings significant benefits to patients suffering from common bile duct disease (benign and malignant).
Choledochoscopy. Although indirect imaging techniques are fundamental in the diagnosis of patients with diseases of the extrahepatic biliary tract, direct examination and visualization of the biliary system is a goal worth pursuing. Choledochoscopy performed during surgery can be effective in identifying bile duct strictures or tumors in patients.
Diagnostic methods for liver disease
The liver is the main laboratory of the human body. About 20 million chemical reactions per minute occur in this organ. Here the synthesis of blood proteins takes place (for example, immunoglobulins responsible for the so-called humoral immunity the whole body, albumins, which hold the required volume of fluid in the bloodstream and others), the synthesis of bile acids - substances necessary for the digestion of food in the small intestine, the accumulation and breakdown of glucose - the main source of energy of the body. The liver exchanges fats, neutralizes toxins (poisons), etc. The slightest violation of at least one of the functions of the liver leads to serious disturbances in the functioning of the entire body. 4
Hepatitis
Hepatitis is acute. Symptoms, course. In mild cases, acute hepatitis is practically asymptomatic, being detected only during random or targeted examination (for example, at work among people in contact with hepatotropic poisons, in case of household group poisoning with mushrooms, etc.). In more severe cases (for example, with toxic hepatitis), clinical symptoms of the disease develop quickly, often in combination with signs of general intoxication and toxic damage to other organs and systems. At the height of the disease, icteric discoloration of the skin and mucous membranes, whitish-clay-colored stools, deep dark-colored (“beer-colored”) urine, and hemorrhagic phenomena are characteristic. The color of the skin is orange or saffron. However, in mild cases, jaundice is visible only in daylight; icteric staining of the sclera and mucous membrane of the soft palate appears most early. Nosebleeds and petechiae are common; patients are worried itchy skin, bradycardia, depressed mental state, increased irritability of patients, insomnia and other signs of damage to the central nervous system are noted.
The liver and spleen are slightly enlarged and slightly painful. With particularly severe lesions and the predominance of necrotic changes in the liver (acute dystrophy), its size may decrease.
Laboratory studies reveal hyperbilirubinemia (100-300 µmol/l or more), increased activity of a number of serum enzymes: aldolase, aspartate aminotransferase and especially alanine aminotransferase (significantly above 40 units), lactate dehydrogenase, hypoalbuminemia, hyperglobulinemia (mainly increased content. Deviated from the norm indicators of protein-sedimentary samples (thymol, sublimate, etc.). The liver's production of fibrinogen, prothrombin, VII, V coagulation factors is impaired, resulting in hemorrhagic phenomena. Differential diagnosis. A carefully collected anamnesis is of great importance, establishing the possibility of professional or household intoxication, taking into account the epidemiological situation in identifying the nature and cause of the disease. In unclear cases, first of all you should think about viral hepatitis. The detection of the so-called Australian antigen is characteristic of serum hepatitis B (it is also detected in virus carriers, rarely in other diseases). Mechanical (subhepatic) jaundice usually occurs acutely only when the common bile duct is blocked by a stone due to cholelithiasis. But in this case, the appearance of jaundice is preceded by an attack of biliary colic; bilirubin in the blood is mostly straight, stool is discolored. With hemolytic adrenal jaundice, free (indirect) bilirubin is detected in the blood, the stool is intensely colored, and the osmotic resistance of red blood cells is usually reduced. In the case of false jaundice (due to staining of the skin with carotene during prolonged and abundant consumption of oranges, carrots, and pumpkins), the sclera is usually not colored, and there is no hyperbilirubinemia.
With timely treatment, complete recovery often occurs. In some cases, acute hepatitis turns into chronic, and then into cirrhosis of the liver. In some cases, acute liver dystrophy develops (see Hepatosis) with the clinical picture of acute liver or hepatorenal failure, from which patients can die.
3.2.Chronic hepatitis
Polyetiological chronic (lasting more than 6 months) liver lesions of an inflammatory-dystrophic nature with moderate fibrosis and predominantly preserved lobular structure of the liver. Among chronic liver diseases, chronic hepatitis is the most common.
