Dysfunction of the liver and gallbladder. Diseases of the liver and gallbladder

Before discussing the gallbladder, let's find out the importance of the bile-forming function of the liver.

Of its many functions, one of the most important is the nutrition of the body. The liver produces bile, which is involved in digestion by helping the body digest and absorb fats.

Bile breaks down fats, turning them into soluble compounds. In this form, they are easily absorbed from the intestine into the blood and lymph.

Bile is secreted into the duodenum from the bile ducts and gallbladder when food enters the stomach. During digestion, liver cells increase the production of bile and its entry into bile ducts.

The role of bile in the human body is not limited to the breakdown of fats into soluble nutrients. Bile helps to increase intestinal peristalsis, thereby helping it to move food, as well as get rid of undigested waste.

In addition, bile reduces the processes of fermentation and putrefaction in the intestines.

Regulates bile secretion, as well as other processes in the liver, the central nervous system and endocrine glands.

like this complex mechanism bile-forming function of the liver and the importance of the normal functioning of the gallbladder.

How is the gallbladder

It is possible to separate the gallbladder, as well as the bile ducts, only conditionally, since these organs are interconnected components of one whole - the liver. Changes in one component inevitably lead to violations in others.

However, in order to distinguish the symptoms of gallbladder disease, let's get acquainted with its structure.

The gallbladder, pear-shaped, about 10 cm in size, is located under the lower edge of the liver. It contains up to 70 ml of bile, which is produced by the liver. Its bottom is directed downward and forward.

As a result of the contraction of the internal muscles located in the walls of the biliary tract, bile leaves the bladder. The motor skills (movement) of these muscles are controlled by the central nervous system.

Diseases of the gallbladder and biliary tract

Biliary dyskinesia

Cause - violation motor functions the muscular layer of the walls of the gallbladder and bile ducts.

What contributes to pathology :

• diseases of the nervous system, VVD (vegetative-vascular dystonia);
• infections, giardiasis, gastritis, colitis and other diseases gastrointestinal tract;
• disorders of the hormonal system;
• congenital malformations of the structure of the biliary tract;
• low physical activity and malnutrition.

Symptoms of the disease :

• Pain in the right hypochondrium or in the pit of the stomach, intermittent, arising in connection with nervous or physical overstrain, as well as in violation of the diet. Usually the pain goes away on its own.
• Constipation, diarrhea, bouts of nausea.

Treatment - streamline the daily routine and nutrition. Avoid overwork. Drink if necessary sedative medicine(tincture of valerian or motherwort). For pain - take no-shpu.

Be sure to undergo an ultrasound and complete medical examination to confirm an accurate diagnosis.

Forecast - usually favorable, since biliary dyskinesia is a functional disease. However, it creates conditions for stagnation of bile with irregular nutrition, abuse of fatty, spicy, smoked foods, alcohol, etc. Thus, it contributes to the development of inflammatory processes in the liver and biliary tract, as well as cholelithiasis.

cholecystitis, cholangitis

Inflammation in the gallbladder is called cholecystitis, and inflammation in the bile ducts is called cholangitis.

Causes :

• sand and stones in the gallbladder and ducts, which impede the outflow of bile;
• acute hepatitis (inflammation of the liver tissue) of any origin;
• microbes and bacteria in gallbladder from the intestines and/or by hematogenous route(with blood) for tonsillitis, tuberculosis, gynecological and other chronic ailments.

What contributes to pathology? chronic diseases gastrointestinal tract, abuse of fatty, spicy foods and alcohol, heredity.

Symptoms of acute cholecystitis :

• paroxysmal severe pain on the right under the ribs or in the pit of the stomach;
• heat;
• nausea and vomiting;
• yellowness of the skin and dark urine a few days after the onset of the disease.

Treatment – emergency health care and examination in the hospital.

Forecast - satisfactory with timely and qualified treatment, diet and regimen.

Symptoms of chronic cholecystitis usually appear during exacerbations illness.

Body temperature may rise, bitterness in the mouth, belching, nausea, problems with stools (constipation or diarrhea) may disturb. It's a dull pain in the area of ​​the liver can give to the back, right shoulder and back of the head.

Chronic form cholecystitis often occurs without obvious symptoms.

Treatment : the diagnosis is made on the basis of the analysis of bile taken during duodenal sounding.

Treatment is prescribed depending on the cause of the pathology. It can be - anti-inflammatory drugs or antibiotics - during an exacerbation, cholagogues, antispasmodics, etc.

Cholelithiasis

Causes : bile stasis and deposition of cholesterol, bilirubin and lime salts.
HThatpromotes education gallstones , factors such as:

Symptoms - hepatic colic with the movement of stones, fever, jaundice and discolored feces with blockage of the bile duct. If the stones do not move, the patient feels healthy.

Treatment : medical assistance in the removal of an attack or surgical removal of stones of the gallbladder and ducts.

Forecast not always comforting, since prolonged blockage of the biliary tract during the layering of infection can lead to purulent cholecystitis and surgical intervention.

Conclusion

When the gallbladder depends on the nature of the violations: functional - with dyskinesia of the bile ducts, or inflammatory - with cholecystitis, cholangitis.

Inflammation is promoted by infection with pathogenic microbes and factors that disrupt a healthy lifestyle.

Diagnosis and treatment of gallbladder diseases are carried out by medical specialists.

Prevention of pathologies of the gallbladder and ducts consists in observing the regime of rest and work, a rational diet, avoiding emotional and physical overload, as well as alcohol and smoking abuse.

Take care of yourself and your liver!

During the recovery period, it is necessary to reduce the load on these organs. As an addition, traditional medicine methods can be used, for some diseases - special gymnastics.

Main functions of the liver and gallbladder

The work of the liver and gallbladder is interconnected. Both of these organs are involved in digestion. Liver cells secrete bile. This secret goes to small intestine and enhances its motility, participates in the breakdown of fats, activates enzymes, neutralizes the acids of the contents of the stomach. Under the action of bile, a more complete assimilation of amino acids, calcium salts, cholesterol, vitamins A, D, E and K occurs, the spread of bacteria is suppressed.

