Liver cholestasis causes, symptoms, diagnosis, treatment & pathology
Cytolysis and cholestasis syndromes
Cytolysis syndrome is a laboratory assessment of the integrity of hepatitis that reliably shows violations. It occurs with pathological changes in liver cells. A factor causing this condition is a violation of the integrity of the hepatocyte membranes.
Cholestasis syndrome is a clinical manifestation of liver dysfunction, visual assessment of pathological processes in which bile production decreases, as a result of which pathological processes begin in the gallbladder.
Cytolysis is a differential diagnosis, confirmation of the disease, based on laboratory tests, confirming the diagnosis - cholestasis syndrome in children. Treatment is not started without analysis and evaluation of its indicators.
Syndrome symptoms cholestasis
Cholestasis occurs in children of two types - intrahepatic and extrahepatic.
With the intrahepatic form, stagnation of bile occurs in the main ducts due to damage to hepatocytes and liver canals. Extrahepatic form - pathological changes that provoke inflammatory processes in the ducts occur in organs and tissues adjacent to the liver.
The symptoms of the disease are ambiguous, therefore, no treatment is started without differential diagnosis of cholestasis syndrome.
It is impossible to observe the course of the disease in dynamics and, on the basis of the clinical picture, to begin the necessary therapeutic measures, since the manifestations of the disease are similar, and the treatment of cholestasis syndrome, depending on the form, is different. Intrahepatic cholestasis cannot be cured without surgery.
The main signs of cholestasis in children and adolescents:
- Itching. The skin on the limbs, abdomen and buttocks is dry and flaky, which causes skin itching. Children become irritable and have insomnia. An explanation of what triggered such changes in the epidermis has not yet been found. Theoretical assumptions: the emerging vitamin A deficiency, impaired synthesis in the liver and the emergence of pruritoges. These substances are carried through the bloodstream and retain part of the bile acids in the layers of the epidermis, as a result of which the nerve endings are irritated.
In young children - up to 5 months - this symptom is absent.
- Jaundice - it can appear from the first hours of the disease or manifest itself much later. The accumulation of bilirubin and its entry into the blood leads to the fact that the epidermis changes color not only to yellow, but also to olive and greenish. Etcand cholestasis, the level of bilirubin in the blood can exceed 50μmol / l;
- The color of the chair changes - it becomes discolored. This condition is characterized as steatorrhea. The main mechanism for the development of cholestasis syndrome is that pathologies appear in the gallbladder, which causes a violation of the flow of bile necessary for digestion. As soon as its deficiency begins to be felt in the duodenum, there is a shortage of stercobilinogen in the large intestine. The digestibility of food decreases, fats are no longer absorbed, which causes pathological changes in the small intestine. The feces become greasy and lightly colored. The lighter the stool, the more pronounced the stagnation of bile. Due to the impaired absorption of a whole complex of vitamins - A, D, E, K - the child quickly loses weight;
- Xanthoma formation is much less common. In adults, these skin lesions are considered markers of cholestasis, and if they do appear, some laboratory tests are unnecessary. In children, flat tumor-like diseases of a mild yellow color are very rare.
If this symptom is identified, then neoplasms can be found in the palmar folds, on the flexors of large joints, back and neck.
In the acute form of the disease of increased severity, not only the epidermis is affected, but also the deeper layers of the dermis - inflammation covers the nerves and tendon sheaths, bone tissue. The mechanism of development of xanthomas - the level of lipids increases in the body and they are deposited in the dermis and epidermis, which provokes the appearance of neoplasms.
After recovery, blood cholesterol levels decrease, lipid levels return to normal, and xanthomas resolve.
Instrumental and laboratory diagnostics
An ultrasound examination is mandatory, since one of the confirmations of the presence of the syndrome is an enlarged liver.
The clinical picture can show the types of cholestasis:
In infants, manifestations of jaundice with cholestasis are mandatory. In children under the first year of life, it is considered the norm when the liver protrudes from the hypochondrium by 1-2 cm.
In preschool children, the physiological norm is if the liver is located 1 cm below the costal arch. Increased protrusion due to costal arches is a sign of cholestasis.
It is not taken into account in infants, but in adolescents it is already taken into account that with asthenic physique or some diseases (for example, myopathy and rickets), the liver can protrude 3 cm from under the costal arch.
But only an ultrasound examination cannot be used to make a diagnosis.
The liver enlarges in many infectious diseases - for example, scarlet fever, measles, tuberculosis and others. For kidsAt an older age, an X-ray examination of the biliary tract is performed. In infants, this test can only be done if the bilirubin level is below 50 μmol / l. If it is exceeded, then another method is used - cholangiography. During it, a 12-hour slow intravenous perfusion is performed.
A contrast agent is injected into the body and its progress along the intestinal loops is monitored. This helps to rule out or determine the presence of obstructions in the extrahepatic bile ducts. During laboratory tests for cholestasis syndrome, indicators of bilirubin and lipids in the blood are determined, which helps to identify cytolysis syndrome.
If it is present in the blood plasma, the activity of indicator enzymes - AsATs, ALATs, LDH, as well as isoenzymes increases, the concentration of serum iron, vitamin B12 and bilirubin increases. The reasons for the change are acidophilic and hydropic degeneration, necrosis of hepacites, which increases the permeability of cell membranes.
The most pronounced increase in acute hepatitis, damage to the heart muscle and severe pathological processes that destroy liver cells.
In obstructive jaundice, cirrhosis and oncological processes, changes in biochemical analysis are moderately expressed.
The treatment regimen is specified depending on the clinical picture and the patient's response to the treatment.
- Triglycerides are prescribed to restore fat absorption and reduce the appearance of steatorrhea, which ensures the absorption of calories;
- Vitamins A, D, E and K necessary to support vital functions are injected or parenterally, that is, through a tube;
- Phenobarbital applies. This drug has a choleretic effect, increases the synthesis of bile salts and their excretion in the feces, reduces the severity of itching;
- Cholestyramine is widely used if no biliary obstruction has been identified in the anamnesis.
However, very often it is necessary to adjust therapeutic measures due to the development of complications, so it is impossible to say exactly which medications will be needed.
Intrahepatic cholestasis cannot be cured without surgery.