Eng / JAUNDICE
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Hepatic jaundice:amebiasis
(intestinal dysfunction - protracted and prolonged
pain in the liver
changes in the contours of the liver
hectic fever
Prolonged hepatic jaundice
chronic, persistent hepatitis (long, relatively favorable course)
chronic active hepatitis (tendency to cirrhosis)
chronic cholestatic hepatitis (transition to biliary cirrhosis, during the period of exacerbation, the clinic of obstructive jaundice).
cirrhosis of the liver (small-nodular, large-nodular, mixed and biliary).
pigmentary hepatoses (Gilbert's syndrome, Erigler-Najjar syndrome, Dubin-Dginson syndrome, Rotor syndrome)
Subhepatic jaundice
clinical and laboratory symptom complex:
-jaundice, hyperbilirubinemia with a predominance of the direct fraction
-acholia feces
-no excretion of urobilin bodies with feces and urine
-dark urine, choluria
-hepatomegaly
-moderate hepatic impairment
Subhepatic jaundice
cholestatic variant of AVH B
cholelithiasis
(age over 40 years old, women are more likely to get sick; a history of diet violations, signs of cholecystitis - a severe pain attack with characteristic irradiation to the right shoulder, shoulder blade and dyspepsia)
-appearance of jaundice following a pain attack
-increase w / bubble (s-m. Courvoisier)
-leukocytosis, accelerated ESR, fever
- increased alkaline phosphatase
- high or normal cholesterol levels
-negative test for urobilin
- Ultrasound - stones in the ducts and dilatation of the bile ducts
Subhepatic jaundice
Neoplasms
-chronic diseases of the stomach, pancreas in history -weight loss, anemia
-gradual and progressive pain syndrome -s-m Courvoisier
-fever from subfebrile to septic
-normal activity of aminotransferases -increased alkaline phosphatase levels
-severe increase in cholesterol -negative test for urobilin -negative glucocorticoid test
-Ultrasound - expansion of extraand intrahepatic bile ducts, enlargement of the gallbladder, tumor-like change in the head of the pancreas
Subhepatic jaundice
Obstructive jaundice caused by parasites (opisthorchiasis, clonorchiasis, schistosomiasis)
-moderate or mild jaundice
-absence of pain attacks
-stay in areas endemic for these helminthiases
-eosinophilia in peripheral blood
-detection of parasites or their eggs in feces, urine, bile
-specific serological and allergological tests
Acute liver failure (ALF)
- a pathological syndrome, which is based on an acute lesion of hepatocytes with a subsequent violation of their main functions (protein-forming, detoxification, production of blood coagulation factors, acid-base balance regulation, etc.).
Acute liver failure
Lightning (fulminant) occurs within the first 7 days
Acute - within 7-28 days
Subacute - 4 to 12 weeks after onset
PATHOGENESIS
Cytolysis of hepatocytes
Violation of the detoxifying function of the liver
Accumulation of cerebrotoxic substances (hepatic encephalopathy, edema-swelling of the brain)
Violation of water and electrolyte balance and CBS (hypokalemia, metabolic alkalosis)
Violation of the synthetic function of the liver (lack of albumin, 1,2,5,7,9,10 and 12 coagulation factors)
Coagulopathy deficiency (gastrointestinal bleeding, hemorrhagic shock)
Multiple organ failure
Etiology of acute liver failure
Most often - fulminant forms of acute viral hepatitis
and drug-induced lesions of the liver.