The term "cholestatic jaundice" refers to a pathological condition in which the secret produced by the liver (bile) does not enter the duodenum, but gradually accumulates in the blood. If the first warning signs occur, you should contact a medical institution as soon as possible. This is due to the fact that cholestatic jaundice can indicate both a slight violation of cellular metabolism, and diseases of the liver and gallbladder, which can be fatal.
Pathogenesis
The mechanism of the development of the disease is based on the defeat of hepatocytes. These are liver cells whose task is to bind indirect bilirubin and excrete it into the duodenum through the bile ducts. Under the influence of various provoking factors, this process is disrupted.
Indirect bilirubin is a compound that is formed in the reticuloendothelial system from hemoglobin released after the breakdown of red blood cells. The process of its synthesis isconstantly, it doesn't stop even for a second.
Under the influence of various negative factors, the functioning of the liver is disturbed, as a result of which the organ cannot cope with the release and processing of indirect bilirubin. A natural consequence is its accumulation in the blood serum. Moreover, stagnation of indirect bilirubin is also found in the liver itself. Due to the fact that the compound stays in the tissues for a long time, the patient's skin turns yellow or green. This is a rather specific sign of cholestatic jaundice. If it occurs, you should contact a medical facility as soon as possible.
Etiology
According to statistics, most cases of cholestatic jaundice are associated with long-term use of drugs such as androgens, broad-spectrum antibiotics, antipsychotics, sulfonamides, anabolic steroids. In addition, the poisoning of the body with certain gases, mercury and s alts of heavy metals can start the development of the pathological process.
The following is a list of pathologies that are not a direct cause of cholestatic jaundice, but play the role of a kind of catalyst:
- Chronic hepatitis.
- Some forms of Botkin's disease.
- Cholestasis of an idiopathic nature.
- Pancreatitis.
- Cirrhosis of the liver.
- Prolonged intoxication of the body.
- Malignant neoplasms localized not only in the liver, gallbladder and its ducts,but also in nearby organs. The greatest danger is presented by tumors in the stage of metastasis.
- Cholestasis of pregnancy.
- Hepatosis (both fatty and alcoholic).
- Pathologies of an infectious nature (most often cholestatic jaundice develops against the background of the progression of toxoplasmosis, malaria and syphilis).
- Cholecystoatonia.
- Wilson's disease (most often hereditary).
It is important to understand that cholestatic jaundice is an ailment that poses a danger not only to he alth, but also to life. This is due to the fact that indirect bilirubin is extremely toxic. When its concentration increases to critical levels, it is customary to talk about an unfavorable prognosis. In such situations, most often a fatal outcome occurs.
Clinical picture
The symptoms of cholestatic jaundice are quite specific, and therefore a competent doctor can recognize the disease already during the physical examination and history taking.
Clinical manifestations of the disease:
- Itching of the skin all over the body. Patients say that sometimes it becomes unbearable.
- Change in the tone of the skin, sclera of the eyes and mucous membranes. Fabrics become yellowish, greenish or completely reddish.
- Nausea, often turning into vomiting.
- Severe weakness.
- Increased degree of fatigue.
- Disturbance of appetite up to its complete absence.
- Rapid weight loss.
- Painful sensations localized on the right side in the area of the ribs. At the initial stage of development of cholestatic jaundice, the symptom is mild, but over time, its intensity increases. Patients in this case complain of acute paroxysmal pain.
Pathology is quite easy to distinguish from other types of jaundice. During its progression, the patient's urine does not acquire a rich shade. Discoloration of feces is also not observed. This is due to the fact that with this type of disease in the blood serum, there is a simultaneous increase in the concentration of both bound and free bilirubin. As a result, the process of removing the toxic compound from the body is hindered.
Regardless of the severity of the symptoms of cholestatic jaundice, it is impossible to delay the treatment of pathology. It is important to remember that delay can cost the patient their life.
Diagnosis
When the first warning signs appear, you should consult a doctor. The pathology is treated by a gastroenterologist and a hepatologist. The specialist will conduct a physical examination, take an anamnesis and issue a referral for an examination.
