Structural and functional state of the liver in patients with extrahepatic cholestasis of non-tumor genesis


  • B.F. Shevchenko SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine
  • O.V. Zeleniuk SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine
  • I.A. Klenina SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine
  • O.M. Babii SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine
Keywords: extrahepatic cholestasis of non-tumor genesis, elastometry, markers of endogenous intoxication, damage to hepatocytes.

Abstract

To date, the diagnosis and treatment of extrahepatic cholestasis (EHC) at various stages of development remains one of the most pressing problems of modern biliary surgery. The purpose of the study is to determine the structural changes of the liver in patients with EHC of non-tumoral genesis according to shear wave elastometry and ultrasound in comparison with biochemical indicators of endotoxemia, inflammation and markers of fibrosis. Preoperatively, 121 patients with EHC of non-tumoral genesis were examined: standard general clinical studies, ultrasound examination of the liver and its shear wave elastometry were performed. Depending on the presence of jaundice and symptoms of hepatocyte damage, all the patients were divided into 4 groups. Serum content of medium molecular weight peptides, free hydroxyproline and glycosaminoglycans was determined. Statistical processing of the obtained data was performed using SPSS 16.0. In patients with EHC of non-tumoral genesis according to shear wave elastography, the stiffness of the liver varied depending on the increase in the intensity of jaundice. It was found that the serum bilirubin level in such patients was significantly different depending on the available jaundice and symptoms of hepatocyte damage both in comparison with the control group and between the study groups. In EHCs, structural changes in the liver depend on abnormalities in the biochemical composition of serum, which are significantly altered by prolonged extrahepatic cholestasis and manifested by severe liver failure. Thus, an increase in endotoxemia (p<0.001) was found in patients with EHC of non-tumoral genesis without jaundice and evidence of cholestasis development; indicators of liver stiffness depend on the level of bilirubinemia (r = 0.84), and in patients with hepatocyte damage also on the duration of cholestasis (r = 0.68). Bilirubin levels cannot be an indicator of long-term EHC.

References

[1] Banerzhi, A., & Parasich, I. V. (2014). Medical Statistics Clear Language. Moscow: Practice medicine. ISBN: 978-5-98811-087-3.

[2] Bergman, S., Al-Bader. M., Sourial, N., Vedel, I., Hanna, W. C., Bilek, A. J. … Fraser, S. A. (2015). Recurrence of biliary disease following non-operative management in elderly patients. Surgical Endoscopy, 29(12), 3485-3490. doi: 10.1007/s00464-015-4098-9.

[3] Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. (2019). Available from: https://www.ncbi.nlm.nih.gov/pubmed/30943551. Accessed: 2019 May 51(5), 472-491. doi: 10.1055/a-0862-0346.

[4] Gaidar, Iu. A., Ostrovs’kii, O. S., Ratchik, V. M., & Kononov, І. M. (2007). Features of morphological liver damage in the dynamics of obstructive cholestasis in the clinic and experiment. Morphology, 1(2), 41-46. doi: 10.26641/1997-9665.2007.

[5] Kamyshnikov, V. S. (2002). Reference Book of Clinical and Biochemical Laboratory Diagnostics. Minsk: Belarus. ISBN: 985-01-0444-9.

[6] Kanіkovs’kij, O. E., Bondarchuk, O. І., Karij, Ja. V., & Babijchuk, Ju. V. (2015). Surgical tactics of treatment complicated forms of gallstone disease in elderly and senile patients. Ukrainian Journal of Surgery, 3-4(26-27), 109-113.

[7] Kashaeva, M. D., Proshin, A. V., Afanas’ev, A. N., Gavrilova, K. V., & Golushko, A. V. (2018). Liver morphology in mechanical jaundice. Bulletin of Novgorod State University, 6(112), 8-11.

[8] Kim, D. K., Choi, J. Y., Park, M. S., Kim, M. J., & Chung, Y. E. (2018). Clinical feasibility of MRE lastography in patients with biliary obstruction. AJR, 210(6), 1273-1278. doi.org/10.2214/AJR.17.19085.

