Prevention of structural changes in liver in patients with chronic acalculous cholecystitis

Chronic acalculous cholecystitis is the cause of violations of the functional state of the liver in the form of stagnation in the intrahepatic bile ducts and a decrease in the activity of hepatocytes and is considered within the framework of a single pathology of the hepatobiliary tract. Complex therapy with the inclusion of the drug ademetionine, which in addition to the hepatoprotective effect affects the outflow of intrahepatic bile, contributes to the restoration of the detected violations.

ЗМІНИ ХОЛЕЦИСТОКІНІНУ-ПАНКРЕОЗИМІНУ У ХВОРИХ НА ХРОНІЧНИЙ НЕКАМЕНЕВИЙ ХОЛЕЦИСТИТ У ПОЄДНАННІ З НЕАЛКОГОЛЬНОЮ ЖИРОВОЮ ХВОРОБОЮ ПЕЧІНКИ І СТАБІЛЬНОЮ ІШЕМІЧНОЮ ХВОРОБОЮ СЕРЦЯ

Disorders in the system of neurohumoral regulation, gastrointestinal peptide hormones, such as cholecystokinin-pancreozymin (CCK-PZ), which also acts as a neurotransmitter, are of great importance in the development of the biliary tract pathology. The influence of CCK-PZ on the gallbladder function in patients with chronic acalculous cholecystitis in combination with non-alcoholic fatty liver disease (NAFLD) and Stable ischemic heart disease (SIHD) remains unexplored.We have examined 60 patients with chronic acalculous cholecystitis, among which patients with concomitant NAFLD and SIHD or without comorbidity were distinguished. The lipid spectrum of the blood was determined for all patients, the level of CCK-PZ in the blood serum was determined by the enzyme immunoassay using reagents made by Peninsula Laboratories Inc (USA). A polypositional ultrasound examination of the gallbladder was performed, as well as a fractional multiple moment duodenal intubation. It was found that the combination of chronic acalculous cholecystitis with NAFLD and SIHD is manifested by a significant violation of lipid metabolism, dyslipidemia, an increase in cholesterol of proatherogenic lipoprotein fractions and a deficiency of high density lipoproteins. A decrease in the level of cholecystokinin-pancreosimin in patients with chronic acalculous cholecystitis leads to a decrease in the contractility of the gallbladder and an increase in the tone of the sphincter of Oddi. An increase in the level of triacylglycerols and total cholesterol leads to an increase in the flow of lipids into the wall of the gallbladder, which is manifested by its thickening and hypotension of the gallbladder.

Chronic acalculous cholecystitis and biliary dysfunction: how does clinical diagnosis affect management?

Similar abdominal pain of biliary type in functional disorders of biliary tract and chronic acalculous cholecystitis causes objective difficulties to differentiate not only between each other, but also with other diseases of gastrointestinal tract. The clinical picture is so homogeneous and difficult to distinguish from cholelithiasis that some patients undergo unreasonable surgical interventions for CAC and FDBT. Individual publications pushing for such an aggressive strategy are sporadic and need to be clarified in larger studies. The first choice drugs for treatment of FDBT are spasmolytics; ursodeoxycholic acid drugs are used as adjuvant agents. In CAC, the initial therapy will be similar, but the treatment regimen can be expanded with targeted etiotropic (if the cause of cholecystitis is identified – giardiasis, opisthorchiasis, etc.) or empirical antimicrobial/antiparasitic therapy. The greatest interest today is caused by hymecromone – a drug with proven by both experimental and controlled studies combined choleretic, selective spasmolytic action, mediated effect of reducing bile lithogenicity and possible anti-inflammatory action. Hymecromone effectively relieves biliary pain without causing gallbladder contractions, which determines the possibility of its wide application both in CAC and FDBT, both in monotherapy and in combination with other agents, primarily with UDCA. In this article the issues of optimization of diagnostic and therapeutic strategy of management of patients with biliary pain to avoid unreasonable cholecystectomies in acalculous diseases of the biliary tract are considered.

Dynamics of Clinical Symptoms and Functional State of the Biliary System in Patients with Chronic Acalculous Cholecystitis on the background of Type 2 Diabetes Mellitus under the Influence of Complex Therapy