The liver is involved in all types of metabolism:

• in protein metabolism, it breaks down and converts proteins, turns amino acids into a reserve energy source and raw materials for the body to build its own cells and tissues;
• in progress carbohydrate metabolism the liver forms and accumulates glycogen - a reserve energy substrate;
• during fat metabolism, the liver and gallbladder break down lipids to fatty acids And ketone bodies produce cholesterol.

Liver maintains balance nutrients in organism. If not enough carbohydrates are supplied with food, then they will be synthesized from proteins. And when a person consumes a lot of sweets, an excess of sugar turns into fats.

In addition to these functions, the liver takes part in the synthesis of hormones, anticoagulants, regulates the metabolism of microelements, protects the body from toxins, and maintains homeostasis. Bile is produced in the liver and stored in the gallbladder. The treatment of these organs is always interconnected.

Liver disease

All liver diseases are divided as follows:

• infectious, in which tissues are affected by viruses, bacteria, fungi, helminths or protozoa (echinococcosis, ascariasis, leptospirosis, etc.);
• autoimmune ( separate view hepatitis, primary biliary cirrhosis, autoimmune cholangiopathy, etc.);
• damage due to exposure to toxins: alcohol, drugs, narcotic substances(toxic hepatitis, cirrhosis, steatosis, fibrosis, etc.);
• vascular (pylephlebitis, hepatic vein thrombosis, portal hypertension, etc.);
• tumor (hepatic cell and intraductal cancer, sarcoma, hemangioma, etc.);
• metabolic (fatty hepatosis, acanthocytosis, glycokenosis, etc.);
• hereditary (hypoplasia and aplasia, hepatic fermentopathy, hemochromatosis, etc.).

Also, violations in the liver can occur due to injuries: blows, bruises, ruptures. Sometimes its functioning changes against the background of diseases of other systems and organs, for example, in heart failure.

Causes of liver disease can be:

1. Reproduction of viral agents (hepatitis A, B, C, D, E).
2. Influence of toxins.
3. The influence of medicines.
4. The influence of alcohol.
5. Infection with helminths, protozoa or bacteria.
6. Eating disorders.
7. Heredity, genetic pathologies and malformations.
8. Acute inflammation in the abdominal organs.
9. Injuries, bruises, tears.
10. Exposure to ionizing radiation, physical and chemical carcinogens.

Symptoms

Most liver diseases are characterized by pain and a feeling of heaviness in the right hypochondrium. These symptoms are constantly present, aggravated during exercise, after eating fatty or fried foods, subsiding during passive rest. The pain is accompanied by a decrease in appetite, the appearance of belching, bitterness in the mouth, heartburn, nausea, and vomiting.

Also, liver diseases are accompanied by yellowing of the skin and sclera, darkening of urine, discoloration of feces. Frequent complaints of itching, weakness, apathy, fatigue, headaches and fainting. Women are disturbed menstrual cycle men develop impotence.

Diagnostics

If signs of liver disease are found, it is necessary to contact a gastroenterologist. After the examination, the doctor will determine the necessary diagnostic procedures, the results of which will help establish a diagnosis and prescribe treatment.

The most common methods of examination for liver pathologies are ultrasound and blood sampling for biochemical analysis. A more accurate selection of diagnostics depends on the data obtained as a result of a medical survey. Depending on the assumptions about the diagnosis, immunological tests may be ordered, genetic research, biopsy, MRI (magnetic resonance imaging), CT (computed tomography), as well as a blood test to detect hepatitis viruses and cancer cells.

Treatment

Treatment of liver diseases is often belated, as the symptoms increase gradually and may not cause much concern for a long time. Traditional treatment may include medication, physiotherapy, diet, and in some cases, surgery.

Drug therapy should be carried out strictly under the supervision of a physician. Depending on the diagnosis, it can be represented by hepatoprotectors, antibiotics, antiviral, antimicrobial, anthelmintic drugs, B vitamins and some organic acids. To effectively eliminate the disease, various treatment regimens are used.

Most universal means are hepatoprotectors. They do not eliminate the causes of the pathology, but restore the functions of the liver, protect its cells from damage. Can be created on the basis of ursodeoxycholic acid (Ursosan, Exhol, Livodex), ademetionine (Heptor, Heptral), phospholipids (Essentiale forte N, Rezalyut pro), ornithine (Hepa-merz), as well as natural ingredients(Sibektan, Liv-52, Gepabene).

Physiotherapy is used to restore the liver after diseases. Depending on the diagnosis, these can be galvanic mud procedures, UHF, microwave, electrosleep, galvanic current to the collar zone.

Surgical intervention required when serious illnesses liver. Operating way complex abscesses, cysts are eliminated, tissues are restored after injuries. Partial or complete removal liver with further transplantation may be required for cirrhosis, cancerous tumors blockage of the hepatic veins.

Treatment with folk remedies

Liver treatment folk remedies starts with cleansing. The most common option is to take some vegetable oil in the morning. The duration of the course is 5 weeks. In the first week, you need to drink 1/2 tsp. oil, in the second - 1 tsp each, in the third - 2 tsp each, in the fourth - 1 tbsp each, in the fifth - again 2 tsp each.

After cleansing, you can use the following recipes:

• Oats. From 1 st. grains, 3 tbsp. l. lingonberry leaves, 1 tbsp. l. birch buds prepare an infusion: pour the mixture with 4 liters of water and put it in a cool place for 20 hours. Separately, prepare a decoction from a glass of rose hips, 2 tbsp. l. knotweed and 200 ml of boiling water. Settle for 45 minutes, and then mix with oatmeal infusion. Store the product in the refrigerator. Drink 30 minutes before meals, 150 ml for 10 days.
• Peel the root crops, grate and squeeze the juice. Drink 1/3 tbsp. 3 times a day. The course of treatment is 14 days.
• Corn silk. Brew 1 tbsp. l. a glass of boiling water, drink instead of tea for 2 weeks.
• Vegetable juice. For cooking, you need 210 grams of carrots, 150 grams of celery and 60 grams of parsley. Drink in the morning on an empty stomach. The duration of treatment is 1 month.
• Bear bile. To prepare an infusion, pour 20 g of raw materials into 0.5 liters of a decoction of St. John's wort and yarrow (or just water). Leave for a week, shaking regularly. Drink 25 drops three times a day for a month. Treatment with bear bile is indicated for various diseases liver, this remedy acts as a hepatoprotector.