Clinic. Characterized by enlarged liver, pain or a feeling of heaviness, fullness in the right hypochondrium, dyspeptic symptoms; Jaundice, skin itching, and low-grade fever are less common. Liver enlargement occurs in approximately 95% of patients, but in most cases it is moderate. There is no enlargement of the spleen or it is slightly enlarged. Pain in the liver area is dull, constant. Frequent loss of appetite, belching, nausea, poor tolerance to fats, alcohol, flatulence, unstable stools, general weakness, decreased ability to work, hyperhidrosis. In a third of patients, mild (subicteric sclera and palate) or moderate jaundice is detected. An increase in ESR and dysproteinemia due to a decrease in albumin concentration and an increase in globulins, mainly alpha and gamma fractions, are frequent, but nonspecific. The results of protein-sedimentary tests are positive - thymol, sublimate, etc. In the blood serum of patients, the content of aminotransferases is increased: ALT, AST and LDH, with difficulty in the outflow of bile - alkaline phosphatase. In approximately 50% of patients, slight or moderate hyperbilirubinemia is found, mainly due to an increase in the level of conjugated (direct) bilirubin in the blood serum. The absorptive-excretory function of the liver is impaired (the half-life of bromsulfalein from the blood is prolonged).
With cholestatic hepatitis, more pronounced persistent jaundice and laboratory cholestasis syndrome are usually observed: the blood serum contains increased levels of alkaline phosphatase, cholesterol, bile acids, conjugated bilirubin, and copper.
There are low-active (inactive), benign, persistent and active, aggressive, progressive recurrent hepatitis.
Liver puncture biopsy and laparoscopy make it possible to more accurately distinguish between these two forms of hepatitis, as well as to carry out differential diagnosis with other liver diseases.
A liver scan allows you to determine its size; with hepatitis, sometimes there is a reduced or uneven accumulation of the radioisotope drug in the liver tissue, in some cases there is an increased accumulation in the spleen.
Differential diagnosis in cases with a clear clinical picture of diffuse liver damage should first of all be carried out with liver cirrhosis. With cirrhosis, the symptoms of the disease are more pronounced, the liver is usually much denser than with hepatitis; it can be enlarged, but often reduced in size (atrophic phase of cirrhosis). As a rule, splenomegaly is observed, liver signs are often detected (vascular telangiectasia, hepatic tongue, hepatic palms), and symptoms of portal hypertension may occur. Laboratory tests show significant deviations from the norm in the results of the so-called liver tests; with a puncture biopsy - disorganization of the liver structure, significant proliferation of connective tissue.
Liver fibrosis, unlike hepatitis, is usually not accompanied by clinical symptoms and changes in liver function tests. Anamnesis (the presence of a disease in the past that could cause liver fibrosis), long-term observation of the patient and a puncture biopsy of the liver (if necessary) make it possible to differentiate it from chronic persistent hepatitis.
With fatty hepatosis, the liver is usually softer than with chronic hepatitis, the spleen is not enlarged, and a puncture biopsy of the liver is crucial in diagnosis.
Differential diagnosis with functional hyperbilirubinemia is based on the characteristics of their clinical picture (mild jaundice with hyperbilirubinemia without significant clinical symptoms and changes in laboratory liver test data and liver puncture biopsy). Amyloidosis with a predominant hepatic localization, in contrast to chronic hepatitis, is characterized by symptoms of other organ localizations of the process, a positive test with Congo red or methylene blue; the diagnosis is confirmed by a puncture biopsy of the liver. In case of focal lesions (tumor, cyst, tuberculoma, etc.), the liver is unevenly enlarged, and scanning determines the focus of destruction of the hepatic parenchyma.
Flow. Low-active (persistent) hepatitis is asymptomatic or with minor symptoms, changes in laboratory parameters are also insignificant. Exacerbations of the process are uncharacteristic.
Chronic active recurrent (aggressive) hepatitis is characterized by severe complaints and clear objective clinical and laboratory signs. Some patients experience systemic autoallergic manifestations of the disease (polyarthralgia, skin rashes, glomerulonephritis, etc.). Frequent relapses of the disease are characteristic, sometimes occurring under the influence of even minor factors (errors in diet, overwork, etc.). Frequent relapses lead to significant morphological changes in the liver and the development of cirrhosis. In this regard, the prognosis for active hepatitis is more severe.
