Obstructive jaundice is a symptom complex that occurs when the outflow of bile through the bile ducts is impaired due to their blockage or compression. The main symptoms are yellow staining of the skin, sclera and visible mucous membranes, discoloration of feces and darkening of urine, which is associated with an increase in the level of bilirubin in the blood.
Normally, bilirubin should be excreted with bile into the lumen of the duodenum, but if there is an obstacle to the outflow of bile, it enters the bloodstream and has a toxic effect on the entire body.
Benign obstructive jaundice appears against the background of the development of an inflammatory process in the liver and biliary tract due to infection with choledocholithiasis parasites.
Scar structures appear in the biliary tract, and a benign formation develops in the duodenal papillae of the ducts.
The cause of the development of malignant pathology is the localization of tumor-like cancerous neoplasms in the gallbladder, pancreas or duodenal papillae. Due to stagnation of bile, metabolic disorders, gallstone disease develops.
Blockage of the biliary tract, the development of inflammatory processes can be triggered by such diseases: pancreatitis, cholecystitis, abnormal structure of the pathways or duodenum (it happens in newborns due to infection with hepatitis from the mother).
Blockage of the bile ducts by calculi inevitably leads to:
- pain in the hypochondrium on the right;
- sharp spasms with recoil to the back, right armpit, chest;
- liver pain on palpation;
- severe itching on the skin;
- nausea and vomiting;
-decrease in appetite and weight;
-increase in body temperature;
-the appearance of loose stools, dark or, conversely, discolored;
- yellowness of the skin or the appearance of an earthy hue;
- no palpation of the gallbladder;
- discharge of dark urine;
- hepatic colic in the acute stage;
- an enlargement of the liver with the development of a malignant process, the appearance of a nodular structure.
What should be done in a patient with jaundice? Question number one is to quickly clarify the situation and make a diagnosis. The fact is that jaundice is not a diagnosis, it is only a statement of the fact that the skin is yellowed. Jaundice is always the result of some other medical condition. Finding the cause of jaundice means making a diagnosis. The simplest classification of jaundice is to divide it into three types:
-mechanical jaundice - a consequence of the presence of a mechanical obstruction in the biliary tract (for example, a stone or tumor);
- parenchymal jaundice - a consequence of damage to the parenchyma, or liver tissue (for example, cirrhosis of the liver, or hepatitis);
- hemolytic jaundice - a consequence of hemolysis, increased destruction of red blood cells. In this case, hemoglobin from destroyed cells in large quantities turns into bilirubin, the liver cannot cope with the excess bilirubin, and it begins to stain the skin.
The challenge is to understand what type of jaundice belongs to in this particular patient. This is important because the treatment is completely different. Surgeons deal only with obstructive jaundice. Parenchymal and hemolytic jaundice are of interest to therapists.
Treatment of patients with breast cancer should be comprehensive. Conservative measures, in addition to normalizing homeostasis and infusion therapy, include the following measures:
- removal of toxic substances from the body. This is achieved by carrying out forced diuresis, as well as the introduction of hemodesis and similar drugs;
- the introduction of plastic substances necessary for the reparative processes of the hepatic parenchyma. In this case, it is necessary to keep in mind two main points: firstly, before the elimination of biliary hypertension, plastic substances are absorbed by hepatocytes poorly and in small quantities; secondly, overloading the patient's body with them until the normal outflow of bile is restored makes increased demands on hepatocytes and, as a result, can cause a breakdown in adaptation processes and worsen liver function. In this regard, plastic substances should be prescribed in doses at the minimum therapeutic level (if cholecysto- or cholangiostomy has not been previously performed) and not too long courses (up to 7-10 days). This group of drugs includes sodium nucleinate and other purine and pyrmidine bases: metacin, pentoxil, potassium orotate, etc .;
-improvement of metabolism in hepatocytes. For this purpose, it is advisable to introduce ATP, coenzyme A, a complex of vitamins of group B, ascorbic acid, mexidol, etc. To normalize the reduced level of blood coagulation factors, prothrombin complex, it is necessary to introduce vikasol;
-use of anabolic hormones. Doses of drugs should not be large, so as not to cause a breakdown of compensatory processes in hepatocytes. It should be warned against the use of hyperbaric oxygenation, which is effective only after the elimination of biliary hypertension. To improve the blood supply to the liver parenchyma, it is necessary to introduce drugs that improve microcirculation (reopolyglucin, etc.);
-fighting infection. The introduction of antibacterial drugs in patients with prolonged breast cancer and consequently reduced immunity should be combined with a course of stimulating therapy with prodigiosan, imunofan or levamisole.
Patient examination consists of:
- scanning of all organs;
-conducting a complete laboratory blood test for tumor markers;
- taking a molecular genetic test to determine the amount of bilirubin fraction in the blood.
-Mechanical jaundice should be eliminated within the first 10 days from the moment of onset due to the threat of cholangitis and liver failure.
-Treatment of patients with obstructive jaundice should be comprehensive.
-Treatment of obstructive jaundice can be more effective through the use of minimally invasive methods, the main purpose of which is not only diagnosis, but also treatment carried out simultaneously.
-At the first stage of treatment, it is necessary to carry out a temporary decompression of the biliary tract as preparation for the main (second) stage of treatment; in some cases, this procedure will completely replace surgical treatment.
You can safely begin treatment, which we carry out as quickly and efficiently as possible in Tashkent. The Gatling Med clinic will make you feel confident in yourself and your health.