Functional and organic

diseases of liver and bile

ducts. Etiology, pathogenesis,
clinical features, diagnostics,
treatment and prophylactic
 Definition of the Biliary
Dyskinesia
 is a disorder of the sphincter’ tonus and
kinetics of the gall-bladder and bile ducts.
 Classification

 hypertonic-hyperkinetic dyskinesia

 hypotonic-hypokinetic dyskinesia
 Clinical manifestation of
hypertonic-hyperkinetic
dyskinesia
 Duration of the disease up to 1 yr.
 Pain syndrome
 Dyspeptic syndrome
 Manifestations of vegetative dysfunction,
neurotic symptoms
 Clinical manifestation of
hypotonic-hypokinetic dyskinesia
 Pain syndrome
 Dyspeptic syndrome
 Hepatomegaly
 Gallbladder symptoms are positive
 Plan of examination
 Fool blood count
 Biochemical test of blood
 Serum aminotransferase
 Serum bilirubin (predominantly the direct reacting
fraction)
 Serum alkaline phosphatase
 Albumin and globulin level

 Stool test
 USE of the abdominal cavity + cholekynetics for
functional investigations
 Stool test:
Norma Biliary dyskinesia
indigested 1-2-3
muscular fibers
non-digestable ++
cellulose
digestable
cellulose +
fatty acids + ++++
mucous ++
epithelium 1-2
leucocytes 1-2-3
erythrocytes 0-1
 USE of the abdominal cavity +
cholekinetics for functional
investigations
 cholekinetics lead to a contraction of the
gallbladder for 1/2-2/3 of the previous volume
 hypertonic dyskinesia - contraction of the
gallbladder more than 2/3 of the previous
volume
 hypotonic dyskinesia - contraction of the
gallbladder less than 1/2 of the previous volume
 Treatment of hypertonic-
hyperkinetic dyskinesia
1. Diet N 5
2. Spasmolitics:
 platyphyllini hydrotartratis (amp. 0.2 % 1 ml)
 papaverini hydrochloridum (tab. 0.01, amp. 2 % 2 ml)
 no-spa (tab. 0.04 or amp. 2 % 2 ml)

3. Choleretic:
 cholagon
 allocholum
 cholenzynum
 galstena
 hepabene
 Treatment of hypotonic-
hypokinetic dyskinesia
1. Diet N 5
 Prokinetic: motilium, domperidone (tabl. 0.01 g) 1
mg/kg/day
3. Choleretic and cholekinetic drugs:
 cholagon

 allocholum

 cholenzynum

 galstena

 hepabene

 chophytol
 Diet 5
 Exclude heavy fats (like pork), spices, fried
foods, "fast food"”; avoid stimulators of
gastrointestinal secretions, the diet must be rich
by metionine, lecithin, and choline to stimulate
synthesis of proteins and enzymes in the liver.
Diet with normal value of proteins and vitamins,
with restriction of fats and carbohydrates is
administered, also restrict salt.
 Foods boiled, steamed and baked are
recommended; food taking 5 times daily
 Hepatoprotectors
 Essentiale (cap., amp.) 1-2 cap. 3 times a
day
 Carsil (dragee) 1-2 dragee 3 times a day
 Hepabene 1-2 dragee 3 times a day
 Thiotriazolinum 1 tabl. 3 times a day
 Chophytol 1-2 tabl. 3 times a day
 Antioxidants (aevitum, tocopheroli
acetatis)
 Enterosortion (enterosgel)

 Probiotics (linex, bifiform, bactisuptil)