Cirrhosis of the liver
About 2 million people die from liver cirrhosis every year. Cirrhosis and liver cancer are the cause of 90-95% of deaths from chronic liver diseases.
What is cirrhosis of the liver?
Cirrhosis is the process of replacing the normal structure of the liver with scar tissue that takes the form of nodes. These nodes not only do not perform any useful functions, but interfere with the normal functioning of the liver by compressing blood vessels, bile ducts and normal liver tissue. In this case, the production and accumulation of vital substances (proteins, fats, carbohydrates, hormones) by the liver is disrupted, and the neutralization of toxic and infectious agents worsens. The liver is the main outpost that receives the entire flow of substances coming from the intestines. Among these substances, in addition to the beneficial ones necessary for the body, there are harmful, toxic, and sometimes dangerous compounds for the body, which the liver neutralizes and returns to the intestines along with bile. And if the liver does not work well, then substances that poison the body penetrate into the blood.
Causes of cirrhosis development.
The most common causes of cirrhosis are hepatitis B and C viruses and alcohol abuse. Alcoholism is the main reason. It has not been established exactly how long and how much alcohol is needed for the development of cirrhosis. Most patients with this disease have been drinking at least 0.5 liters of strong alcoholic beverages or several liters of wine or beer every day for at least 10 years. The higher the daily dose of alcohol, the faster cirrhosis will develop. In women, less alcohol consumption leads to its development. In 10-20% of patients chronic hepatitis B and C develop cirrhosis of the liver. Alcohol-viral cirrhosis is especially difficult. They most often develop into liver cancer. There is a hereditary predisposition to the development of rare forms of cirrhosis (hemochromatosis, Wilson-Konovalov disease). In approximately 10-20% of patients, the cause cannot be determined. 5
80% of cirrhosis occurs unnoticed, without attracting the attention of either the patient or the doctor. The remaining patients complain of increased fatigue, pain in the right hypochondrium, bloating, periodic darkening of urine, weight loss, a tendency to bruise, and redness of the palms. In many patients, the disease is recognized only when complications develop: accumulation of fluid in the abdomen, impaired consciousness, bleeding from the esophagus and stomach, jaundice. A healthy liver protects the brain from toxins, and with cirrhosis, the blood, not cleared of harmful substances by the liver, enters the brain. There is a disturbance in thinking and memory. 60-90% of liver cancer develops against the background of cirrhosis. Cancer in the early stages is difficult to recognize; its manifestations are taken as signs of progression of cirrhosis. Most often, the tumor manifests itself as abdominal pain. Sometimes you can feel a tumor-like space-occupying formation in the right hypochondrium.
In case of liver cirrhosis, alcohol and any alcohol-containing drinks are strictly contraindicated, as this contributes to the progression of the disease. It is not recommended to drink carbonated drinks. If you do not have complications of cirrhosis, then no special dietary restrictions are required. With this disease, low potassium levels in the blood are often found, so you need to include more potassium-rich fruits in your diet.
Fatty liver
Fatty liver (liver steatosis) is a fatty transformation of liver tissue when liver cells suffer from excess fat accumulation.
Causes of fatty degeneration.
The main causes of hepatosis are exposure to toxic substances on the liver, endocrine disorders, and poor nutrition. Among toxic agents, alcohol occupies a special place. However, in people who abuse alcohol, the development of the disease is associated both directly with the effect of alcohol on liver cells and with poor nutrition. The speed of development and severity of changes is higher, the greater the amount of alcohol consumed. The role of other toxic factors (insecticides, organophosphorus compounds, etc.) is less significant. It is possible to develop drug-induced liver steatosis, for example, during the treatment of tuberculosis, taking antibiotics, mainly tetracyclines, and hormonal drugs. In the group of endocrine diseases, the leading cause of hepatosis is diabetes mellitus, especially in the elderly. It is possible to develop “fatty liver” in diseases of the thyroid gland. Steatosis also accompanies general obesity. The determining factor in the imbalance of nutritional factors is the discrepancy between the total calorie content of food and the content of animal proteins in it, as well as a deficiency of vitamins and other substances. Malnutrition is the main cause of the development of steatosis in chronic diseases of the digestive system (chronic pancreatitis). In chronic pancreatitis, it occurs in 25-30% of cases. Lack of oxygen is the main cause of the development of liver steatosis in people suffering from pulmonary diseases and cardiovascular failure.
