RESUMO
The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.
RESUMO
The complex determination of serum autoantibodies to hepatic antigens using enzyme immunoassay and immunoblot allows to increase the frequency of overlap syndrome identification during autoimmune hepatic disorders and its early diagnostics, that has a big clinical, diagnostic and prognostic importance. The levels of overlap autoantibodies combine with biochemical index and with disease activity and intensity of autoimmune processes during overlap syndrome of primary biliary cirrhosis/autoimmune hepatitis (PBC/AIH).
Assuntos
Autoanticorpos/sangue , Autoantígenos/imunologia , Hepatite Autoimune/diagnóstico , Cirrose Hepática Biliar/diagnóstico , Fígado/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatite Autoimune/imunologia , Humanos , Cirrose Hepática Biliar/imunologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Síndrome , Adulto JovemRESUMO
AIM: To estimate the diagnostic value (DV) of direct markers of liver fibrosis, such as type IV collagen (C-IV), hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1) in combination with indirect markers of fibrosis, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (gamma-GTP), alkaline phosphatase (ALP), platelets, tumor necrosis factor-alpha (TNF-alpha) in evaluating liver fibrosis. SUBJECTS AND METHODS: Sixty-seven patients with chronic diffuse liver diseases were examined. ALT, AST, gamma-GTP, and ALP were determined as indirect indicators of fibrosis. The levels of TIMP-1, HA, C-IV, and TNF-alpha were estimated by ELISA; the stage of fibrosis was determined by the results of indirect liver ultrasound fibroelastography (FE). RESULTS: According to the results of FE, the patients were divided into 2 groups: 1) (n = 25) F < or = 2 METAVIR and 2) (n = 42) F3-F4. While estimating DV of severe fibrosis stages (F3-F4), the area under the ROC curve (AUC) increased for platelets, HA, and C-IV. DV of ALT, AST declined with the higher degree of fibrosis. The highest ratio of test specificity and sensitivity (TSp and TSen) and AUC were observed for AST and HA. ALT and platelets showed low TSen, and TNF-alpha and TIMP-1 had no TSp. For evaluation of fibrosis (F4), a HA increase of over 57.7 ng/ml had 92.6% TSen and 67.5% TSp; for a C-IV elevation of above 133.1mkg/l, TSen was 85.2%, TSp was 57.5%; for a TIMP-1 rise from 24.4 ng/ml, TSen was 74.1% and TSp was 62.5%. For the diagnosis of fibrosis (F4) with a HA rise of more than 57.7 ng/ml, DV of a positive test was 65.8 (48.65-80.4; 95% CI) and that of a negative test was 93.1 (76.8-99.2; 95% CI). Thus, the negative rather than positive test results are of great diagnostic value for evaluation of the degree of fibrosis. CONCLUSION: The results of the investigation convincingly suggest that examination of the serum markers of fibrosis allows one to estimate with a high probability its presence and severity in patients with hepatic cirrhosis. The so-called direct markers (substances reflecting the biochemistry and regulation of fibrogenesis) are undoubtedly of great diagnostic value.
Assuntos
Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Área Sob a Curva , Biomarcadores/sangue , Doença Crônica , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Among 106 patients with autoimmune liver disease in 12 (11.3%) were found autoantibodies to asialoglycoprotein receptor (anti-ASGPR): in 5 (9.1%) of 55 with PBC, and 4 (17.4%) of 23 with AIH and 3 (10.7%) of 28 patients with syndrome chiasm (PBC + AIH). Detection of antibodies against the ASGPR is an effective method for diagnosis of autoimmune hepatitis. Further improvement of this method allows for monitoring and disease. Anti-ASGPR levels correlate with biochemical parameters and with the severity and manifestation autoimmune processes in patients with autoimmune hepatitis.
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Receptor de Asialoglicoproteína/imunologia , Autoanticorpos , Hepatite Autoimune , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Autoanticorpos/imunologia , Feminino , Hepatite Autoimune/sangue , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/imunologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors presents the clinical case of autoimmune overlap syndrome: autoimmune hepatitis and primary biliary cirrhosis with outcomes in the hepatic cirrhosis complicated fatal intestinal bleeding.
