The term "cholestatic jaundice" means a pathological condition in which the secret produced by the liver (bile) does not enter the duodenum, but gradually accumulates in the blood. If the first alarming signs occur, you should contact a medical institution as soon as possible. This is due to the fact that cholestatic jaundice can indicate both a slight violation of cell metabolism and diseases of the liver and gall bladder, which can be fatal.
Pathogenesis
The basis of the mechanism of development of the disease is the defeat of hepatocytes. These are liver cells whose task is to bind indirect bilirubin and excrete it into the duodenum through the bile ducts. Under the influence of various provoking factors, this process is disrupted.
Indirect bilirubin is a compound that forms in the reticuloendothelial system from the hemoglobin released after the decay of red blood cells. The process of its synthesis is ongoing, it is not interrupted for a second.
Under the influence of various negative factors, the functioning of the liver is disrupted, as a result of which the organ can not cope with the allocation and processing of indirect bilirubin. A natural consequence is its accumulation in blood serum. Moreover, stagnation of indirect bilirubin is also found in the liver itself. Due to the fact that the compound stays in the tissues for a long time, the skin of the patient is painted in yellow or green. This is a rather specific sign of cholestatic jaundice. If it occurs, you must contact a medical institution as soon as possible.
Etiology
According to statistics, most cases of cholestatic jaundice are associated with prolonged use of drugs such as androgens, broad-spectrum antibiotics, antipsychotics, sulfonamides, anabolic steroids. In addition, poisoning the body with certain gases, mercury and salts of heavy metals can trigger the development of a pathological process.
The following is a list of pathologies that are not a direct cause of cholestatic jaundice, but play the role of a kind of catalyst:
- Hepatitis of a chronic nature.
- Some forms of Botkin's disease.
- Idiopathic cholestasis.
- Pancreatitis
- Cirrhosis of the liver.
- Prolonged intoxication of the body.
- Malignant neoplasms, localized not only in the liver, gall bladder and its ducts, but also in nearby organs. The most dangerous are tumors in the stage of metastasis.
- Cholestasis of pregnant women.
- Hepatosis (both fatty and alcoholic).
- Pathologies of an infectious nature (most often cholestatic jaundice develops against the background of the progression of toxoplasmosis, malaria and syphilis).
- Cholecystoatonia.
- Wilson's disease (most often hereditary).
It is important to understand that cholestatic jaundice is such an ailment that poses a danger not only to health, but also to life. This is because indirect bilirubin is extremely toxic. When its concentration increases to critical levels, it is customary to talk about an unfavorable prognosis. In such situations, most often fatal.
Clinical picture
Symptoms of cholestatic jaundice are quite specific, in connection with which a competent doctor can recognize the ailment already during a physical examination and medical history.
Clinical manifestations of the disease:
- Itching of the skin throughout the body. Patients note that sometimes it becomes unbearable.
- Change in skin tone, sclera of the eyes and mucous membranes. Fabrics acquire a yellowish, greenish or even completely reddish hue.
- Nausea, often turning into vomiting.
- Severe weakness.
- Increased fatigue.
- Violation of appetite until its complete absence.
- A rapid decrease in body weight.
- Painful sensations localized on the right side in the area of ββthe ribs. At the initial stage of development of cholestatic jaundice, the symptom is weakly expressed, but over time its intensity intensifies. Patients in this case complain of acute paroxysmal pain.
Pathology is quite easy to distinguish from other types of jaundice. During its progression, the patientβs urine does not acquire a saturated shade. Discoloration of feces is also not observed. This is due to the fact that with this type of disease in the blood serum, a simultaneous increase in the concentration of both bound and free bilirubin occurs. As a result, the process of removing a toxic compound from the body becomes difficult.
Regardless of the severity of symptoms of cholestatic jaundice, treatment of the pathology cannot be delayed. It is important to remember that procrastination can cost a sick person life.
Diagnostics
If the first alarming signs occur, you should consult a doctor. A gastroenterologist and a hepatologist are involved in the treatment of pathology. The specialist will conduct a physical examination, collect an anamnesis and issue a referral for examination.