How do fatty liver diseases manifest?
Steatosis can occur latently, manifesting itself only as a slight enlargement of the liver, or with pronounced manifestations. The most consistent symptom is an enlarged liver. Palpation reveals tenderness of the liver. Most patients also experience independent pain in the right hypochondrium, and there may be nausea. Steatosis can last a long time, over many years. Periods of deterioration are followed by relative improvements in well-being. Exacerbations are often associated with mental or physical stress, alcohol intake, and infection.
Complications of steatosis, which are observed mainly in its severe forms, include the formation of liver cirrhosis. Due to immune disorders, patients with steatosis often experience pneumonia, and pulmonary tuberculosis may develop.
Treatment of hepatosis
Treatment of steatosis is a rather complex, but solvable task for professionals and consists of several areas. Among them are a properly selected diet, modification of behavioral patterns (changes in eating habits, changes in the amount and composition of alcohol consumed, increased physical activity), a set of measures aimed at normalizing the energy metabolism of the liver, drug therapy with modern drugs, the action of which is aimed at stabilizing and protecting membranes liver cells, normalization of liver metabolism. The prognosis is usually favorable and, with adequate treatment, reverses itself quite quickly. However, supportive measures may be necessary for quite a long time.
Prevention of hepatosis.
Prevention of hepatosis consists of eliminating the influence of toxic factors, adequate treatment of diabetes mellitus, a nutritious balanced diet, and effective treatment of chronic diseases of the digestive system. Patients taking hormones for a long time should be prescribed drugs that improve liver function for prophylactic purposes.
Diets for liver diseases.
If the disease worsens, you need to adhere to Diet No. 5 for 3-4 weeks; after the condition improves, you can switch to Diet No. 5. This diet is complete and basic, that is, the longer you stick to it, the more guaranteed your health will improve.
If it is necessary to enhance the choleretic properties of the diet, resort to its lipotropic-fat version, increase the amount of vegetables, fruits, dose vegetable oil brought to 50%, instead of the usual 30%. Both butter and vegetable oil are added to prepared dishes.
For liver cirrhosis, the recommendations remain the same: Diet No. 5 if the condition worsens and Diet No. 5 if the condition is in remission. But if diarrhea occurs, fat is limited to 50-60 g. Products that have a laxative effect are also excluded - milk in pure form, honey, jam, etc. If you are prone to constipation, add prunes, dried apricots, figs, raisins, beets, plums, etc.
If you have completely lost your appetite or have a perversion of taste, you should try to eat more fruits, berries, salads, and drink juices. At this time, it is better to get protein from dairy products, mild cheese, cottage cheese, eggs, and boiled fish. For some time, you can include your favorite dishes in your diet, but without going beyond what is permitted.
For portal hypertension, diets with a normal content of protein, carbohydrates, fats, but without salt are recommended. It’s good even if the bread is salt-free. The amount of liquid is also limited, but prunes, figs, and dried apricots are recommended. If hormonal therapy is carried out (prednisolone, triamcinolone, etc.), Special attention it is necessary to give protein and potassium, their quantity should be increased.
Conclusion
A close study of the pathology of the biliary system is determined by the complexity of many issues of the etiology and pathogenesis of diseases in this area, and, consequently, by the problem of prescribing rational etiopathogenetic therapy. These issues have been discussed in the literature for decades, but interest in them continues unabated. Currently, many researchers consider the pathology of the biliary system as a consequence general neurosis, however, the possibility of the occurrence of diseases of the gallbladder based on pathological viscero-visceral interactions in the pathology of other abdominal organs (gastritis, peptic ulcer, colitis, diseases of the female genital area, etc.) cannot be excluded. The issues of targeted and adequate treatment of patients with biliary tract pathology still remain controversial.