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Hemorragia Gastrointestinal/complicações , Hepatite Autoimune/complicações , Intestino Delgado/irrigação sanguínea , Cirrose Hepática Biliar/complicações , Evolução Fatal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/imunologia , Hemorragia Gastrointestinal/terapia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/imunologia , Hepatite Autoimune/terapia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/imunologia , Cirrose Hepática/terapia , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/imunologia , Cirrose Hepática Biliar/terapia , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
Research of features of a current of a spontaneous bacterial peritonitis (SBP) allows to allocate close interrelation between SBP, system inflammatory reaction and a sepsis to consider SBP, as one of stages in evolution of the difficult infectious process caused, as a rule, by resident flora, developing at patients with decompensated liver cirrhosis (LC), which demands timely preventive maintenance and adequate antibacterial therapy. In the present work therapy and preventive maintenance SBP questions are considered. In article the extensive review of the data of the literature and own supervision by efficiency of treatment SBP also is presented. For the purpose of optimization of pharmacotherapy of the sick LC, the complicated ascites, had been conducted pharmacokinetics research ciprofloxacin (CPF) according to dynamics of its maintenance in blood serum (BS) and ascitic fluid (AF) depending on presence and ascites size. Materials and methods. Researches are spent 18 sick decompensated liver cirrhosis (a class B and C on Ch-P), without signs SBP after unitary reception of 500 mg CPF per os on an empty stomach. All patients have been divided on two groups: I gr. (n = 10) with the expressed, intense ascites (> 10 1) and II gr. (n = 8) with the moderate, small ascites. Definition CPF in BS also was already carried out by a method of a highly effective liquid chromatography. On the basis of the received data for each patient counted the semidelucing period (T1/2), the area under pharmacokinetic curve (curve concentration - time) - (AUC), volume of distribution of a preparation (Avd), factor AUC(AF)\MIC (size of the relation of the area under pharmacokinetic curve to its minimum inhibitive concentration). Results of research have shown that concentration levels (C) (CPF in BS and AF for the given concrete patient are at one level, showing thus distinctions in dynamic behavior. Average value AUC(AF)\MIC (MIC - minimum inhibitive concentration) at patients II gr. has made 187,3 +/- 5,6 h that almost in 2 times more than necessary value, as has allowed not to recommend to patients increase in dose CPF. On the contrary, parity AUC(AF)/MIC at patients I gr. has made 43,8 +/- 3,6 h (less than 100 h) that it is not enough for therapeutic effect. Conclusions. The conducted research has allowed to make the conclusion that presence and ascites size make essential impact on pharmacokinetic parameters CPF and to recommend increase in dose CPF to 1000 mg/days for sick LC with sharply expressed ascites and safe nephritic function.
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Anti-Infecciosos/administração & dosagem , Infecções Bacterianas , Ciprofloxacina/administração & dosagem , Cirrose Hepática , Peritonite , Líquido Ascítico/metabolismo , Líquido Ascítico/microbiologia , Infecções Bacterianas/sangue , Infecções Bacterianas/etiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Masculino , Peritonite/sangue , Peritonite/etiologia , Peritonite/microbiologia , Peritonite/prevenção & controleRESUMO
The article provides a brief overview of recent data on non-Hodgkin's lymphoma. We describe a special case primary isolation non-Hodgkin's lymphoma of the liver in a patient with chronic hepatitis C. Were analyzed medical errors at all stages of inspection and treatment of the patient. This exceptional case supplements small number of publications on a problem of the isolated lymphoma of a liver. We also wanted to pay attention once again to need of lifetime morphological research of a liver.