Any folk remedies should be taken only after the permission of the doctor. For some of them, contraindications are stomach diseases, allergies. Such funds should be used in the chronic course of diseases.

Diet

Diet is important component general therapy liver diseases. It is necessary to exclude coffee, strong teas from the menu, alcoholic drinks, grape and tomato juices, rich broths, fatty meat and fish, soda, fresh bread and muffin. Any fried, spicy, too salty, smoked dishes are prohibited. You can not eat sweets with cocoa and chocolate, eggs, sauces, fresh fruits and berries, mushrooms. From vegetables under the ban are white and Brussels sprouts, onions, garlic, turnips, radishes, eggplants, spinach, sorrel, tomatoes.

It is recommended to introduce rosehip broth, juices, compotes, dried bread, biscuits, biscuits, lean meat and fish, oils, dairy products with no more than 2% fat content into the diet. From vegetables, you can cook dishes for a couple, by baking, boiling, stewing. Allowed potatoes, pumpkin, carrots, zucchini, beets, cauliflower and Beijing cabbage, bell pepper. To enhance the taste, it is permissible to use soy sauce, cinnamon, parsley, honey, jam.

Prevention

Preventive measures for liver disease include:

• maintaining a healthy lifestyle: balanced diet, giving up alcohol and smoking, regular moderate physical activity;
• strengthening immunity;
• compliance with precautionary measures in hazardous production, the use of personal protective equipment;
• injections against hepatitis B;
• exclusion of uncontrolled, spontaneous medication intake;
• timely treatment of diseases leading to violations of the liver.

Gallbladder diseases

In modern gastroenterology, the most common diseases of the gallbladder are:

• chronic and acute cholecystitis;
• post-cholecystectomy syndrome;
• cholelithiasis;
• tumors (polyps and cancer).

Causes

Causes of gallbladder disease can be:

• infectious lesions;
• violations of the composition of bile and the ratio of its basic components;
• violation of the connection of the organ with nerve fibers;
• violations of metabolic processes;
• heredity and genetic factors;
• degeneration of the cells of the mucous membrane of the organ.

Symptoms

The liver and gallbladder are anatomically located side by side, form the biliary system, the symptoms and treatment for diseases of these organs are also similar. The main symptom is the appearance of pain in the right hypochondrium, aggravated after taking fatty, spicy and fried foods, physical exertion. Digestive disorders are also characteristic: heartburn, nausea, vomiting, belching, flatulence.

The skin and sclera of patients turn yellow, skin itching appears. The feces become lighter, and the urine dark, brownish. During vomiting, bile is expelled.

Diagnostics

Diagnosis of diseases of the gallbladder begins with a medical interview and examination. On palpation of the abdomen, there is pain right side. Most pathologies require ultrasound and X-ray examination.

Depending on the clinical picture, the gastroenterologist may refer to the following diagnostic procedures:

• blood chemistry;
• additionally - ultrasound of the liver;
• study of the composition of bile (probe insertion);
• cholecystography.

Ultrasound data may be required not only to clarify the diagnosis, but also in the course of therapy, recovery period. In some cases, the doctor needs the results of drug tests.

Treatment

Most gallbladder diseases are treatable conservative methods. First of all, it is the intake of medicines, the selection of which is carried out by the doctor individually. At infectious diseases antibiotics, antimicrobial, antiprotozoal and anthelmintic drugs are prescribed.

To restore the outflow of bile, choleretic agents are used, as well as antispasmodics and drugs that affect nervous system (vegetative department). To restore the mucous membrane, herbal medicines are used, in case of intoxication - enterosorbents.

In order to influence contractile functions gallbladder and its sphincters, duodenal sounding and tubage are performed. Thanks to such procedures, the outflow of bile is quickly restored, even in severe cases. Physiotherapy includes laser exposure, mud electrophoresis, UHF, HF, microwave, sinusoidal modulated currents, magnetic field.

Gallstone disease, depending on the stage, can be cured by chemical or ultrasonic crushing or surgically. Surgical intervention is required in the detection of tumors, cysts, large abscesses. In some cases, the complete removal of the gallbladder (cholecystectomy) is performed.

Patients who have undergone cholecystectomy are often interested in the question: how to treat the liver if there is no gallbladder? Since now the entire load will fall on this organ, it will be necessary to support its work by all means: take hepatoprotectors, observe therapeutic diet, give up alcohol and smoking.

Treatment with folk remedies

• Herbal collection. It is necessary to prepare a mixture of equal parts of yarrow, wormwood, mint, fennel fruit and immortelle flowers. Then pour a dessert spoon of these herbs into 400 ml of water, cover with a lid and wait 9 hours. Filter before use. Drink a third of a glass 3 times a day, before meals.
• Birch leaves. Grind 2 tsp. leaves, brew a glass of boiling water and insist for an hour. Drink 1/3 cup three times a day before meals.
• Dandelion. Squeeze juice from the roots and leaves of the plant, dilute boiled water. Drink 1 tbsp. l. three times a day.

The course of treatment in each case should last at least 2 months.

Diet

The diet for gallbladder disease is the same as for liver disease. All foods that load the biliary system should be excluded: fatty, fried, smoked, salty, with cocoa and chocolate. It is forbidden to drink coffee, soda, alcohol, eat muffins, fresh wheat bread. Some cereals and vegetables, all mushrooms, as well as raw fruits and berries are banned.

It is recommended to introduce into the diet products with a choleretic effect and dishes from them: carrots, zucchini, beets, milk and low-fat sour cream. Useful boiled vegetables and vegetable broths, bran, germinated wheat, kefir, oranges, pears, prunes, tangerines, and from spices - turmeric. Dishes should be prepared using vegetable oils. Otherwise, follow the diet recommended for liver diseases.

Prevention

To prevent the development of gallbladder disease, you must:

• lead healthy lifestyle life, stop smoking, drinking alcohol, spicy, smoked, salty and fried foods;
• perform regularly physical exercise easy and moderate degree severity, abandon intense training, including with weights;
• drink mineral water (Narzan, Essentuki, etc.);
• follow the dietary recommendations for diseases of this group.