Many researchers and clinicians consider the stabilization of the function of the central nervous system and the elimination of general neurotic reactions to be the leading therapeutic measure. More than once on the pages of the medical press it has been pointed out that it is necessary to prescribe antidepressants and tranquilizers in the complex treatment of diseases of the gallbladder and the sphincter apparatus of the biliary system. Many schemes drug therapy are aimed at differentiated correction of the function of the gallbladder and sphincter apparatus, depending on the type of disorders, including with the help of modern myotropic agents. In recent years, sufficient experience has been gained in the use of enzyme preparations of the latest generations in the treatment of disorders of small intestinal digestion, dyskinetic disorders in the biliary system, acute and chronic cholecystitis, reactive pancreatitis.
List of used literature
Propaedeutics of internal diseases: Textbook for universities./ N.A. Mukhin, V.S. Moiseev. - M.: Geotar-Media, 2007.- 848 p.
Propaedeutics of internal diseases. Textbook for universities./ N.V. Ivashkin.- M.: MEDpress, 2005.- 240 p.
Propaedeutics of internal diseases: Textbook for universities./ V.S. Moiseev.- M.: INFRA-M, 2004.- 768 p.
Propaedeutics of internal diseases: textbook./ A.S. Svistov.- M.: Medicine, 2005.- 536 p.
Grebnev, A.L. Propaedeutics of internal diseases: textbook./ A.L. Grebnev.- M.: Medicine, 2002.-592 p.
1 Grebnev, A.L. Propaedeutics of internal diseases: textbook./ A.L. Grebnev.- M.: Medicine, 2002.-P.254.
2 Propaedeutics of internal diseases: Textbook for universities./ V.S. Moiseev.- M.: INFRA-M, 2004.- P. 369.
3 Propaedeutics of internal diseases: textbook./ A.S. Svistov.- M.: Medicine, 2005.- P.299.
4 Propaedeutics of internal diseases. Textbook for universities./ N.V. Ivashkin.- M.: MEDpress, 2005.- P.104.
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Short description
The purpose of the work is to study, according to literary sources, a group of medicinal plants used for diseases of the liver and biliary tract.
To achieve this goal, it is necessary to solve the following tasks:
1. Conduct an analysis of literature data and characterize liver and biliary tract diseases.
2. Based on literary sources, study the main medicinal herbs used in the treatment of these pathologies of the liver and biliary tract.
3.Give the botanical characteristics of medicinal plants, their distribution, method of procurement and use of raw materials. According to literary sources, characterize their chemical composition.
Introduction. 4
Chapter 1. Brief description of diseases of the liver and biliary tract 6
1.1.Hepatitis 6
1.1.1.Hepatitis A. (Botkin's disease) 7
1.1.2.Hepatitis B. 7
1.1.3.Hepatitis C. 8
1.1.4.Toxic hepatitis. 9
1.1.4.1.Alcoholic hepatitis. 9
1.2.Cholecystitis. 10
1.3. Gallstone disease. 12
1.4.Cirrhosis of the liver. 13
Chapter 2. Classification of medicinal plants used for the treatment of diseases of the liver and biliary tract 17
2.1 Medicinal herbs that stimulate bile formation 18
2.2 Medicinal herbs with anti-inflammatory effects 18
2.3 Medicinal herbs with antitoxic effects 18
2.4.Medicinal plants with membrane-stabilizing effects 18
2.5.Medicinal plants with regenerating effects 18
2.6.Medicinal plants with antispasmodic action 19
2.7.Medicinal plants with antimicrobial action: 19
Chapter 3. Botanical characteristics of medicinal plants 20
3.1 Dandelion (Taraxacum officinale) 20
3.2 Calendula officinalis (Calendula officinalis). 22
3.3 Yarrow (Achillea millefolium) 23
3.4 Sandy immortelle (Helichrysum arenarium) 26
3.5 Tansy (Tanacetum vulgare) 28
3.6 Corn (Zea mays L) 30
3.7 Milk thistle (Silybum marianum) 31
Conclusions 34
References 37
Attached files: 1 file
Introduction. 4
Chapter 1. Brief description of diseases of the liver and biliary tract 6
1.1.Hepatitis 6
1.1.1.Hepatitis A. (Botkin's disease) 7
1.1.2.Hepatitis B. 7
1.1.3.Hepatitis C. 8
1.1.4.Toxic hepatitis. 9
1.1.4.1.Alcoholic hepatitis. 9
1.2.Cholecystitis. 10
1.3. Gallstone disease. 12