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Hepatite C Crônica/diagnóstico , Hepatite C Crônica/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/terapia , Erros de Diagnóstico , Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Humanos , Fígado/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/patologia , Pessoa de Meia-IdadeRESUMO
AIM: To develop criteria of early diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic cirrhosis (HC). MATERIAL AND METHODS: Clinical symptoms of SBP including systemic inflammatory reaction were analysed in 286 patients. The count of polymorphonuclear neutrophils (PNL) in ascitic liquid (AL), microbiological study of the blood and AL were made. Ultrasound investigation assessed acoustic homogeneity of AL. Blood serum (BS) and AL were tested for cytokines content: interleukine-1beta, TNF-alpha, interleukine-4, transforming growth factor beta, C-reactive protein. Gas chromatography--mass spectrometry (GC-MC) estimated quantity and quality of chemical components--markers of potential infectious agents of AL. RESULTS: Three groups of patients were identified: group A (a classic SBP) consisted of 23 patients with clinical symptoms of SBP and PNL content > 0.25 x 10(9)/l; group B (control) consisted of 19 patients free of SBP symptoms and PNL content < 0.25 x 10(9)/l; group C (patients at risk)--18 patients with SBP symptoms and PNL content < 0.25 x 10(9)/l. Cultural test of AL was negative in all the groups. Symptoms of SIR occurred equally often in groups A and C. CRP in AL was higher (23.8 +/- 4.3 g/l) in group A than in group B (p < 0.05). CRP concentration (8.6 +/- 2.1 g/l) was higher in group C than in group B (p < 0.05). Changes in cytokine composition were similar in groups A and C. The number of chemical bacterial markers was higher in groups A and C (p < 0.005). CONCLUSION: Patients of group C with SIR, elevated CRP, changed cytokine status, high content of chemical markers of AL infection by GC-MC are at high risk of SBP. Such patients need adequate and early antibacterial therapy.
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Infecções Bacterianas/diagnóstico , Biomarcadores/metabolismo , Inflamação/diagnóstico , Cirrose Hepática/complicações , Peritonite/diagnóstico , Líquido Ascítico/citologia , Líquido Ascítico/metabolismo , Infecções Bacterianas/etiologia , Infecções Bacterianas/metabolismo , Proteína C-Reativa/metabolismo , Citocinas/metabolismo , Diagnóstico Diferencial , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Inflamação/metabolismo , Cirrose Hepática/diagnóstico , Cirrose Hepática/metabolismo , Neutrófilos/patologia , Peritonite/etiologia , Peritonite/metabolismoRESUMO
We presented the results of our research in comparison with the literature on the etiology, pathogenesis and diagnosis of spontaneous bacterial peritonitis (SBP) at liver cirrhosis (LC), complicated by ascites. Based on these data, was proposed a classification of SBP. Were identified criteria for early diagnosis of SBP on the basis of clinical manifestations of bacterial peritonitis, systemic inflammatory response, results of studies of ascitic fluid (AF) using gas chromatography-mass spectrometry (GC-MS). In accordance with the proposed criteria was proposed a scheme for the diagnosis, treatment and prevention of STDs. Presents data on the effectiveness of therapy and prevention of SBP. Denote the potential major long-term trends in the treatment of SBP in cirrhosis.
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Ascite/microbiologia , Infecções Bacterianas/microbiologia , Translocação Bacteriana , Cirrose Hepática/microbiologia , Peritonite/microbiologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ascite/complicações , Ascite/diagnóstico por imagem , Líquido Ascítico/citologia , Líquido Ascítico/microbiologia , Infecções Bacterianas/diagnóstico por imagem , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Biomarcadores/análise , Contagem de Colônia Microbiana , Humanos , Contagem de Leucócitos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Neutrófilos/citologia , Paracentese , Peritonite/diagnóstico por imagem , Peritonite/etiologia , Peritonite/prevenção & controle , Troca Plasmática , UltrassonografiaRESUMO
The problem of chronic HCV-infection in the elderly patients is poorly known. During the HCV-infection and progression of fibrosis in chronic liver diseases depends on age of the patient.