Liver and gallbladder diseases have similar causes, symptoms, and treatments. They often develop due to malnutrition, smoking, alcohol abuse and uncontrolled medication. The first signs are pain in the right hypochondrium and digestive disorders. Treatment can be conservative (medications, physiotherapy, diet, traditional methods) and operational. The sooner the disease is diagnosed and measures are taken to eliminate it, the faster recovery will be achieved.

Useful video about the structure and functions of the liver

With the development of the ability to diagnose diseases internal organs it has been found that liver disease (hepatopathy) is much more common than previously thought, and that many of the vague signs of disease are hepatotic in origin. Due to the importance and variety of functions, the liver is endowed with a natural ability for high regeneration. Therefore, arising under the influence various factors pathological processes in it become noticeable and manifest clinically only in the progressive stages of the disease. Thus, jaundice associated with hepatopathy unmistakably indicates a severe condition of the liver.

The main symptoms that characterize hepatopathy:

Dyspeptic syndrome: lethargy, depression, anorexia, vomiting, defecation disorders;

Jaundice: bradycardia, brown urine, light gray clay feces, icteric staining of mucous membranes, pruritus;

Hemorrhagic syndrome: hemorrhages in the skin and mucous membranes, anemia, increased bleeding time;

Portal hypertension syndrome: an increase in the abdomen in the epigastrium, ascites, dilatation of the saphenous veins of the abdomen;

Hepatolienal syndrome: liver enlargement, simultaneous enlargement of the spleen.

An increase in the liver, determined radiographically, is not always evidence of impaired organ functions. Equally, one cannot immediately conclude that there is no pathology only on the basis of favorable results of examinations of urine and blood samples. Crucial have bromsulfalein test, determination of activity alkaline phosphatase or evaluation of transaminase samples over time.

Hepatopathy is a toxic-inflammatory degenerative damage to the cells of the liver parenchyma occurring under the influence of a number of factors. According to the degree of importance in the etiology of liver disease, they are distributed as follows:

1) toxins from food (when feeding with spices and smoked meats - the effect of phenols!), And toxins formed during incomplete digestion of food in case of intestinal disease;

2) toxic substances arising from kidney failure;

3) toxic degradation products of proteins in large malignant tumors, hemolytic processes and leukemia;

4) poisoning with hepatotoxic substances;

5) violations of protein, carbohydrate, fat metabolism substances, diabetes mellitus;

6) heart failure and circulatory failure;

7) infections (leptospirosis, adenovirus hepatitis);

8) infestations (toxocariasis, hookworm, coccidiosis, dipilidiosis, opisthorchiasis);

9) alimentary protein deficiency(with poor feeding of dogs).

Depending on the intensity and duration of the action of these factors, the following develop: fatty degeneration, necrosis of the liver cells, inflammation of the liver tissues, lymphoid leukemic infiltration, tumor destruction or diffuse proliferation of connective tissue. However, in practice, it is impossible to make such a distinction between morphological damage, because in the arsenal veterinarians there are still not enough special methods of research. Therefore, it is supposed to single out acute and chronic hepatopathy, chronic hepatopathy with cholestasis and cirrhosis of the liver, which covers the whole complex of painful manifestations and at the same time is a sufficient distinction for a differentiated therapeutic approach.

Acute hepatopathy. Acute liver failure. Hepatic coma. Massive damage to the liver parenchyma severe poisoning hepatotoxic poisons, infections, sepsis, despite the significant compensatory capabilities of this organ, are accompanied by profound violations of its numerous and extremely important functions for organs, which is distinguished by practical doctors as an acute liver failure. Syndrome develops within hours or days immediately after onset of action pathological factor. The development of acute liver failure is based on diffuse fatty degeneration and total necrosis of hepatocytes, which is manifested by a significant decrease in all liver functions, the formation of numerous vascular collaterals between the portal and vena cava, due to which toxic products bypass the liver. Severe self-poisoning of the body due to the almost complete cessation of liver activity leads to the development of hepatic coma. The most toxic are the non-disinfected products of bacterial intra-intestinal protein breakdown - especially ammonia. toxic action also have phenols, which are normally inactivated by the liver. In acute liver failure, electrolyte metabolism is disturbed, hypokalemia, hyponatremia, and metabolic acidosis occur.

Symptoms. Clinical manifestations of acute liver failure quickly develop into a coma. Impairment of consciousness progresses up to its complete loss. The animal is in a state of prostration and constant indomitable vomiting. From the mouth of the animal comes a sweet liver fetid odor due to the release of methyl mercaptan, which is formed as a result of a violation of methionine metabolism. In the terminal phase develop vascular insufficiency and shock.

Usually, hepatic coma ends with the death of the animal. However, in some cases recovery is possible. In acute liver failure, the patient dies not so much from an excess of toxic products, such as in acute renal failure, but from a catastrophic lack of essential and irreplaceable substances.

Diagnosis. They put it taking into account the data of a biochemical study of blood serum (Table 6).

6. Differentiation of hepatopathy based on radiological and serological data (Nimand 1980)

Designations: - decrease in values; 0 - norm; + increasing values

Treatment. The main task of the treatment of acute liver failure is the drug maintenance of the life of the body until the onset of liver regeneration. If the causes that caused hepatonecrosis are eliminated, then hepatocytes regenerate within 10 days.

Therapy for acute liver failure is divided into the following components: stopping hepatonecrosis, improving preserved liver functions, biochemical correction and elimination of concomitant syndromes. To do this, animals are prescribed prednisolone at least 30 mg per day and stimulate diuresis with mannitol in order to decompress swollen liver tissues. A glucose solution with gemodez (20:1), choline chloride and glutamic acid, which binds ammonia, is dripped into the vein. Alvezin is infused, oxygen therapy is carried out. To prevent the formation of ammonia, the intestines are cleansed and antibiotics are prescribed. You should strive for the longest possible application of medications for several hours, calculating in total allowable amount injected liquid 30-50 ml/kg. The longer and more continuous the therapy, the more pronounced and fuller the expected effect.