1.4.Cirrhosis of the liver. 13
Chapter 2. Classification of medicinal plants used for the treatment of diseases of the liver and biliary tract 17
2.1 Medicinal herbs that stimulate bile formation 18
2.2 Medicinal herbs with anti-inflammatory effects 18
2.3 Medicinal herbs with antitoxic effects 18
2.4.Medicinal plants with membrane-stabilizing effects 18
2.5.Medicinal plants with regenerating effects 18
2.6.Medicinal plants with antispasmodic action 19
2.7.Medicinal plants with antimicrobial action: 19
Chapter 3. Botanical characteristics of medicinal plants 20
3.1 Dandelion (Taraxacum officinale) 20
3.2 Calendula officinalis (Calendula officinalis). 22
3.3 Yarrow (Achillea millefolium) 23
3.4 Sandy immortelle (Helichrysum arenarium) 26
3.5 Tansy (Tanacetum vulgare) 28
3.6 Corn (Zea mays L) 30
3.7 Milk thistle (Silybum marianum)
References 37
Introduction.
Relevance. Disease of the liver and biliary tract is a pressing problem of modern medicine, this is due to high level morbidity and mortality from this pathology.
Chronic liver diseases are extremely common and therefore represent a major health problem worldwide. Today in the world there are more than 170 million people suffering from viral hepatitis “C” and more than 350 million from hepatitis “B”. In Russia, the number of patients infected with hepatitis B and C viruses is about 4 million people. And if we take the general statistics of liver diseases in Russia, then every second Russian suffers from liver diseases, and every fourth has fatty liver, that is, the accumulation of fat in liver cells. As a result, there will be more than 8 million people suffering from liver disease.
Liver disease is caused by various etiological factors such as hepatotropic viruses, bacteria, protozoa, helminths, many medications, toxic substances, as well as alcohol, which is one of the current causes of the disease in Russia.
For the treatment of liver and biliary tract diseases, they are developed and used various methods treatment. The most commonly used drug treatment, but currently the use of medicinal plants is very popular, since medicinal plant materials have low toxicity and a later manifestation of adverse reactions, unlike drugs of a synthetic composition.
The purpose of the work is to study, according to literary sources, a group of medicinal plants used for diseases of the liver and biliary tract.
To achieve this goal, it is necessary to solve the following tasks:
1. Conduct an analysis of literature data and characterize liver and biliary tract diseases.
2. Based on literary sources, study the main medicinal herbs used in the treatment of these pathologies of the liver and biliary tract.
3.Give the botanical characteristics of medicinal plants, their distribution, method of procurement and use of raw materials. According to literary sources, characterize their chemical composition.
Chapter 1. Brief characteristics of the most common diseases of the liver and biliary tract
According to WHO statistics, the most common diseases are hepatitis, cholecystitis, cholelithiasis, and cirrhosis of the liver.
All liver diseases can be divided into two groups: diffuse diseases, when the entire mass of the liver is affected by the inflammatory process (acute viral hepatitis and cirrhosis) and focal processes (tumors, cysts, cancer). In addition, diseases of the gallbladder and bile ducts are inextricably linked with liver diseases. The disease of one of them entails changes in the others.[ 11 ]
But more often, inflammation begins in the liver.
1.1.Hepatitis
Hepatitis - common name acute and chronic diffuse inflammatory diseases of liver tissue caused by viruses, toxins and other factors.
Classification of hepatitis:
1. Viral or infectious hepatitis with types:
Hepatitis A;
Hepatitis B;
Hepatitis C;
2. Toxic hepatitis with types:
Alcoholic hepatitis;
Drug-induced hepatitis;
Viral or infectious hepatitis.
This type of hepatitis is the most common.
Let's look at each type of viral hepatitis sequentially.
1.1.1.Hepatitis A. (Botkin's disease)
Caused by the hepatitis A virus.