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Serviços de Saúde para Idosos , Hepacivirus , Hepatite C Crônica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Hepatite C Crônica/patologia , Hepatite C Crônica/fisiopatologia , Hepatite C Crônica/terapia , Humanos , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Cirrose Hepática/terapia , MasculinoRESUMO
Liver damage causes serious metabolic disorders, immune response, detoxification functions and antimicrobial protection. Therefore, the problem of finding new high effective drugs for the restoration and normalization of liver function is extremely urgent. This article presents a new domestic plant hepatoprotector Ropren, which is a biopolymer polyprenols isolated from the green of pine and spruce, and an analog of the endogenous lipid--dolichol. Presented the Ropren efficiency in patients with nonalcoholic steatohepatitis. The drug reduces the clinical and biochemical disease activity, contributes to the normalization of lipid profile. The resulting decrease in the index treatment of fibrosis, determined by indirect transient elastometry, indicates an increase in the elasticity of the liver and reducing the risk of developing cirrhosis.
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Dolicóis/uso terapêutico , Preparações de Plantas/uso terapêutico , Fígado Gorduroso/complicações , Fígado Gorduroso/tratamento farmacológico , Fígado Gorduroso/metabolismo , Fígado Gorduroso/patologia , Humanos , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/metabolismo , Cirrose Hepática/patologia , Cirrose Hepática/prevenção & controle , Hepatopatia Gordurosa não AlcoólicaRESUMO
THE PURPOSE OF THE STUDY: Determination of the diagnostic value of ultrasound elastometry of liver (UEL) in the assessment of liver fibrosis in patients with chronic diffuse liver diseases (CDLD). MATERIAL AND METHODS: The study involved 316 patients with various etiologies of the CDLD, with the underwent both liver biopsy, the UEL, and evaluation of fibrosis (F) according to the Metavir classification. RESULTS: The maximum diagnostic accuracy of the UEL was obtained in determining of the 4-th stage of fibrosis according to the Metavir. The accuracy of the method was 91% with a sensitivity of 100%. The lowest sensitivity of the UEL determined in patients with nonalcoholic fatty liver disease (NAFLD): F1 - 25%, F2 - 33%, F3 and F4 - 50%. The High body mass index (BMI = 30,1 +/- 3,8 kg/m2) is a factor which is limiting the use of elastometry for patients NAFLD. The low sensitivity for F1 and F2 - 14,3% and 10%, respectively, 100% for F4, with a BMI = 24,4 +/- 5,1 kg/m2 was obtained in primary biliary cirrhosis (PBC). In the alcoholic liver disease (ALD) obtained high sensitivity (100%) for F2 and F4. In the CDLD of viral etiology the sensitivity of UEL was 33-71,4% in the early stages of fibrosis (F1 and F2) with high specificity - 100% and 93.5% respectively. CONCLUSION: The use of the UEL allows the diagnosis of fibrosis in chronic liver diseases of different etiologies as an alternative to needle biopsy of the liver.
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Técnicas de Imagem por Elasticidade , Cirrose Hepática/diagnóstico por imagem , Hepatopatias/patologia , Adulto , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Hepatopatias/etiologia , Hepatopatias/virologia , Masculino , Sensibilidade e EspecificidadeRESUMO
AIM: To examine content, diagnostic and prognostic role of autologous antibodies in gastrointestinal diseases (GID). MATERIAL AND METHODS: Enzyme immunoassay was used to measure content of autologous antibodies to N+/K+ ATPase (Aab) of gastric parietal cells, mitochondria, microsomes, tissue transglutaminase in blood serum of 196 patients with gastric, gallbladder, small and large intestinal diseases. Aab relations with heterologous antibodies were studied with kits provided by Bektor-Best (Novosibirsk), DRG-Diagnostics, Orgentec (Germany) and others. RESULTS: In GID high circulation of Aab to parietal cells (Ab-PC) was detected in 42% cases, mean content being 217 +/- 32.4 U/ml, 10 U/ml in the control. Maximal concentration (180 = 340 U/ml) occurred in hepatic cirrhosis, celiac disease, atrophic gastritis. In exacerbations of pancreatitis, colelithiasis and duodenal ulcer ab-PC concentration was 190-210 U/ml, in remission--6-12 U/ml. Minimal concentration (8-38 U/ml) was seen in polyps, gastric cancer, nonspecific ulcerative colitis. For primary biliary cirrhosis more typical was high A/ab concentration to mitochondria (in 83%; 200 U.ml), for autoimmune hepatitis--Aab to microsomes (in 81%; 170 U/ml), in celial disease--Aab to tissue transglutaminase (93%, 75 U/ml). High autoantibodies concentration in GID is accompanied with overcirculation of heteroantibodies to infectious-toxic agents confirming their role in development of autoimmune processes. CONCLUSION: GID are associated with high circulation of autologous antibodies--markers of systemic humoral autoimmune reactions differing in duration, severity, site of lesion, form, stage, disease duration. Maximal detection rate and concentration of serum autologous antibodies were observed in hepatic cirrhosis, active hepatitis, celiac disease, atrophic gastritis, exacerbations of cholelithiasis, ulcer, pancreatitis. Estimation of Aab concentration is essential for diagnosis, prognosis of autoimmune diseases, it reflects intensity and duration of autoimmune reactions in GID.