Chronic hepatopathy. chronic insufficiency liver. Jaundice. The definition of hepatopathy in relation to liver diseases was not chosen by chance, since in itself the distinction between the concepts of hepatitis, hepatosis with modern point view is very relative. Severe acute and chronic liver diseases (fatty degeneration, infectious hepatitis, leptospirosis, tuberculosis, cirrhosis, tumors, lymphoid infiltration of the liver) due to gradual progressive dystrophy and death of hepatocytes lead to the development of chronic liver failure, which, unlike acute liver failure, increases over weeks, months and becomes more complicated sometimes jaundice. Jaundice and hyperbilirubinemia occur as a result of disorganization of the liver structures and cholestasis in the blood, when the kidneys can no longer cope with the removal of excess bile pigments. Unrealized bile pigments are poison for the body, and their accumulation in the blood of an animal almost always predicts a bad outcome. Due to a violation of the synthesis of albumin in the liver and severe hypoalbuminemia, hypoproteinemic edema may appear in the dewlap and ascites. The development of ascites in liver disease is also associated with portal hypertension due to impaired blood flow in the portal vein system. An important consequence of a violation of protein metabolism is a decrease in the production of blood coagulation factors, leading to the occurrence of hemorrhagic diathesis, which is partly due to a violation of the resorption of vitamin K from the intestine.

Symptoms.

Clinical manifestations of chronic liver failure are usually combined with symptoms of liver disease, which led to the insufficiency of its function. IN initial stage the development of liver failure is evidenced mainly by dyspeptic phenomena (anarexia, vomiting, diarrhea). There may be symptoms of a fever. At x-ray examination note an increase in the size of the liver and spleen (hepatolienal syndrome) (Fig. 40). In the blood serum, an increase in bilirubin, transaminases, see table. 6). An increase in creatinine in some cases indicates a secondary involvement of the kidneys in the pathological process (hepatorenal syndrome). Rarely, only in some diseases of the liver (leptospirosis, infectious hepatitis, tumors in the region of the gates of the liver), icterus of the mucous membranes and skin appears.

Rice. 40 Pathological hypertrophy liver, splenomegaly: 1 - costal arch, 2 - border of the diaphragm, 3 - contours of the liver outside the costal arch, the caudal angle of the liver edge is more than 30°, 4 - enlarged contours of the spleen

In the final stage of the disease, harbingers of coma, depression, and a decrease in body temperature below normal develop. Against this background, jaundice intensifies, hemorrhages occur under the epithelial covers, often there is an admixture of blood in the feces. X-ray sometimes note a decrease in the liver. Laboratory studies show mild anemia, leukocytosis, increased erythrocyte sedimentation rate, low platelet count, prolongation of bleeding time and blood clotting time.

Diagnosis. The final one is set according to the data of a biochemical blood test, especially aminotransferases (see Table 6), and in the case of infections, according to serological studies.

differential diagnosis. First of all, it is extremely important to determine the degree of liver dysfunction, and then to distinguish parenchymal jaundice from obstructive and hemolytic. Parenchymal jaundice is directly related to hepatopathy and destruction of the liver parenchyma; obstructive due to the closure of the lumen of the bile ducts, hemolytic - hemolytic processes occurring in the body.

Differential signs of hepatopathy and types of jaundice are shown in tables 6 and 7. Additional differentiation of parenchymal jaundice from mechanical is possible with the help of a prednisolone test: 30 mg of prednisolone is prescribed per day. In the case of parenchymal jaundice, the icterus of the integument will greatly decrease in a few days.

Designations: - decrease in values; 0 - norm; + increasing values

Forecast. Mild forms of chronic compensated hepatopathy are asymptomatic and do not have of great importance for animal life. But with long-term liver failure in dystrophic process kidneys, heart, spleen, pancreas, intestines are involved. Then the prognosis worsens. The progression of liver failure with the addition of jaundice, ascites, coma and shock is always a very unfavorable sign.

Treatment. Chronic hepatopathy, depending on the severity of the condition and taking into account the need to eliminate the causes that caused the disease, provides for a set of measures:

Diet. They make up a diet containing little protein (not more than 17% crude protein), easily digestible fats (sunflower oil - 60% linoleic acid), easily digestible carbohydrates (increase liver gluconeogenesis). Obese animals reduce the total caloric content of the diet. For better bowel movements, it is recommended to give a decoction of flaxseed or glycerin. To reduce putrefactive processes in the intestines, reduce the production of ammonia and eliminate flatulence, bifidumbacterin is prescribed;

Antibiotics. Prescribed for suspected leptospirosis and others bacterial infections, on the putrefactive decomposition of chyme in the intestines;

Glucocorticoids. Always appointed! It is preferable to use prednisolone. The initial dose is 30 mg per day daily (regardless of the size of the animal). The dose is maintained until transaminase activity normalizes, then it is halved and then every five days - by 5 mg. After a daily dose of 5 mg for a long time, for 1-2 months, maintain a dose of 2.5 mg;

Vitamins. B1, B6, B12 and E are shown;

Choleretic agents. Silibinin;

Glucose, electrolytes. Drip intravenous infusion of drugs is performed with the progression of signs of liver failure. The drugs are used after 1-2 days until the condition stabilizes.

Cirrhosis of the liver. This is a chronic progressive hepatopathy characterized by dystrophy and necrosis of the hepatic parenchyma, accompanied by nodular regeneration of the parenchyma and diffuse proliferation of connective tissue with a deep restructuring of the liver architectonics. Cirrhosis of the liver is very rare in dogs, as animals do not usually live to this condition. It develops as a resolving phase of acute and chronic hepatopathy, but sometimes due to alimentary protein deficiency, with congestion in the liver associated with heart disease.

Symptoms. They are generally the same as in chronic hepatopathy, but there may be deeper loss of organ functions. The combination of symptoms of liver failure with gynecomastia in males and dysfunction of the genital area in females due to delayed decay may suggest cirrhosis. steroid hormones(estrogen) in the liver.

The course is usually progressive. The total duration of the disease usually does not exceed 1 year.

Diagnosis. Intravital diagnostics difficult.

Treatment. With an active process, glucocorticoid hormones, sirepar, silibinin, and vitamins are prescribed. Recommend periodic intake of diuretics. For ascites that does not respond to diuretic treatment, fluid is released by laparocentesis.

Gallbladder stones. Gallbladder stones are very rare in dogs and are discovered incidentally during revision of the abdominal organs during surgery. Whether dogs have cholelithiasis (cholelithiasis) is still not clear. With non-specific phenomena: the presence of vomiting, mucous stools, an increase in the activity of alkaline phosphatase and normal values ​​of transaminases, the formation of stones in the gallbladder can be assumed.