The hepatitis A virus has a direct cytopathic effect, that is, it is capable of directly damaging hepatocytes. Hepatitis A is characterized by inflammatory and necrotic changes in the liver tissue and intoxication syndrome, liver enlargement.
Treatment of hepatitis A.
No special antiviral drugs are needed to treat hepatitis A. Our body is able to fight off the infection itself. Treatment for hepatitis A involves supporting some of the liver functions that suffer during the disease. So, the body needs detoxification - the removal of toxins that the diseased liver is not yet able to neutralize on its own. Detoxification is carried out using special solutions that dilute the blood and reduce the concentration of toxic substances in it (hemodesis). In addition to detoxification, hepatoprotectors are used to treat hepatitis A - these are medications that protect liver cells. Among other things, for a speedy recovery it is necessary to replenish the supply of vitamins that help the body recover after illness.
In the treatment of hepatitis A, medicinal plants are used: fruits and young shoots of rose hips, St. John's wort, oregano, fireweed, mint, currant shoots, and Rhodiola rosea root.
1.1.2.Hepatitis B.
Hepatitis B - viral disease, the causative agent of which is the hepatitis B virus, from the hepadnavirus family.
The most significant pathogenetic factor in viral hepatitis is the death of infected hepatocytes due to an attack by their own immune agents. Massive death of hepatocytes leads to dysfunction of the liver, primarily detoxification, and to a lesser extent - synthetic.
Treatment of hepatitis B.
In acute hepatitis B, only supportive and detoxification therapy is prescribed, aimed at removing toxins and restoring liver tissue. Antiviral treatment is not carried out.
For chronic hepatitis B, complex treatment is carried out, which is selected individually. Special medications are prescribed according to the form and severity of the disease.
In the treatment of hepatitis B, medicinal plants are used: fruits and young shoots of rose hips, St. John's wort, oregano, fireweed, mint, currant shoots, and Rhodiola rosea root.
1.1.3.Hepatitis C.
Hepatitis C is called the “gentle killer” because of its ability to mask the true cause under the guise of many other diseases.
Hepatitis C virus (HCV) is small and contains genetic material in the form of enveloped RNA. Before the discovery of HCV in 1989, the infection was called “non-A, non-B hepatitis.”
The main feature of the hepatitis C virus is its genetic variability and pronounced ability to mutate.
Treatment of hepatitis C.
Combined antiviral therapy. International studies and clinical practice have shown that currently the most effective combination of two drugs is interferon-alpha and ribavirin.
To prevent hepatitis C, medicinal plants are used: fruits and young shoots of rose hips, St. John's wort, oregano, fireweed, mint, currant shoots, and Rhodiola rosea root.
1.1.4.Toxic hepatitis.
Toxic hepatitis - acute lesion liver, developing on the 2-5th day after intoxication and characterized by an enlarged liver, its pain on palpation, and increasing jaundice. The severity of these changes depends on the severity of intoxication.
Types of toxic hepatitis include alcoholic hepatitis.
1.1.4.1.Alcoholic hepatitis.
Alcoholic hepatitis is an inflammatory disease of the liver caused by long-term consumption of alcoholic beverages. Systematic consumption of large doses of alcohol leads to this disease. For example, if a person drinks 100 g of alcoholic beverages in pure alcohol every day for 5 years, he will be provided with alcoholic hepatitis. This disease also goes by other names: toxic alcoholic hepatitis, fatty hepatitis and alcoholic steatonecrosis.
Entering the human body through the digestive tract, alcohol is immediately absorbed into the blood, which delivers this poison to all organs. Of course, this is not good for the body. In the liver, alcohol is neutralized by alcohol dehydrogenase enzymes, and as a result of this breakdown, acetaldehyde is formed. This substance is a poison for the body, several tens of times stronger than alcohol itself. The liver takes on the task of neutralizing this breakdown product of alcohol, and in this case non-toxic substances are formed, which are excreted from the body in the urine.