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Formação de Anticorpos/imunologia , Autoanticorpos/sangue , Autoimunidade , Doenças do Sistema Digestório/imunologia , Biomarcadores/sangue , Humanos , Células Parietais Gástricas/imunologiaRESUMO
The case of spontaneous bacterial peritonitis (SBP) in the patient, with alcoholic cirrhosis, is presented in the article. Clinical observation demonstrates diagnostic hardships of latent clinical course of alcoholic cirrhosis, complicated SBP. Clinical observation demonstrated diagnostic consequence of ultrasound elastometry.
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Infecções Bacterianas/complicações , Cirrose Hepática Alcoólica/complicações , Peritonite/complicações , Idoso , Ascite/complicações , Ascite/diagnóstico , Líquido Ascítico/microbiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , Evolução Fatal , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/terapia , Testes de Função Hepática , Masculino , Peritonite/diagnóstico , Peritonite/microbiologia , Peritonite/terapiaRESUMO
Working out of the new methodical approaches of diagnostics and treatment of spontaneous bacteriological peritonitis (SBP) in the patients with cirrhosis of the liver (CL). The ascitic liquid (AL) was examined in 35 patients with CL by the method of gas chromatography--mass-spectrometry (GCH-MS). The results of quantitative and qualitative examination of the chemical components--markers of potential infection (aerobe and anaerobe) with the GCH-MS method testify to the infected AL. The proposed method demonstrates the high precision revealing of infected abdominal cavity in the patients with CL and proposes the proper treatment according to the varieties of microorganisms.
Assuntos
Ascite/microbiologia , Líquido Ascítico , Infecções Bacterianas/microbiologia , Biomarcadores/análise , Cirrose Hepática/complicações , Peritonite/microbiologia , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ascite/etiologia , Líquido Ascítico/química , Líquido Ascítico/citologia , Líquido Ascítico/microbiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Quimioterapia Combinada , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Paracentese , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Peritonite/etiologia , Probióticos/administração & dosagem , Probióticos/uso terapêutico , Sensibilidade e EspecificidadeRESUMO
Heptral (Ademetionine) plays one of the main functions in the intermediate metabolism, takes part in the processes of methylation and transulfurization and aminopropylation. The use of Heptral in patients with chronic liver diseases with accompanying holystase and encephalopathy of different degree, at depressions, related to alcohol and toxic liver disorders, is pathogenically reasoned for prevention of liver encephalopathy.
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Hepatopatias/tratamento farmacológico , Fígado/metabolismo , S-Adenosilmetionina/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Crônica , Ensaios Clínicos como Assunto , Hepatite Viral Humana/tratamento farmacológico , Humanos , Hepatopatias/metabolismo , Hepatopatias/virologiaRESUMO
Our research demonstrated the high efficiency of using lactulose in patients with the latent and first grades of portal-systemic encephalopathy. Lactulose is an efficient and safe remedy, and its consistent application prevents the development of portal-systemic encephalopathy and makes it possible to control the level of hyperammonemia and improve a patient's quality of life.