Cholestasis is a violation of the secretion of bile as a result of its insufficient formation in the liver cells or the cessation of outflow through the bile ducts.
There are intrahepatic and extrahepatic cholestasis. Intrahepatic cholestasis develops when liver cells are damaged by a viral infection, drug and toxic liver damage, including alcohol. Drug damage to the liver is observed with prolonged use of antibiotics, including anti-TB, as well as anti-inflammatory, hormonal and psychotropic drugs. Toxic liver damage is caused by salts of heavy metals, benzene and its derivatives, hydrocarbons with chlorine. In some cases, the causes of intrahepatic cholestasis are unknown. This also applies to a condition such as cholestasis during pregnancy.
As a result of damage to the liver cells, bile secretion, reabsorption and fluid secretion in the bile canaliculi are impaired.
Extrahepatic cholestasis occurs as a result of the presence of a mechanical barrier to the outflow of bile. This occurs with calculous cholecystitis, acute pancreatitis, tumors of the head of the pancreas and biliary tract.
In addition to these diseases, the symptoms of cholestasis can be observed with allergic diseases, systemic lesions of the connective tissue, some endocrine diseases.
The clinical picture of cholestasis
Subjective symptoms of cholestasis are determined during a conversation with the patient. The patient complains of dryness and bitterness in the mouth, especially expressed in the morning, pain or a feeling of heaviness in the right hypochondrium. When examining a patient, icteric coloration of the skin and mucous membranes is revealed, which is accompanied by intense skin itching. The appearance of itching is associated with the irritating effect of bilirubin, the level of which increases sharply with cholestasis. The patient's tongue is covered with a yellowish coating, tooth prints appear along the edge of the tongue, the so-called scalloped tongue forms. On palpation, the liver is painful, protrudes from under the edge of the costal arch. A positive Ortner symptom (soreness when tapping on the right costal arch), Kerr symptom (pain on palpation at the site of the projection of the gallbladder) is determined. A characteristic feature is discolored feces and dark urine.
The clinical symptoms of cholestasis are quite typical. They are supplemented by laboratory research data.
Symptoms of cholestasis in a biochemical blood test - an increase in the content of direct bilirubin, the content of bile acids and cholesterol, the high activity of alkaline phosphatase. In a general urinalysis, bile acids and a high level of urobilin are determined.
Cholestasis treatment
Since cholestasis is just a symptom, the presence of which is possible in many diseases, treatment should be carried out only after determining the diagnosis of the underlying disease.
If cholestasis has developed, treatment should begin with a diet. Patients are shown diet No. 5. The purpose of the diet is aimed at the maximum restriction of irritating effects on the liver.
Drug therapy consists in the appointment of hepatoprotectors, choleretic drugs, antispasmodics. Effectively the appointment of herbal medicine. With cholestasis, a decoction of the immortelle sand, corn stigmas, rose hips can be used. To prevent the development of cholestasis, normalize the outflow of bile, blind sounding is used, the use of which is prohibited in the presence of large stones in the gallbladder.
Prevention of cholestasis is the timely diagnosis and treatment of diseases of the liver and biliary tract.