 Chronic cholecystitis and
cholecystocholangitis

 Chronic recurrent inflammatory process

of gallbladder and intrahepatic bile ducts,
accompanied with bile ducts motor
disorders
 Clinical manifestation
 Pain syndrome
 Dyspeptic syndrome
 Intoxication syndrome
 Cholestasis
 Inflammatory syndrome
 Dyscholia
 Ph of bile is acidic
 Treatment of hypotonic-
hypokinetic dyskinesia
1. Diet N 5
2. Prokinetic: motilium, domperidone (tabl. 0.01 g) 1
mg/kg/day
3. Choleretic and cholekinetic drugs:
 cholagon
 allocholum
 cholenzynum
 galstena
 hepabene
 chophytol
 Hepatoprotectors
 Essentiale (cap., amp.) 1-2 cap. 3 times a
day
 Carsil (dragee) 1-2 dragee 3 times a day
 Hepabene 1-2 dragee 3 times a day
 Thiotriazolinum 1 tabl. 3 times a day
 Chophytol 1-2 tabl. 3 times a day
 Treatment of lambliasis,
girardiasis
 Furasolidone 8-10 mg/kg 4 times a day-
10 days (tabl. 0.05)
 Tinidazole 50-60 mg/kg/day (tab. 0.5,
0.15)
 Metronidazolum 15-20 mg/kg for 5 days
(tabl. 0.5)
Definition of the chronic hepatitis
 a continuing hepatic inflammatory process
manifested by elevated hepatic transaminase
level, lasting 6 mo or more and accompanied
with pain, dyspeptic, intoxication and
cholestatic syndromes
 Classification of the hepatitis
Forms of chronic hepatitis:
1. Chronic viral hepatitis (В, С, D)
2. Autoimmune hepatitis
3. Drug-induced hepatitis
4. Toxic hepatitis
5. Cryptogenic
 The activity of the chronic hepatitis
1. Active period:
а) mild activity (elevation of ALT < 3 times);
б) moderate activity (elevation of ALT < 10
times);
в) severe activity (elevation of ALT >10 times).
2. Inactive period
 Stages of chronic hepatitis
0- fibrosis is absent;
1- mild fibrosis;
2- moderate fibrosis;
3- severe fibrosis;
4- cirrhosis.
 Clinical manifestation
 Pain syndrome
 Dyspeptic syndrome
 Intoxication syndrome
 Objective examination shows
 Inadequate weight gain or failure to thrive
 Sexual delay
 Jaundice
 Pruritus
 Hyperpigmentation or hypopigmentation of
the skin
 Symptoms of hypovitaminosis
 Telangiectasias (spider angiomas)
 Palmar erythema
 Clubbing fingers
Jaundice
 Objective examination shows
 Hepatic smell
 Hepatomegaly
 Symptoms of portal hypertension
 Splenomegaly
 Ascites

 Collateral circulation

 Splenism
 Hemorrhagic syndrome
 Encephalopathy
Hepato-
spleno-
megaly
Collateral
circulatio
n in case
of biliary
cirrhosis
 Plan examination
 Fool blood count
 Biochemical test of blood
 Serum aminotransferare
 Serum bilirubin (predominantly the direct reacting
fraction)
 Serum alkaline phosphatase
 Serum γ-globulin levels
 Albumin and globulin level
 The prothrombin time
 serum iron and serum ferritin

 Stool test
 USE of the abdominal cavity
 Tests in case viral hepatitis
 ELISA test
 PCR examination
 Quantitative PCR
 Viral genotyping
 Autoimmune hepatitis
 Hypergammaglobulinemia.
 Serum IgG levels usually exceed 16 g/L.
 Serum antiactin (smooth muscle), antinuclear,
and antimitochondrial antibodies.
 Additional less common autoantibodies
include rheumatoid factor, anti-parietal cell
antibodies, and antithyroid antibodies.
 A Coombs-positive hemolytic anemia may be
present.
 Treatment of the viral hepatitis
 Regime
 Diet 5
 Interferon-therapy: (α-Interferon).
 Interferon-therapy:
1. Intron А (α2b-Interferon),
Form of production - vial with 3 and 5 М units
2. Viferon (α2- Interferon+ vit. E and C)
Form of production rectal suppository
Viferon 1 - 150000 units
Viferon 2 - 500000 units
Viferon 3 – 1000000 units
Viferon 4 – 2000000 units.
n Pegasis (peginterferon α-2а)
Form of production syrette with 135 mcg and 180 mcg
Modern treatment of viral hepatitis
 HBV: Interferon+Lamivudine.
the doses of Lamivudine is 3 mg/kg (up to 100
mg) once per day

 HСV: Interferon+Ribavirin
the doses of Ribavirin is 1000-1200 mg once
per day
 Autoimmune hepatitis
 Prednisone is given at an initial dose of 1–2
mg/kg/day and continued until aminotransferase
values return to less than twice the upper limit of
normal.
 The dose should then be lowered in 5-mg decrements
over a 4- to 6-wk period, until a maintenance dose of
less than 20 mg/day is achieved.
 In patients who respond poorly, who experience
severe side effects, or who cannot be maintained on
low-dose steroids, nazathioprie (1.5 mg/kg/day, up to
100 mg/day) may be added, with frequent monitoring
for bone marrow suppression.
 Hepatoprotectors
 Heptral (tabl.- 0.4 g, amp.- 0.4 g) 1-2 tabl. 3
times a day (20-25 mg/kg/day)
 Ursophalk (cap. 250 mg) 8-10 mg/kg/day
 Essentiale (cap., amp.) 1-2 cap. 3 times a day
 Carsil (dragee) 1-2 dragee 3 times a day
 Hepabene 1-2 dragee 3 times a day
 Thiotriazolinum 1 tabl. 3 times a day
 Chophytol 1-2 tabl. 3 times a day
 Antioxidants (aevitum, tocopheroli acetatis)
 Enterosortion (enterosgel)
 Probiotics (linex, bifiform, bactisuptil)