THE POSSIBILITIES OF COMPLEX VISUAL DIAGNOSTICS OF LIVER PATHOLOGY IN PATIENTS WITH DIFFUSE LIVER DISEASES ASSOCIATED WITH COVID-19.

The research shows the possibilities of visual diagnostics of liver pathology in patients with various diffuse liver diseases and COVID-19. The analysis is based on the results of examination of patients, who got hospital treatment in Clinical Hospital №1 of Smolensk from September to November 2021. The research shows the efficiency of ultrasound diagnosis as the first step of examination. Using Magnetic Resonance Imaging (MRI) allowed to study the symptoms of liver pathology more deeply. In order to improve the exact specific diagnosis of liver pathology in patients with diffuse liver diseases and COVID-19, arterial spin labeling technique is recommended to use. The research shows the efficiency of complex using of diagnostic methods in patients with diffuse liver diseases and SARS-CoV-2 infection

Features of management of patients with liver diseases in the conditions of the COVID-19 pandemic

Liver dysfunction is common with COVID-19 infection, and the prevalence is higher in men as well as in the elderly. Manifestations of liver damage such as high aspartate aminotransferase and alanine aminotransferase activity, increased bilirubin levels, low albumin levels, and prolonged prothrombin time are associated with severe COVID-19 infection. Mortality in patients with diffuse liver diseases without cirrhosis with COVID-19 infection was 12 %, in the presence of liver cirrhosis up to 40%, decompensated liver cirrhosis up to 4363%. The mechanisms of liver damage in COVID-19 include direct hepatotoxicity and indirect liver damage (due to systemic inflammation with impaired immunity, sepsis, hypoxia, ischemia, coagulopathy, endotheliitis, right ventricular failure, worsening of the course of existing liver diseases, drug liver damage). Treatment of patients with diffuse liver diseases includes lifestyle and nutritional modification, the use of hepatoprotective drugs, and means of correcting the intestinal barrier (bibliography: 30 refs).

HEMOSTATIC AND RHEOLOGICAL DISORDERS IN PATIENTS WITH OBSTRUCTIVE JAUNDICE WITH CHOLESTASIS SYNDROME

Одной из наиболее тяжелых патологий гепатопанкреатодуоденальной зоны являются диффузные заболевания печени: хронический гепатит (ХГ) и цирроз печени (ЦП), которые часто являются неблагоприятным осложнением обструктивной желтухи. В последнее время наблюдается тенденция к увеличению обструктивной желтухи некалькулезного происхождения; стеноз (БДС) большого двенадцатиперстного сосочка 1629%; панкреатит 5,427,4%, стриктура рубцов внепеченочного желчного тракта 5. 315%, паразитарные заболевания печени 1,64%; уровень гомеостаза и реологических нарушений зависит от продолжительности холестаза, что способствует развитию цитологических процессов в печени и увеличению печеночной недостаточности. Выявление скрытых механизмов печеночноренальной недостаточности в обструктивной желтухе в различные периоды холестаза имеет большое значение для своевременной диагностики и активной предоперационной коррекции и после хирургического лечения данной патологии с целью снижения операционного риска и послеоперационной летальности. One of the most severe pathologies of the hepatopancreatoduodenal zone is diffuse liver diseases: chronic hepatitis (CG) and cirrhosis of the liver (LC), which are often an unfavorable complication of obstructive jaundice. Recently, there has been a tendency to an increase in obstructive jaundice of noncalculous origin; stenosis (BDS) of the large duodenal papilla 16- 29%; pancreatitis 5.4-27.4%, cicatricial stricture of the extrahepatic biliary tract 5.3-15%, parasitic liver diseases 1.6-4%.The level of homeostasis and rheological disorders depends on the duration of cholestasis, which contributes to the development of cytological processes in the liver and an increase in liver failure. Revealing the hidden mechanisms of hepatic-renal insufficiency in obstructive jaundice at different periods of cholestasis is of great importance for timely diagnosis and active preoperative correction and after surgical treatment of this pathology, in order to reduce the operational risk and after the operational lethality