Diagnosis of cholestatic jaundice involves the following studies:
- General blood test. Based on the results, the doctor will be able to judge the health of the patient as a whole.
- Biochemical blood tests. In the presence of cholestatic jaundice, both bound and free bilirubin are elevated.
- Ultrasound of the liver, gall bladder and its ducts. If necessary, an ultrasound examination of adjacent systems is carried out.
- CT scan of the liver and gall bladder with ducts. It can be appointed in order to confirm the results of ultrasound.
- Endoscopic retrograde cholangiopancreatography. This method allows you to identify the exact cause of cholestatic jaundice.
- Radiography with contrast.
If a malignant neoplasm is suspected, the doctor may prescribe a liver biopsy.
Only based on the results of a comprehensive diagnosis, a specialist can provide information regarding how to treat cholestatic jaundice.
Drug therapy
It implies the implementation of measures aimed at getting rid of the root cause of the ailment. Additionally, symptomatic treatment of cholestatic jaundice is carried out.
The classical regimen includes taking or administering the following groups of drugs:
- Hormonal drugs. They are prescribed to stop the inflammatory process and to stabilize cell membranes.
- Cholagogue. They allow to accelerate the outflow of hepatic secretion.
- Vitamins. Necessary to strengthen the body.
- Hepatoprotectors. The active components of the drugs protect hepatocytes and prevent the process of their death.
- Hemostatics. Assigned in case of increased bleeding.
- Infusion solutions. They help rid the body of toxic compounds and normalize the water-electrolyte balance.
Treatment of cholestatic jaundice can be successful only if all necessary measures have been taken to eliminate the root cause. In severe cases, the patient is shown hospitalization in a hospital.
Surgical treatment
In severe cases and with the ineffectiveness of conservative methods of therapy, surgical intervention is indicated. There are several types of techniques that can be used to treat cholestatic jaundice:
- Drainage of the gallbladder and its ducts. During the operation, accumulated pathological fluid is removed.
- Choledochotomy. During the intervention, the surgeon forcibly opens the lumen of the common bile duct.
- Papillosphinterterotomy. During the operation, the sphincter of the duodenum is opened.
- Hepatectomy. It implies a partial resection of the liver, that is, the affected segment.
- Cholecystectomy During the operation, the gallbladder is completely removed.
In isolated cases, after the performed manipulations, the clinical picture remains or even acquires a greater intensity than before. In such situations, the doctor makes a decision regarding the feasibility of transplanting a donor organ.
Power Features
Diet adjustment is a prerequisite, if not observed, treatment cannot be successful. With cholestatic jaundice, doctors prescribe the diet "Table No. 5", developed by Dr. Pevzner M. I. Doctors consider it the most suitable for people suffering from pathologies of the liver, gall bladder and its ducts.
General principles of diet:
- You need to eat 4-5 times a day. Moreover, the size of one serving should not exceed 200 g.
- Dishes should be prepared only in the following ways: stewing, cooking, baking.
- It is forbidden to eat very cold or too hot food. Dishes should be warm.
- The amount of salt must be minimized.
- It is important to observe the drinking regimen. It is recommended to use 1.5-2 liters of pure still water per day.
- The caloric content of the daily diet should be up to 2800 kcal.
Allowed foods and drinks:
- Weak black tea with lemon.
- Compotes.
- Rosehip based broth.
- Kissels.
- Mousse, jelly with a minimum sugar content.
- Soups (vegetarian, dairy, cabbage soup, beetroot, pea, pearl barley). The meat must be boiled separately and added to the finished dish.
- Borscht.
- Mashed cereals.
- Pilaf.
- Cereals.
- Muesli.
- Bulgur.
- Couscous.
- Rabbit meat.
- Veal.
- Chicken.
- Turkey meat.
- Beef.
- Milk sausages.
- Low-fat fish.
- Oysters
- Shrimp
- Mussels
- Squid.
- Bread (rye or bran).
- Galetny cookies.
- Unfinished baking.