The diagnosis is confirmed by cholecystography. In the evening, the dog's intestines are recommended to be cleaned with vaseline oil or a decoction of flaxseed. In the morning on an empty stomach, bilivestan is slowly injected into a vein over 5 minutes at a dose of 0.3-0.5 mg/kg and a picture is taken 90 minutes later. The gallbladder is projected in the 5-6th intercostal space. In case of violation of the concentration ability of the gallbladder or obstruction of the cystic duct, the shadow of the gallbladder is absent in the picture. In the presence of stones, the shadow of the gallbladder looks heterogeneous, areas of enlightenment are determined in it according to the number and size of stones. This is a contraindication diagnostic procedure are a serious condition of the liver and kidneys, severe cardiovascular insufficiency.

The course of the disease is asymptomatic for a long time.

Treatment. It is carried out when disease state or the appearance of jaundice associated with obstruction of the bile duct. Perform cholecystotomy with extraction of stones or cholecystectomy.

Operation technique. General anesthesia, dorsal position of the animal, laparotomy in the supra-umbilical region.

Reveal the wound abdominal wall and do an audit of the organs. In the presence of gallstones, the gallbladder has a glazed, cartilage-like appearance. The gallbladder is isolated, its walls are opened in the area of ​​the apex, stones are removed and the cavity is washed with isotonic solution. sodium chloride. The wall is sutured with a sealed one-story continuous seam with silk No. 0.

In cases of severe inflammatory changes in the wall of the gallbladder, with its rupture and outflow of bile into the abdominal cavity, obstruction of the bile duct with a stone, cholecystectomy is performed (Fig. 41). The bladder neck is closed with clamps and crossed between them. The stone localized in the bile duct is pushed through. The stump of the neck is pulled together with two silk ligatures No. 0. The wound of the abdominal wall is closed in the usual way.

The activity of the liver and gallbladder is very significant and varied: participation in metabolism, blood circulation and digestion. The liver is the main organ that cleanses the blood of toxic substances and synthesizes many biologically active compounds necessary for the life of the whole organism. With liver damage, no manifestations may occur for a long time, due to its powerful ability to self-heal. If symptoms of liver and gallbladder disease still occur, which indicates that the process is not new, you should immediately adjust your lifestyle, but it is better to seek qualified help.

Causes of diseases of the liver and gallbladder

So, the main causes of hepatic pathology can be:

• Infections (viruses, bacteria, protozoa, helminths);
• Intoxications (alcohol, drugs, chemical additives food products, pesticides, etc.);
• Metabolic disorders, obesity;
• Gross eating disorders (a lot of fatty, spicy, fried foods);
• Neoplasms.

Nonspecific symptoms of the disease

As mentioned above, specific symptoms in liver diseases may be absent for a long time. But there are more general, but no less unpleasant, symptoms that indirectly indicate liver pathology. The main ones are:

• Weakness, high fatigue, malaise and other manifestations of nervous and mental pathology;
• Aches in the joints, muscles;
• Skin rashes and subcutaneous hemorrhages;
• Temperature increase;
• Anemia.

Specific Symptoms

Soreness in the right side, itching, jaundice, ascites, "jellyfish head", dyspeptic manifestations, enlarged liver, spleen - all these are the main characteristic symptoms disorders of the liver and ducts.

1. Pain. Feelings of heaviness and pain in the right side are mainly associated with stretching of the capsule of the enlarged liver, as well as with inflammation of the gallbladder and ducts. In a chronic and long-lasting process in the liver, the pains are dull, aching in nature. Hepatic colic is characterized by greater force and suddenness and occurs with spasm of the bile ducts or bladder, with blockage by a stone (most often). The pain often radiates between the shoulder blades, to the right shoulder, and also to the lower back. Such an attack may be preceded by nausea and accompanied by vomiting. The attack can last up to a day (on average, several hours).
2. Jaundice. The skin, sclera of the eyes and visible mucous membranes turn yellowish due to the ingress of bilirubin into them. What often happens with acute hepatitis or blockage of the ducts with a stone (sometimes with ascariasis, pancreatic tumors).
3. Skin itching. This symptom occurs when skin receptors are irritated by blood toxic substances, bile acids in mechanical or parenchymal jaundice. The itching is very intense.
4. Dyspepsia. Signs of dyspepsia (decreased appetite, nausea, bitterness in the mouth, belching, vomiting) can appear both in acute (acute hepatitis, cholecystitis, hepatic colic) pathology, and in cirrhosis. Sometimes there is a discolored, or vice versa, black bloody stool.
5. Ascites. This symptom is associated with obstructed blood flow through portal vein and is formed when fluid accumulates in the abdominal cavity. Often they are signs of cirrhosis of the liver. Due to dropsy of the abdomen (ascites), on its front surface, around the navel, a venous expansion is formed, which is called the "jellyfish head". Vascular "asterisks" may appear on the body. Expansion of the veins can also occur in the esophagus, which in severe cases can be complicated by internal bleeding.

The human liver is quite justifiably given the definition of "laboratory of the body." Considering all the functions of this organ, such a comparison seems to be quite accurate. After all, millions pass through the human liver every minute. chemical reactions. It is the main filter that neutralizes all incoming substances. In case of violation of liver functions, harmful substances enter the human blood, as a result of which general poisoning organism.

Causes of liver disease

Diseases of this organ develop in humans for several reasons. As the most common among them, experts distinguish infectious factor (we are talking about hepatitis viruses), disease, impaired fat metabolism, as well as the constant abuse of alcohol by a person.

Often a person has a liver pain if he long period accepts medical preparations or contact with toxins. In this case, pain in the liver occurs as a consequence of its poisoning. Symptoms of liver disease are also manifested in those people who have a hereditary tendency to such a pathology. The protective system of the body of a sick person begins to be mistaken for foreign cells of the liver and bile ducts, which is why the patient subsequently learns how the liver hurts.

However, in some cases, a person may not even guess why the liver is gradually disrupted. So, sometimes the cause of the disease is the wrong approach to daily nutrition, constant adherence to strict, rapid set. What to do in this case, the specialist should tell, since self-treatment may aggravate the situation.

