Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus

Khatkov, Igor; Евгеньевич, Хатьков Игорь; Avanesyan, R. G.; Гарриевич, Аванесян Рубен; Ахаладзе, Г. Г.; Германович, Ахаладзе Гурам; Бебуришвили, А Г; Георгиевич, Бебурешвили Андрей; Bulanov, A.Yu.; Юльевич, Буланов Андрей; Быков, М И; Ильич, Быков Михаил; Винницкая, Е. В.; Владимировна, Винницкая Елена; Виршке, Э. Р.; Рейнгольдович, Виршке Эдуард; Габриэль, С. А.; Александрович, Габриэль Сергей; Гранов, Д. А.; Анатольевич, Гранов Дмитрий; Дарвин, В. В.; Васильевич, Дарвин Владимир; Долгушин, Б. И.; Иванович, Долгушин Борис; Dyuzheva, T. G.; Геннадьевна, Дюжева Татьяна; Ефанов, Михаил; Германович, Ефанов Михаил; Коробка, В. Л.; Леонидович, Коробка Вячеслав; Korolev, M P; Павлович, Королев Михаил; Кулабухов, В. В.; Витальевич, Кулабухов Владимир; Maystrenko, N. A.; Анатольевич, Майстренко Николай; Мелехина, О. В.; Вячеславовна, Мелехина Ольга; Nedoluzhko, I; Юрьевич, Недолужко Иван; Охотников, О. И.; Иванович, Охотников Олег; Pogrebnyakov, V. Yu.; Юрьевич, Погребняков Владимир; Поликарпов, А. А.; Александрович, Поликарпов Алексей; Prudkov, M. I.; Иосифович, Прудков Михаил; Ratnikov, V. A.; Альбертович, Ратников Вячеслав; Солодинина, Е. Н.; Николаевна, Солодинина Елена; Stepanova, Y.; Александровна, Степанова Юлия; Субботин, В. В.; Вячеславович, Субботин Валерий; Федоров, Е. Д.; Дмитриевич, Федоров Евгений; Шабунин, А. В.; Васильевич, Шабунин Алексей; Shapovalyants, S. G.; Георгиевич, Шаповальянц Сергей; Shulutko, A M; Михайлович, Шулутко Александр; Shishin, K; Вячеславович, Шишин Кирилл; Tsvirkun, V.; Викторович, Цвиркун Виктор; Чжао, А. В.; Владимирович, Чжао Алексей; Kulezneva, Yu. V.; Валерьевна, Кулезнева Юлия

doi:10.26442/00403660.2021.02.200619

Terapevticheskii arkhiv

2021

DOI: 10.26442/00403660.2021.02.200619

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Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus

Igor Khatkov¹,

Хатьков Игорь Евгеньевич²,

R. G. Avanesyan³

et al.

Abstract: 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 actuali… Show more

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Cited by 3 publications

References 35 publications

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Recurrence of primary sclerosing cholangitis in the graft

Pak,

Petrova,

Korobka

et al. 2024

Med. vestn. Ûga Ross.

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Primary sclerosing cholangitis (PSC) is a disease characterized by inflammation, fibrosis and obliteration of both intra- and extrahepatic bile ducts, accompanied by cholestasis, with further outcome in biliary cirrhosis of the liver, cholangiocarcinoma. The pathogenesis of the disease is poorly understood, but, according to various sources, it involves genetic factors, innate and adaptive immunity mechanisms, the toxic effects of hydrophobic bile acids and, possibly, intestinal dysbiosis. The strong association with inflammatory bowel disease is associated with a significantly increased risk of colorectal cancer, which, along with cholangiocarcinoma, represents the most significant diagnostic challenge in the long-term management of PSC. The diagnosis of PSC is established based on the identification of typical cholangiographic lesions of the bile ducts and the exclusion of secondary causes of sclerosing cholangitis. Complex pathophysiology, heterogeneity of clinical features and the rare nature of the disease have led to the lack of effective therapy to date; there are no treatment algorithms, but a course of ursodeoxycholic acid in doses of 17–23 mg/kg/day can be prescribed for up to a year in order to monitor the dynamics of the decrease in levels serum alkaline phosphatase. A number of drugs are under investigation, including FXR (farnesoid X receptor) agonists with choleretic and antimicrobial properties. Clinically significant stenoses can be successfully treated with interventional endoscopy, but liver transplantation (LT) is currently the only curative treatment with a high survival rate. According to various literature data, 20–25% of patients develop disease relapse in the graft. Our case report of recurrent PSC in a patient 5 years after orthotopic LT provides an overview of management options from a practical, patient-centered perspective.