The Effect of Diffuse Liver Diseases on the Occurrence of Liver Metastases in Cancer Patients: A Systematic Review and Meta-Analysis

This systematic review with meta-analysis aimed to assess the effect of diffuse liver diseases (DLD) on the risk of synchronous (S-) or metachronous (M-) liver metastases (LMs) in patients with solid neoplasms. Relevant databases were searched for systematic reviews and cross-sectional or cohort studies published since 1990 comparing the risk of LMs in patients with and without DLD (steatosis, viral hepatitis, cirrhosis, fibrosis) in non-liver solid cancer patients. Outcomes were prevalence of S-LMs, cumulative risk of M-LMs and LM-free survival. Risk of bias (ROB) was assessed using the Newcastle-Ottawa Scale. We report the pooled relative risks (RR) for S-LMs and hazard ratios (HR) for M-LMs. Subgroup analyses included DLD, primary site and continent. Nineteen studies were included (n = 37,591 patients), the majority on colorectal cancer. ROB appraisal results were mixed. Patients with DLD had a lower risk of S-LMs (RR 0.50, 95% CI 0.34–0.76), with a higher effect for cirrhosis and a slightly higher risk of M-LMs (HR 1.11 95% CI, 1.03–1.19), despite a lower risk of M-LMs in patients with vs without viral hepatitis (HR 0.57, 95% CI 0.40–0.82). There may have been a publication bias in favor of studies reporting a lower risk for patients with DLD. DLD are protective against S-LMs and slightly protective against M-LMs for viral hepatitis only.

Features Of Anemia In Patients With Chronic Liver Diseases

The features of the epidemiology, clinical picture, diagnosis and treatment of chronic diffuse liver diseases in combination with anemia are considered according to the literature on this problem. It has been shown that anemia aggravates the course, causes progression and worsens the prognosis of chronic diffuse liver diseases. The incidence of anemia in chronic diffuse liver diseases reaches 80%. Disclosure of the mechanisms of anemia in chronic diffuse liver diseases is necessary for timely correction and prevention of the progression of both pathological changes in red blood and underlying liver disease.

Complex ultrasonography in the assessment of intrarenal hemodynamic impairments in patients with portal hypertension

Rationale. Hepatorenal syndrome is a threatening complication in patients with liver cirrhosis and portal hypertension. The occurrence of renal dysfunction associated with hepatorenal syndrome manifestations significantly affects the condition severity, the disease duration, and the survival time during the waiting period for liver transplantation.The study purpose was to investigate the potential of a complex ultrasonography examination in the assessment of intrarenal hemodynamic impairments in patients with various diffuse liver diseases.Material and methods. The ultrasound examination results of 167 patients were analyzed. The 1st group included 28 patients with confirmed diffuse liver diseases of viral etiology who did not have signs of cirrhosis formation, the 2nd group included 139 patients with liver cirrhosis due to diffuse liver diseases of various etiologies, and the 3-rd group included 137 patients who had previously been in the 2nd group in whom orthotopic liver transplantation was performed.Results. The study revealed a statistically significant increase in the incidence of secondary hemodynamic impairments in kidney function in patients with liver cirrhosis and no relationship of their severity and incidence to the disease etiology, and also to such markers of the portal hypertension severity as splenomegaly, ascites, and portal vein thrombosis.Conclusions. The resistive index measured on the renal arterial branches by Doppler ultrasound, has a certain predictive value in relation to hepatorenal syndrome in patients with liver cirrhosis of various origins. This also makes it possible to timely identify a group of patients at a high risk of developing severe renal dysfunction and to assess the efficacy of the treatment that has been given.