Thus, not only serious illness and disturbances in the functioning of body systems, but also the habits and preferences of a person, ecological situation. In any case, preliminary diagnosis and the right approach to therapy are necessary.

Symptoms of liver disease

If a person develops hepatitis , then we are talking about acute or chronic diffuse inflammation of the liver, which can have a different origin.

At acute hepatitis sometimes the symptoms are mild. Therefore, the disease is detected in the process of diagnosing other ailments. But basically acute hepatitis begins with the so-called preicteric stage. At this time, the signs of the disease may resemble the symptoms of. After about two weeks, the icteric stage begins.

A more formidable disease is acute toxic hepatitis . In connection with the intoxication of the body, the disease progresses very quickly. The skin of the patient, as well as his mucous membranes, become yellowish, the urine becomes brown, and the stool becomes whitish-brown. If there is acute manifestation disease, it is possible to develop skin itching, nosebleeds, heart rhythm disturbances, and also present individual features CNS lesions.

When examining a patient with suspected acute hepatitis, the specialist reveals that his liver is enlarged, and there is slight pain on palpation. With the help of laboratory tests, the diagnosis is confirmed, and treatment is prescribed.

When making a diagnosis, it is important for the doctor to carefully study the history, since there is always a possibility that the patient viral hepatitis .

When diagnosing liver diseases, quite often all patients are diagnosed with chronic hepatitis . Symptoms of liver disease in this case are manifested by its increase, a feeling of heaviness or pain in the right hypochondrium. Signs such as itchy skin and jaundice are less common, with only mild yellowing of the mucous membranes and skin noted. But at the same time, a person has regular nausea, a decrease in appetite. In addition, the person is concerned unstable chair, a feeling of weakness. Affects the state and nutrition: the patient does not tolerate fats well. That is why the diet for liver disease is very important.

In addition to the described forms of hepatitis, doctors in the process of diagnosing determine other varieties of this disease: benign And aggressive hepatitis , inactive And active hepatitis , progressive recurrent hepatitis . Determine the form of the disease high precision allows for laparoscopy and taking material for the liver.

At hepatosis the patient develops a violation of metabolic processes in the liver cells. Gradually develop dystrophic changes. There is no inflammation. Most often, patients are diagnosed fatty hepatosis , resulting from too frequent and abundant intake of fats in the liver. The result is fatty liver cells.

With an advanced form of hepatitis in a person, it can gradually develop. This disease has chronic course, it is characterized by liver damage of a progressive type. A complete restructuring of the liver tissue occurs, as a result of which all functions of the organ are disrupted, and a person manifests chronic liver failure . With cirrhosis of the liver, a person mainly complains of a manifestation of general weakness, constant pain or a feeling of heaviness in the right hypochondrium and pit of the stomach, feeling, belching, weight loss,. He has jaundice, reddening of the palms, vasculature on the face, chest, palms. The liver with cirrhosis is enlarged, while its reduction is considered an unfavorable sign. The patient also has an enlarged spleen. Further development the disease proceeds already with signs of portal hypertension. A person accumulates fluid in the abdominal cavity, as a result of which the stomach increases, the rectum, esophagus, stomach are observed, and edema appears. Possible.

Basically, cirrhosis of the liver affects people who have been drinking alcohol regularly for many years. Cirrhosis sometimes develops against the background of infectious diseases, hepatitis C and B viruses.

Treatment

Thanks to the intensive development of modern medicine, as well as the adoption of pharmacotherapy methods and other non-traditional methods by doctors, liver treatment is effective. Before prescribing drugs for treatment, the doctor clearly establishes the diagnosis and eliminates the causes that led to the development of the disease.

Treatment of cirrhosis of the liver and other pathologies of this organ is a painstaking and lengthy process. In this case, it is important for the patient to seek help in time and not miss the moment, since delay is fraught with the development of formidable diseases, in particular, liver cancer . Some patients believe that traditional medicine will be effective. But the treatment of the liver with folk remedies can be practiced only under the strict guidance of a doctor, and not independently. Practicing complex therapy, the attending physician may recommend treatment with herbs and other folk remedies (treatment of the liver, honey, oats, etc. is widely practiced).

An equally important point in the process of liver treatment is a sparing diet. So, if a person develops fatty hepatosis, in which fatty liver cells occur, his diet should be dominated by protein products. Developed fatty degeneration involves a strict restriction of the amount of fat in the diet. Patients who have developed hepatosis are not recommended to consume animal fats. At the same time, vitamins and drugs are prescribed to stimulate liver functions. Recommended to lead active image life.

If the patient is diagnosed or liver cyst , then the treatment of such formations depends on their location and size. In this case, it is important to accurate diagnosis, after which the doctor individually makes a decision on treatment.

As a drug treatment of diseases of the liver and biliary tract, depending on the characteristics of the disease, the so-called hepatotropic drugs . They are divided into three subgroups. Cholagogue preparations activate the secretion of bile and improve the process of its entry into the duodenum. Hepatoprotective drugs improve metabolic processes in the liver, allowing it to perceive pathogenic effects more stably, contribute to the restoration of the liver. Cholelitholytic drugs activate the process of dissolution of gallstones.

During treatment hepatitis of various forms complex therapy is practiced, including various procedures and methods. In particular, apply medications which favorably affect the functioning of the liver, special diet and mode. At the stage of recovery, patients are prescribed physiotherapy and spa treatment.

At sharp viral hepatitis to ensure the removal of toxic substances from the body is recommended plentiful drink infusions and decoctions of herbs. ethnoscience recommends the use of decoctions of common flax, chamomile, cinnamon rosehip, red clover, peppermint, oats, St. John's wort, and other herbs and plants. With viral hepatitis, it is recommended to take vitamins E and A, as well as oils and products that contain these vitamins. Treatment is practiced with black radish juice, milk thistle, sea buckthorn oil, etc.

With cirrhosis of the liver, the patient is prescribed a diet, alcohol is categorically excluded. If an active process occurs in the liver, then the patient is prescribed a course of treatment, which includes taking, b vitamins , ascorbic acid , vitamins A , D . If the patient shows symptoms that indicate liver failure, he is shown, 5% glucose solution , salt solutions . In the presence of a pronounced inflammatory process, corticosteroid hormone therapy is practiced, and () . Treatment must be under the supervision of a doctor.