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Recurrence of primary sclerosing cholangitis in the graft

Pak,

Petrova,

Korobka

et al. 2024

Med. vestn. Ûga Ross.

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Results of regional care for patients with cirrhosis of the liver in the outcome of viral hepatitis C in the era of direct-acting antiviral drugs

Pak,

Korobka,

Pasechnikov

et al. 2024

jour

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Objective: to assess the effect of antiviral therapy on the clinical course and survival in patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C.Materials and methods: a retrospective analysis of the medical histories of 325 patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C, who were on the waiting list for liver transplantation from 2014 to 2024. The patients were divided into 2 groups: patients who received antiviral therapy (n=273), and patients who did not receive antiviral therapy (n=52).Results: in the group of patients who received antiviral therapy, 219 (80.2%) patients were alive at the time of the diagnosis, including 57 (20.8%) people achieved liver function compensation and were excluded from the waiting list for liver transplantation; 42 (15.3%) patients underwent liver transplantation. The dynamics of clinical and laboratory indicators in patients from this group improved. In the group of patients who did not receive antiviral therapy, 2 (3.8%) patients were alive at the time of the examination, none of the patients had achieved liver function recompensation. The dynamics of clinical and laboratory indicators in patients of this group worsened.Conclusion: antiviral therapy has a positive effect on the survival of patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C, as well as on the clinical course and laboratory parameters, which necessitates the earliest possible implementation of this therapy. Clinical and laboratory monitoring of these patients is also needed to prevent re-infection with viral hepatitis C, early detection of decompensation of liver function, and the occurrence of hepatocellular carcinoma.

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Liver morphology in regulated mechanical jaundice (experimental study)

Makhmadov,

Ashurov,

Tagoikulov

2023

jour

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Aim. To examine the morphology of the liver in controlled obstructive jaundice in experimental animalsMaterials and Methods. This research was conducted through an experimental study involving 24 male Shingilla rabbits and 18 white rats of both sexes, all of which were maintained under identical conditions of care and diet. To establish a model of varying degrees of obstructive jaundice, the animals were divided into three groups. Group I comprised animals (n=8) which, following cholecystectomy and drainage of the choledochus, experienced a complete block of hepaticocholedochus within 48 hours. Group II (n=8) included animals wherein the block of hepaticocholedochus persisted for 48-60 hours, and Group III (n=8) involved animals experiencing more than 60 hours of hepaticocholedochus blockage.Results. Histological examination of liver biopsy specimens from the experimental animals revealed distinctive morphological changes in the parenchyma based on the duration of obstructive jaundice modeling, as compared to the liver of a healthy animal. In the pathohistological study of the Group I animals, liver micro-preparations displayed uneven color throughout the entire area of the sections, central vein expansion with altered shape, and traces of a small number of erythrocytes. Analysis of biopsy specimens from Groups II and III revealed irreversible dystrophic and necrotic processes in hepatocytes.Conclusion. Thus, experimental studies, premised on the modeling of controlled obstructive jaundice, revealed that complete blockage of the hepaticocholedochus, over varying time intervals, corresponded with hepatocyte damage, underpinned by escalating cholestatic processes.

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Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus

Cited by 3 publications

References 35 publications

Recurrence of primary sclerosing cholangitis in the graft

Recurrence of primary sclerosing cholangitis in the graft

Results of regional care for patients with cirrhosis of the liver in the outcome of viral hepatitis C in the era of direct-acting antiviral drugs

Liver morphology in regulated mechanical jaundice (experimental study)

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