Diagnosis of cholestatic jaundice involves the following studies:
- General blood test. Based on the results, the doctor will be able to judge the he alth of the patient as a whole.
- Biochemical blood tests. In the presence of cholestatic jaundice, both conjugated and free bilirubin are elevated.
- Ultrasound of the liver, gallbladder and its ducts. Atif necessary, an ultrasound examination of adjacent systems is performed.
- CT scan of the liver and gallbladder with ducts. May be ordered to confirm ultrasound results.
- Endoscopic retrograde cholangiopancreatography. This method allows you to identify the exact cause of the development of cholestatic jaundice.
- X-rays with contrast.
If cancer is suspected, your doctor may order a liver biopsy.
Only based on the results of a comprehensive diagnosis, a specialist can provide information regarding how to treat cholestatic jaundice.
Drug therapy
Implies the implementation of activities aimed at getting rid of the root cause of the disease. Additionally, symptomatic treatment of cholestatic jaundice is carried out.
The classic treatment regimen includes taking or administering the following groups of drugs:
- Hormonal drugs. They are prescribed to stop the inflammatory process and to stabilize cell membranes.
- Cholagogue drugs. Allow to accelerate the outflow of hepatic secretions.
- Vitamins. Needed to strengthen the body.
- Hepatoprotectors. The active components of the preparations protect hepatocytes and prevent the process of their death.
- Hemostatics. Appointed in case of increased bleeding.
- Infusion solutions. Helps rid the body of toxic compounds and normalize water and electrolyte balance.
Treatment of cholestatic jaundice can only be successful if all necessary measures have been taken to address the underlying cause. In severe cases, the patient is shown hospitalization.
Surgical treatment
In severe cases and when conservative methods of therapy are ineffective, surgical intervention is indicated. There are several types of techniques that can be used to treat cholestatic jaundice:
- Drainage of the gallbladder and its ducts. During the operation, the accumulated pathological fluid is removed.
- Choledochotomy. During the intervention, the surgeon forcibly opens the lumen of the common bile duct.
- Papillosphinterotomy. During the operation, the sphincter of the duodenum is opened.
- Hepatectomy. It implies a partial resection of the liver, that is, the affected segment.
- Cholecystectomy. During the operation, the gallbladder is completely removed.
In isolated cases, after the manipulations, the clinical picture persists or even becomes more intense than before. In such situations, the doctor makes a decision regarding the advisability of transplanting a donor organ.
Features of food
Adjustment of the diet is a prerequisite, if not followed, the treatment cannot be successful. With cholestatic jaundice, doctors prescribe the “Table No. 5” diet, developed by Dr. M. I. Pevzner. Doctors consider it the mostsuitable for persons suffering from pathologies of the liver, gallbladder and its ducts.
General Diet Guidelines:
- You need to eat 4-5 times a day. At the same time, the size of one serving should not exceed 200 g.
- Dishes should be prepared only in the following ways: stewing, boiling, baking.
- It is forbidden to eat very cold or too hot food. Meals should be warm.
- The amount of s alt should be minimized.
- It is important to observe the drinking regime. It is recommended to consume 1.5-2 liters of pure non-carbonated water per day.
- The calorie content of the daily diet should be up to 2800 kcal.
Allowed foods and drinks:
- Weak black tea with lemon.
- Compotes.
- Decoction based on wild rose.
- Kisely.
- Mousses, jelly with minimal sugar content.
- Soups (vegetarian, milk, cabbage soup, beetroot, pea, pearl barley). The meat must be cooked separately and added to the finished dish.
- Borscht.
- Mashed cereals.
- Pilaf.
- Oatmeal.
- Muesli.
- Bulgur.
- Couscous.
- Rabbit meat.
- Veal.
- Chicken.
- Turkey.
- Beef.
- Milk sausages.
- Low-fat fish.
- Oysters.
- Shrimp.
- Mussels.
- Squid.
- Bread (rye or bran).