- Bread rolls.
- Dry sponge cake.
- Sour cream with a low fat content.
- Natural yogurt.
- Starchy vegetables.
- Sea kale.
- Avocado.
- Cucumbers
- Tomatoes (in limited quantities).
- Broccoli.
- Celery.
- Sweet apples.
- Bananas (not more than 1 pc per day).
- Garnet.
- Watermelon.
- Prunes
- Dried apricots.
- The eggs.
- Olive oil.
- Squash caviar.
- Sauerkraut.
- Berries
- Marmalade.
From the diet, it is necessary to exclude:
- Cocoa.
- Coffee.
- Carbonated drinks.
- Alcohol (its use is unacceptable even rarely and in a minimal amount).
- Green tea.
- Whey.
- Chocolate.
- Karkade.
- Chicory.
- Packaged and freshly squeezed juices.
- Meat, fish and mushroom broths.
- Okroshka.
- Lentils.
- Greasy paste.
- Offal.
- Lard.
- Sushi rolls.
- Canned food.
- Meat and fish of fatty varieties.
- Red caviar.
- Crab sticks.
- Products from butter and puff pastry.
- Pancakes.
- Fresh bread.
- Fried pies.
- Salted cheeses.
- High-fat dairy products.
- Mushrooms.
- To the corn.
- Spinach.
- Sorrel.
- Chives.
- Pickled vegetables.
- Tomato paste.
- White cabbage in raw form.
- Nuts.
- Sunflower seeds.
- Lemon.
- Ginger.
- Fat.
- Smoked meats.
- Black olives.
- Olives.
- Artichokes.
- Ketchup.
- Mayonnaise.
- Horseradish.
- Mustard
- Vinegar.
- Pepper.
- Adjiku.
- Spices.
- Ice cream.
- Halvah.
- Chewing gum.
- Popcorn.
- Condensed milk.
- Hematogen.
- Kozinaki.
The first 5 days of dieting are a trial period. If the body normally switches to a new diet, it must be maintained for about 5 weeks. Many doctors recommend a diet until complete recovery.
Folk remedies
In order to facilitate well-being, you can resort to unconventional methods. However, it is important to understand that their use does not eliminate the need to seek qualified medical help.
The most effective are the following recipes:
- Take 25 g of pre-ground immortelle. Pour in raw materials 1 liter of water. Put the container on fire. Boil for half an hour. Cool, strain. Take the drug before a meal of 100 ml until the symptoms disappear completely.
- Take 50 g of immortelle flowers, 20 g of coriander, 20 g of peppermint, 40 g of three-leaved watch. Grind all components and mix thoroughly. Take 2 tbsp. l raw materials and pour 400 ml of boiling water. Put the container on fire. Boil for 20 minutes. Then wrap the container with a towel and let it brew for 1 hour. Strain. Take 100 ml three times a day before meals.
- Take 20 g of pre-chopped wormwood. Place the raw materials in a 0.5 liter glass bottle. Pour wormwood with vodka without additives. Put in a dark place. Let it brew for a week. From time to time, shake the bottle with the contents. The resulting tincture is taken twice a day for 20 minutes before meals, 20 drops.
It is important to remember that any medicinal plant is a potential allergen. If there are signs of an unwanted reaction, treatment using non-traditional methods must be completed.
Forecast
Cholestatic jaundice is a pathology, the outcome of which directly depends on the timeliness of a visit to a doctor. If the patient fulfills all the prescriptions of a specialist and strictly follows a diet, the prognosis is considered favorable. An exception are cases when a person was taken to a medical facility in serious condition. The forecast in this situation can be both favorable and not.
Ignoring the warning signs leads to the progression of both the underlying disease and cholestatic jaundice. In this case, the likelihood of a fatal outcome is extremely high.
Finally
Cholestatic jaundice is an ailment, the basis of the development mechanism of which is damage to liver cells - hepatocytes. As a rule, this occurs against the background of prolonged use of certain drugs. If you experience the first alarming signs, you must consult a gastroenterologist or hepatologist.