The urgent problem of modern medical science and practice is the rapid increase of comorbid pathology spreading among the population of the whole world. Among the nosological forms, which are quite often combined with each other, there are cardiovascular system, digestive tract and endocrine diseases, namely type 2 diabetes mellitus. Diseases of the biliary tract, in the form of chronic acalculous cholecystitis, occur in patients with type 2 diabetes more often than in its absence. There is no doubt that the combination of diseases of the gallbladder and type 2 diabetes significantly affects the course and prognosis of both diseases, and the development of complications is one of the main causes of disability and mortality in patients. In this regard, the priority areas of health protection are the search for preventive measures to eliminate the development of diseases, their complications and the amendment of therapeutic patterns. The purpose of the study was to evaluate the efficacy of complex therapy with the addition of ursodeoxycholic acid and alpha-lipoic acid in patients with concomitant chronic acalculous cholecystitis and type 2 diabetes on the basis of studying the dynamics of clinical symptoms and the content of bile acids in blood serum, as well as parameters of cholecystosonography (in overview and dynamic versions). Material and methods. In the course of the study, 62 patients with the combined course of chronic hepatitis and diabetes mellitus were examined. The age of the patients ranged from 44 to 75 years old. The duration of type 2 diabetes was from 1 to 19 years. The group was representative in terms of age and number of male and female probands. Upon admission to the hospital, all patients underwent a thorough examination using generally accepted clinical, laboratory and instrumental studies. Results and discussion. The complex treatment included hypoglycemic drugs, medical nutrition, prescription of antispasmodic and antibacterial therapy, ursodeoxycholic acid drugs at a dose of 15 mg / kg / day for 4 weeks, as well as preparations of alpha-lipoic acid 600 I / V drip for 10 days, followed by oral administration in within 12 weeks. In order to assess the effectiveness of therapy, clinical symptoms, serum levels of fatty acids, indicators of survey and dynamic cholecystosonography were evaluated after 3 months in the dynamics of treatment. Conclusion. The study showed that the addition of ursodeoxycholic acid and alpha-lipoic acid to the complex therapy was accompanied by positive effects due to an improvement in the contractility of the gallbladder, a decrease in the serum fatty acid content, improved the motor and cholesecretory functions of the gallbladder and the clinical condition of patients by eliminating abdominal pain and reducing the percentage of patients with chronic acalculous cholecystitis and type 2 diabetes with manifestations of dyspeptic, neuro-vegetative and asthenic syndromes

Combination of general and local action drugs in treatment of patients with generalized periodontitis on the basis of the pathology of the hepatobilary system

The pathology of the hepatobiliary system significantly affects the state of the organs of the oral cavity. A clinical and index study of the state of periodontal tissues in 122 patients was conducted, which showed the prevalence of periodontal disease in patients with chronic acalculous cholecystitis. The examined patients were divided into groups depending on the treatment method, and the result was evaluated before treatment, directly after treatment and 6 months following treatment. Antidysbiotic hepatoprotector and 2% thiotriazolin ointment were included in the combination therapy. Studies have shown that patients with hepatobiliary pathology have increased likelihood of periodontal diseases, and after treatment, periodontal indicators and the hygiene index are significantly reduced, especially in the group where the proposed scheme was used, and the long-term results were stable for 6 months.

Changes in thyroid hormones in patients with chronic acalculous cholecystitis in the practice of a family doctor

Among biliary pathology, chronic acalculous cholecystitis (CAC) occupies one of the central places. The important role of the hormonal system in the regulation of the functioning of the biliary tract has been known for a long time, but the specific mechanisms of these influences remained unclear. Based on the results of a comprehensive clinical, laboratory, biochemical and instrumental examination, all patients with chronic acalculous cholecystitis were divided into three groups depending on the variant of impairment of the motor-kinetic function of the gallbladder. The first group consisted of patients with CAC and hypertensive-hyperkinetic gallbladder dyskinesia (group I) – 17 people; the second – patients with CAC with mixed hypotonic-hyperkinetic gallbladder dyskinesia (group II) – 19 people; the third – patients with САС and hypotonic-hypokinetic dyskinesia of gallbladder (III group) – 29 people. The level of free FT3, FT4, and thyroid-stimulating hormone (TSH) was determined by the immunofluorescence method using BREAHMS test systems (Henning Berlin GMBH). The disproportion between the thyroid hormones and the quantitative predominance of the inactive form made it possible to identify the relative hypothyroid syndrome in group I patients. The disproportion between the biologically inactive and active forms of thyroid hormones with a quantitative predominance of the inactive form made it possible to judge the presence of a relative hypothyroid syndrome in group II patients. In group III patients, a significantly increased TSH level was revealed, which was a response of the hypothalamic-pituitary system to a decrease in the level of FT3.

ОСОБЛИВОСТІ ЛІКУВАННЯ ХВОРИХ НА ХРОНІЧНИЙ БЕЗКАМ’ЯНИЙ ХОЛЕЦИСТИТ ІЗ СУПУТНЬОЮ ГІПЕРТОНІЧНОЮ ХВОРОБОЮ З УРАХУВАННЯМ ПОРУШЕНЬ В СИСТЕМІ ГОМЕОСТАЗУ

Recovery of chronic acalculous cholecystitis (CAC) in patients with hypetension disease (HD) is shown to be accompanied by inhibition of antioxidant system parameters and significant changes in lipid peroxidaton, which cause elevation of anti-inflammatiry cytokines level. The studied parameters correlate with thecharacterof the inflammatory processand the type of the gallbladder dyskinesia. The use of Choliver and Duspatalin in complex treatment of CAC in patients with HD provides clinical and laboratory remission, which allows to recommend these drugs for treatment of the above persons.

Engilen: from different therapeutic possibilities to effective clinical use

Composition of the Engilen preparation, medicinal properties of plants that make up the preparation, indications for its prescription are analyzed in detail in the article. Particular attention is paid to the advantages of Engilen, such as: optimal doses and ratio of active ingredients, wide range of indications, effectiveness upon combined diseases of the digestive system and with the concomitant pathology of other organs and systems. The results of our own study are presented, showing the effectiveness of Engilen upon chronic acalculous cholecystitis and non-alcoholic steatohepatitis in patients with excessive body mass or obesity. In addition, an effective correction of various types of the gall-bladder dysfunction has been obtained.