Interdependence of the state of the liver and pancreas at chronic biliary pancreatitis combined with obesity: approaches to the complex treatment

Abstract

Objective — to investigate the structural state of the liver and pancreas, their relationship with the functional capacity of the pancreas, and to evaluate the effectiveness of the treatment scheme that includes metadoxinе to correct the reveled disorders in patients with chronic biliary pancreatitis(CBP) combined with obesity. Materials and methods. The investigation involved 22 patients with CBP (comparison group) and 88 patients with CBP combined with obesity (the main group) with the mean age (50.57 ± 8.81) years, from them 60 (54 %) women and 50 (46 %) men. The control group included 20 age‑ and gender‑matched healthy subjects. The index of liver stiffness in patients with CBP was higher by 30.2 % than in control group, and the index of pancreas stiffness — by 27.9 %, respectively (p < 0.05). CAP of the liver and pancreas were significantly higher in patients with CBP and concomitant obesity than in those without concomitant obesity by 33.2 % and 34.4 %, respectively (p < 0.05). To assess the efficacy of treatment schemes, the patients were divided into two groups: subjects of the 1st group (n = 35) received standard therapy: pancreatin at a dose of 25 thousand units with meals, pantoprazole at a dose of 40 mg once a day, domperidone at a dose of 1 tablet three times a day, patients of the 2nd group (n = 38) additionally received hepatotropic drug metadoxine (Liveria IС) 1 (0.5 g) tablet twice a day 15 — 30 mins before meals during 3 months. Results. In CBP patients, liver stiffness the liver stiffness index was 30.2 % higher than that in the control group, and pancreas stiffness index by 27.9 % (p < 0.05). The ultrasound attenuation coefficient (UAC) of the liver and pancreas in CBP patients with concomitant obesity was significantly higher compared to the indicator in CBP patients by 33.2 and 34.4 %, respectively (p < 0.05). After the treatment, an improvement in liver structure and elasticity increase were defined, as evidenced by the decreased stiffness and UAC. Conclusions. The investigations with shear wave elastography and steatometry in patients with CBP combined with obesity the significantly increased liver and pancreatic stiffness and UAC up to steatosis levels have been established. The use of metadoxinе in the complex treatment of chronic pancreatitis combined with obesity promoted the significant increase in the efficacy of standard treatment along with the improvements in the structure of hepatic and pancreatic parenchyma and increased levels of fecal a‑elastase (р < 0.05).

Optimization of the Teaching of Surgical Disciplines in the Training of Family Medicine Specialists at the Undergraduate Level of Education

“…На основі аналізу діючих навчальних планів і програм освіти лікарів з фаху «Загальна практика-сімейна медицина» та оцінки навчальної ефективності набутих теоретичних знань, спеціальних практичних навичок та умінь, отриманої за результатами випускного іспиту та врахуванням відсотка набраних правильних відповідей під час проходження тесту з хірургії через ліцензійний тестовий іспит «КРОК 2» до та після впровадження інноваційно-інтегральних методик навчання отримано велику кількість матеріалів, на підставі яких можна говорити про певні сформовані висновки [4][5][6][7].…”