Diet

Speaking about providing a sparing regimen for liver ailments, first of all, we are talking about right approach to human nutrition. A sparing diet allows not only to treat liver diseases more effectively, but also to normalize liver function, the processes of bile formation in the body, and restore metabolic processes. Patients who are at risk of fatty degeneration of the organ are shown a special diet for liver disease. As recommended products, cod, soy, cottage cheese should be noted, which contain a lot of lipotropic substances . People who show symptoms of liver disease are shown to eat low-fat foods. A person should not consume more than 80 g of fat per day, while every day it is recommended to consume vegetable oil, which provides a choleretic effect, and, therefore, treatment of the liver. If the patient has signs of a violation of the outflow of bile, he is shown to consume about 150 g of fat per day, and half of them should be vegetable oils.

It is not recommended to eat a lot of carbohydrate food. Used in chronic liver disease fractional nutrition meals containing a full ratio of proteins, carbohydrates and fats. Food should be boiled or steamed. With hepatitis, the diet should contain a lot of easily digestible proteins.

It is strictly forbidden to eat fatty meat, smoked meats, rich broths, canned food, chocolate, sour foods, alcohol. If, for most liver diseases, a diet is required to be observed only at the stage of treatment and recovery, then with cirrhosis of the liver, it will be lifelong. Moreover, dietary restrictions in this formidable disease are especially serious.

gallbladder located under the liver, which is connected to the bladder by the bile duct system. , produced by the liver, provides activation of the production of fats in the liver. The purpose of bile is to improve the absorption of fats and activate the movement of food through the intestines. On the walls of the gallbladder and ducts there is a layer of muscles that, by contracting, stimulate the movement of bile. If failures occur in such contractions, then a person is diagnosed dyskinesia , that is, a violation of the mobility of the biliary tract. Dyskinesia manifests itself intermittently painful sensations in the region of the right hypochondrium.

If we consider gallbladder disease in general, then dyskinesia is not considered dangerous disease however, due to the prolonged progression of this condition, symptoms of gallstone disease may develop.

In gallstone disease, stones form in the bile ducts or gallbladder. Most often, this disease affects women of working age who have excess weight. While in the gallbladder, stones may not cause concern to the patient, but when they enter the bile ducts, an attack begins. biliary colic . A person suffers from severe pain in the abdomen, nausea, vomiting, bitterness in the mouth. The attack subsides if the stone went into the duodenum on its own. Otherwise bile ducts clogged, and the result is inflammatory process gallbladder - spicy . With this condition, there is already a serious danger to life, so it should be treated immediately.

If the inflammatory process in the gallbladder proceeds gradually and slowly, then we are already talking about chronic cholecystitis . His treatment is carried out with an exacerbation of the disease. Also, the patient must constantly follow a sparing diet, you can practice treatment with herbs and other folk methods. With an exacerbation of the disease, doctors recommend eating a minimum of food for several days. Prescribed medications from several different groups, which eliminate the main symptoms of the disease and allow the gastrointestinal tract to normalize.

If a patient has a congenital fold of the gallbladder the disease may not appear at all. This is simply a feature of the shape of the gallbladder, which can be found by chance during an ultrasound examination. But in some cases, the bend of the gallbladder is formed as a consequence of cholecystitis,. Periodically, symptoms appear that provoke the bending of the gallbladder: this poor digestion, nausea, vomiting. Acquired inflection of the gallbladder must be treated. Initially held drug treatment, also practiced physiotherapy, diet.

Treatment of the gallbladder is done only under the guidance of a doctor. If therapeutic treatment does not give the desired effect, and the inflammation progresses, then in this case you have to turn to the surgeon.

In some pathologies of the gallbladder, it is possible exclusively surgery. So, surgery is often necessary if the patient is found gallbladder polyp , and gallstones . Although in the latter case, sometimes it is possible to do without surgery. In this case, practice modern methods treatment, as well as therapy with some folk remedies.

Often in the treatment of gallstone disease, the most acceptable method is the removal of the gallbladder (cholecystectomy). It is carried out as normal operation and laparoscopic method.

Pancreas located in the human abdomen. The main function of this organ is the production, which in the body take part in the process of processing fats, proteins and carbohydrates. Initially, the enzymes are secreted into the duct of the gland, later the enzymes are in the duodenum. This is where food digestion takes place. Also produced in the pancreas insulin responsible for the regulation of sugar metabolism. Therefore, its deficiency leads to the development diabetes.

The main diseases of the pancreas are acute and chronic form, and tumors . The symptoms of these diseases may be similar.

Diseases of the pancreas, as a rule, are manifested by pain in the epigastric region, which are given to the back under the left shoulder blade. These symptoms of pancreatic diseases are aggravated after a person has eaten a fried or fatty dish, drank a certain amount of alcohol. Therefore, an important point in the treatment process is the right diet. The person is also worried about vomiting, diarrhea, nausea. In addition, his appetite disappears, body weight is lost.

At acute pancreatitis an inflammatory process occurs in the pancreas. This disease can affect a person due to the use copious amounts alcohol, and also as a consequence of diseases of the gallbladder and duodenum. In acute pancreatitis, a person is in severe pain and needs medical attention. Treatment of the pancreas with folk remedies without a preliminary examination by a doctor in this case cannot be practiced.

The acute form often becomes chronic. At chronic pancreatitis the inflammatory process of the pancreas is long and sluggish. As the disease progresses, the gland tissue is gradually replaced by connective tissue. As a result, fewer enzymes are released, digestion of food worsens. In addition, the risk of developing diabetes mellitus increases, as insulin production also decreases.

In the treatment of the chronic form of the disease, it is important to follow a diet, practice taking medications that reduce the production of gastric juice, as well as products containing enzymes. In this case, it is also possible to treat the pancreas with herbs.

Tumors of the pancreas are divided into two types: pancreas cancer And hormonally active tumors . With oncological education, the patient develops jaundice, chronic pancreatitis, diabetes mellitus, he is worried about very severe pain, weight is decreasing. Surgical treatment is practiced. With hormonally active tumors, it is initially determined during the diagnostic process whether the tumor is malignant or benign. After that, a decision is made whether to undergo chemotherapy or surgery.

It is important that the treatment of such diseases be comprehensive and carried out immediately after the diagnosis of the disease.