- Cookies.
- Bad pastries.
- Bread.
- Dry biscuit.
- Low-fat sour cream.
- Natural yogurt.
- Starchy vegetables.
- Seaweed.
- Avocado.
- Cucumbers.
- Tomatoes (limited).
- Broccoli.
- Celery.
- Sweet apples.
- Bananas (no more than 1 per day).
- Garnet.
- Watermelon.
- Prunes.
- Dried apricots.
- Eggs.
- Olive oil.
- Zucchini caviar.
- Sauerkraut.
- Berries.
- Marmalade.
It is imperative to exclude from the diet:
- Cocoa.
- Coffee.
- Soda drinks.
- Alcohol (it is unacceptable to use it even rarely and in a minimal amount).
- Green tea.
- Whey.
- Chocolate.
- Karkade.
- Chicory.
- Packaged and freshly squeezed juices.
- Meat, fish and mushroom broths.
- Okroshka.
- Lentils.
- Fatty paste.
- Offal.
- Pork fat.
- Sushi, rolls.
- Canned food.
- Meat and fatty fish.
- Red caviar.
- Crab sticks.
- Products from sweet and puff pastry.
- Pancakes.
- Fresh bread.
- Fried pies.
- S alted cheeses.
- Dairy products with a high fat content.
- Mushrooms.
- Corn.
- Spinach.
- Sorrel.
- Green onion.
- Marinated vegetables.
- Tomato paste.
- Raw white cabbage.
- Nuts.
- Seeds.
- Lemon.
- Ginger.
- Salo.
- Smoked meats.
- Olives.
- Olives.
- Artichokes.
- Ketchup.
- Mayonnaise.
- Fuck.
- Mustard.
- Vinegar.
- Pepper.
- Ajika.
- Spices.
- Ice cream.
- Halva.
- Chewing gum.
- Popcorn.
- Condensed milk.
- Hematogen.
- Kozinaki.
The first 5 days of dieting is a trial period. If the body normally transitions to a new diet, it must be maintained for about 5 weeks. Many doctors recommend dieting until complete recovery.
Folk remedies
In order to make you feel better, you can resort to non-traditional methods. However, it is important to understand that their use does not eliminate the need to seek qualified medical help.
The most effective are the following recipes:
- Take 25 g of pre-crushed immortelle. Pour raw materials with 1 liter of water. Put the container on fire. Boil for half an hour. Cool, strain. Take 100 ml before meals until the symptoms disappear completely.
- Take 50 g of immortelle flowers, 20 g of coriander, 20 g of peppermint, 40 g of three-leaf watch. Grind all ingredients and mix thoroughly. Take 2 tbsp. l. raw materials and pour 400 ml of boiling water. Put the container on fire. Boil for 20 minutes. Then wrap the container with a towel and let it brew for 1 hour. Strain. Take three timesday before meals 100 ml.
- Take 20 g of pre-ground wormwood. Place the raw material in a glass bottle with a capacity of 0.5 liters. Pour wormwood with vodka without additives. Remove to a dark place. Let it brew for a week. Periodically, the bottle with the contents must be shaken. Take the resulting tincture twice a day 20 minutes before meals, 20 drops.
It is important to remember that any medicinal plant is a potential allergen. If signs of an adverse reaction occur, treatment with non-traditional methods should be terminated.
Forecast
Cholestatic jaundice is a pathology, the outcome of which directly depends on the timely visit to the doctor. If the patient follows all the instructions of the specialist and strictly follows the diet, the prognosis is considered favorable. An exception is cases when a person was taken to a medical facility in serious condition. The prognosis in this situation can be either favorable or not.
Ignoring the warning signs leads to the progression of both the underlying disease and cholestatic jaundice. In this case, the probability of a fatal outcome is extremely high.
In closing
Cholestatic jaundice is an ailment, the development mechanism of which is based on damage to liver cells - hepatocytes. As a rule, this occurs against the background of long-term use of certain drugs. If the first warning signs appear, you should contact a gastroenterologist or hepatologist.
