Symptoms of cholestasis, its diagnosis and treatment

Cholestasis is a disorder of bile excretion as a result of insufficient formation of it in the hepatic cells or termination of outflow along the bile ducts.

There are cholestasis intrahepatic and extrahepatic. Intrahepatic cholestasis develops when liver cells are damaged by a viral infection, medication and toxic damage to the liver, including alcohol. Medication of liver damage is observed with prolonged use of antibiotics, including anti-tuberculosis, as well as anti-inflammatory, hormonal and psychotropic drugs. Toxic liver damage causes 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 the state of cholestasis during pregnancy.

As a result of damage to the liver cells, secretion of bile, reabsorption and secretion of the fluid in the bile duct are disturbed.

Extrahepatic cholestasis occurs as a result of the presence of a mechanical obstruction to the outflow of bile. This occurs with calculous cholecystitis, acute pancreatitis, swelling of the head of the pancreas and bile ducts.

In addition to these diseases, the symptoms of cholestasis can be observed in allergic diseases, systemic lesions of the connective tissue, and certain endocrine diseases.

Clinical picture of cholestasis

Subjective symptoms of cholestasis are determined during a conversation with a patient. The patient complains of dryness and bitterness in the mouth, especially pronounced in the morning, pain or a feeling of heaviness in the right hypochondrium. When the patient is examined, the icteric color 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 sharply increases with cholestasis. The patient's tongue becomes covered with a yellowish coating, teeth prints appear along the edge of the tongue, a so-called scalloped tongue is formed. When palpation, the liver is painful, protruding from under the edge of the costal arch. A positive symptom of Ortner (painfulness when tapping on the right costal arch), Kerr's symptom (pain during palpation at the site of the gallbladder projection) is determined. A characteristic feature is discolored feces and dark urine.

The clinical symptoms of cholestasis are quite typical. They are supplemented by data from laboratory studies.

Symptoms of cholestasis in biochemical analysis of blood - an increase in the content of bilirubin, the content of bile acids and cholesterol, high activity of alkaline phosphatase. In the general analysis of urine, bile acids are determined , a high level of urobilin.

Treatment of cholestasis

Since cholestasis is only a symptom whose presence is possible in many diseases, treatment should be performed only after determining the diagnosis of the underlying disease.

If cholestasis develops, treatment should begin with the appointment of a diet. Patients are shown diet number 5. The purpose of the diet is aimed at limiting the irritant effects on the liver.

Medicamentous therapy consists in the appointment of hepatoprotectors, choleretic preparations, antispasmodics. Effectively the appointment of phytotherapy. When cholestasis can be used decoction of the immortelle sand, corn stigmas, hips. To prevent the development of cholestasis, the normalization of the outflow of bile uses blind probing, the use of which is prohibited in the presence of large stones in the gallbladder.

Prevention of the development of cholestasis is the timely diagnosis and treatment of liver and bile duct diseases.