Contribution of changes in iron metabolism in pathogenesis of chronic diffuse liver diseases

Objective. To assess the role of iron metabolism changes in the pathogenesis of chronic diffuse liver diseases (CDLD). Assessment of the hepatic fibrosis progression and the most significant factors, influencing it, is still an actual target of modern medicine. A certain interest from the point of view of complex approach to studying the mechanism of development and progression of fibrosis is the determination of serum markers of iron metabolism. Materials and methods. The study included 170 patients with CDLD: 150 with chronic viral hepatitis C and 20 with alcohol hepatic cirrhosis (AHC). Iron metabolism indices and functional hepatic biochemical tests were studied. Expression of hepatic fibrosis in hepatitis was estimated by means of the liver density index with the scale METAVIR using the data of ultrasound elastography (Fibroscan 502, Echosens, France); fibrosis development rate was calculated with T. Poynard method. The control group enclosed 100 persons. Results. There was revealed a significant elevation of the blood ferritin concentration among patients with chronic hepatitis up to 107.9 [31; 250] ng/ml compared with the control (22.0 [11; 33] ng/ml) and to 325.8 [209; 401] ng/ml in patients with AHC. Conclusions. Progression of fibrosis into cirrhosis in patients with CDLD is interconnected with iron metabolism disorders in the form of increased ferritin concentration, which correlates with the parameters of liver lesion severity that confirms a direct involvement of iron metabolism disorders in CDLD pathogenesis.

Liver transplantation in hepatic cirrhosis: the experience of work of the Federal Siberian research clinical centre

Prevalence and mortality in terminal stages of diffuse liver diseases amount to 60 %. Foremost, liver transplantation is required by hepatic cirrhosis patients with life expectancy below one year or low quality of life conditioned by the disease. Over the past decade, it has become apparent that only orthotropic liver transplantation is a radical, eff ective and life-saving treatment for hepatic cirrhosis patients. Th is article reports our own results of operative treatment provided for 13 patients using orthotropic liver transplantation advised in relation to diff erent reasons. Th e patients underwent surgery at the surgical department of the Federal Siberian Research Clinical Centre under FMBA of Russia. The earliest outcomes observed during the postoperative period and the structure of complications have been analysed. A clinical case of successful orthotropic liver transplantation is presented. It is postulated that development of this fi eld leads to correction of indications to transplantation and the number of absolute contraindications decreases. Consequently, a possible increase in the number of patients advised to undergo transplantation is to be expected.

ALGORITHM OF DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF CHRONIC DIFFUSE LIVER DISEASES (CHRONIC HEPATITIS AND LIVER CIRRHOSIS) IN DIFFICULT CLINICAL SITUATIONS, BASED ON DETERMINATION OF ENZYMATIC ACTIVITIES OF BLOOD SERUM

Background. The search for non-invasive criteria for differential diagnosis of chronic hepatitis and liver cirrhosis is one of the urgent tasks of hepatology. Aim. Development of an algorithm for the diagnosis and differential diagnosis of chronic diffuse liver diseases (chronic hepatitis and liver cirrhosis) in difficult clinical situations, namely in patients with questionable results of routine laboratory research. Materials and Methods. 55 patients were examined who had a characteristic clinical picture of chronic diffuse liver diseases, however, the levels of AST and ALT were close to normal values. Chronic hepatitis was confirmed in 14 patients (mean age 55.0±11.2 years), liver cirrhosis in 40 patients (mean age 55.0±9.9 years). The control group included 43 practically healthy individuals (mean age – 52.8±4.2 years). All patients underwent determination of the levels of hyaluronidase, elastase, trypsin-like and deoxyribonuclease serum activities, as well as levels of alpha-1-defensin and interleukin-13 in blood serum. Results. An algorithm for the differential diagnosis of chronic hepatitis and cirrhosis of the liver was developed, which makes it possible to identify liver disease with odds ratio of 988.0 [CI95%=31.3-31207.7]. Conclusion. The algorithm allows to optimize diagnostic measures in difficult clinical situations.