With regular alcohol consumption, enzymes become unusable and are replaced by new ones. But the set of alcohol dehydrogenases does not have time to be replenished, so alcohol and acetaldehyde are no longer processed by the liver, and toxins do not leave it. This is how alcoholics develop alcoholic hepatitis. Other diseases of the digestive system resulting from alcohol abuse - gastritis, cholecystitis, pancreatitis - also play a certain role in the development of this disease. Once liver resources are depleted, cirrhosis and liver failure develop.
Treatment of alcoholic hepatitis can lead to success only if the patient completely abstains from alcohol. Treatment usually begins in a hospital setting and may end on an outpatient basis.
If alcoholic hepatitis is still in initial stage, and the patient stops drinking alcohol, follows the diet and all the doctor’s prescriptions, the prognosis for recovery can be very favorable. The generative and compensatory capabilities of the liver are such that even with hepatitis with cirrhosis already in progress, complete abstinence from alcohol can lead to recovery.
To treat alcoholic hepatitis, hepaprotectors are used - medications that help restore damaged liver cells. These are “Essliver Forte”, “Heptral”, “Heptor”, “Karsil” and others.
1.2.Cholecystitis.
Cholecystitis - inflammation of the gallbladder - is one of the most common complications of gallstone disease. The basic principles of the development of the inflammatory process in the wall of the gallbladder: the presence of microflora in the lumen of the bladder and disturbances in the outflow of bile.
Cholecystitis has 2 forms: chronic and acute.
Acute cholecystitis is caused by an inflammatory process in the gallbladder, usually accompanied by impaired bile circulation due to its blockade. Acute cholecystitis is characterized by destructive processes in the wall of the bladder and often the presence of stones. Almost acute cholecystitis is considered as an acute complication of chronic cholecystitis or cholelithiasis. B clinical picture pain, fever, and signs of peritoneal irritation predominate.
Chronic acalculous cholecystitis is an inflammatory process in the gallbladder, often in the cervix, accompanied by impaired outflow of bile, recurrent painful attacks, sometimes with fever, jaundice, and manifestations of inflammation of the peritoneum. Chronic calculous cholecystitis is inflammation of the gallbladder in the presence of stones in it (cholelithiasis); the presence of destructive processes in the gallbladder and disruption of bile outflow are not necessary.
When determining indications for herbal medicine, it is first of all necessary to exclude the need for urgent surgical intervention due to the risk of developing obstructive jaundice, bile peritonitis, acute pancreatitis, or to evaluate the feasibility of using medicinal plants in connection with the upcoming planned operation. In herbal medicine, priority should be given to plants with choleretic, anti-inflammatory, sometimes antispasmodic, analgesic, and stool-regulating effects. It is necessary to take into account the differences between plants that have a predominantly choleretic effect (sandy immortelle, common barberry, common tansy, cinnamon rose hips, peppermint, common chicory, common corn, etc.) and cholekinetic (common rowan, common coriander, Tangut rhubarb, etc.) .
1.3. Gallstone disease.
Gallstone disease is a disease of the hepatobiliary system in which the metabolism of cholesterol and bilirubin is disrupted.
With cholelithiasis, stones form in the gallbladder and bile ducts, often against the background of a chronic inflammatory process, which is caused by impaired metabolism of cholesterol, bile acids, bilirubin, stagnation of bile, past or chronic infection. The dissolution of stones or their “expulsion” with the help of medicinal plants is very doubtful and scientifically unproven. Although surgical treatment is mainly used for cholelithiasis, herbal medicine can help eliminate inflammatory phenomena in the gallbladder or bile ducts, increase the outflow of bile, improve its biochemical properties, and reduce pain.
Until recently, there were only two realistic approaches to the treatment of gallstone disease. The first approach is surgical treatment - cholecystectomy, the second is to wait and watch. Currently, treatment options have expanded significantly thanks to active pharmacological therapy aimed at dissolving stones, as well as crushing stones and the use of less traumatic surgical techniques through a laparoscope.
Medicinal herbs are also used for the treatment of cholelithiasis: cinquefoil (herb), lingonberry (leaf), silver birch (leaf), wild strawberry (leaf), St. John's wort (herb), tansy (inflorescences), horsetail (herb) , peppermint (herb), knotweed (knotweed), chamomile (flowers), yarrow (inflorescences), blueberry (berries), cinnamon rose hips (roots, fruits).