[9] Kliaritskaia, I. L., Shelikhova, E. O., Moshko, Iu. A., Semenikhina, E. V., Krivoi, V. V., & Tsapiak, T. A. (2017). Elastometry in the diagnosis of liver diseases. Crimean Therapeutic J., 2, 28-35.

[10] Kubo, K., Kawakami, H., Kuwatani, M., Nishida, M., Kawakubo, K., Kawahata, S. … Sakamoto, N. (2016). Liver elasticity measurement before and after biliary drainage in patients with obstructive jaundice: a prospective cohort study: a prospective cohort study. BMC Gastroenterol., 6(1), 65. doi: 10.1186/s12876-016-0479-3.

[11] Kushaeva, M. D., Proshin, A. V., Afanas’ev, A. N., Gavrilova, K. V., & Golushko, A. V. (2018). Liver morphology in mechanical jaundice. Bulletin of Novgorod State University, 112(6), 8-11.

[12] Millonig, G., Reimann, F. M., Friedrich, S., Fonouni, H., Mehrabi, A., Büchler M. W. … Mueller S. (2008). Extrahepatic Cholestasis Increases Liver Stiffness (FibroScan). Irrespective of Fibrosis Hepatology, 48(5), 1718-1723. doi: 10.1002/hep.22577.

[13] Natal’skij, A. A., Tarasenko, S. V., Zajcev, O. V., & Peskov, O. D. (2014). Current ideas about liver failure in surgery. Russian Medical and Biological Bulletin named acad. I.P. Pavlova, 4, 42-49.

[14] Nikolaichuk, V. V., Moin, V. M., & Kirkovskii, V. V. (1991). The method of determining “medium molecular peptides”. Laboratory science, 10, 13-16.

[15] Nikol’skaia, V. A., Danil’chenko, Iu. D., & Memetova, Z. N. (2013). Biochemical aspect of the consideration of the role of medium-mass molecules in the body. Scientific Notes of Taurida National University named V.I. Vernadsky, series “Biology, Chemistry”, 65(56), 1, 139-145.

[16] Osadchuk, M. A., & Kapustin, V. M. (1987). Protein-bound plasma oxyproline in acute viral hepatitis. Laboratory Science, 7, 16-18.

[17] Sadiku, E., Taci, S., Dibra, A., Nela, E., & Babameto, A. (2019). The differential diagnosis of intra and extra-hepatic cholestasis: Causes and diagnosis of intrahepatic cholestatic disorders. Hepatology. Retrieved from: http://www.ishp.gov.al/the-differential-diagnosis-of-intra-and-extra-hepatic-cholestasis-causes-and-diagnosis-of-intrahepatic-cholestatic-disorders/

[18] Sergeeva, E. A., Burdina, E. G., & Minushkin, O. N. (2014). Cholestasis syndrome. Kremlin Medicine. Clinical Herald, 3, 84-90.

[19] Shen, Q. L., Chen, Y. J., Wang, Z. M., Zhang, T. C., Pang, W. B., Shu, J., & Peng, C. H. (2015). Assessment of liver fibrosis by Fibroscan as compared to liver biopsy in biliary atresia. World J. Gastroenterol., 21(22), 6931-6936. doi: 10.3748/wjg.v21.i22.6931.

[20] Siplivyi, V. A., Evtushenko, D. V., Naumova, O. V., Andreeshchev, S. A., & Evtushenko, A. V. (2016). Morphological changes of the liver in obturation jaundice, caused by choledocholithiasis, depending on its duration. Clinical Surgery, 2, 20-23.

[21] Smith, I., Monkemuller, K., & Wilcox, C. M. (2015). Incidentally identified common bile duct dilatation: a systematic review of evaluation, causes, and outcome. J. Clin. Gastroenterol, 49(10), 810-815. doi: 10.1097/MCG.0000000000000394.

[22] Soumitra R., Eachempati S., & Reed R. (2015). Acute Cholecystitis. Springer International Publishing, 225. doi: 10.1007/978-3-319-14824-3_1.

[23] Tereshchenko, O. A., Botashev, A. A., Pomeshchik, Iu. V., Petrosian, E. A., & Sergienko, V. I. (2012). Syndrome of endogenous intoxication and systemic inflammatory reaction in biliary peritonitis complicated by abdominal sepsis. Bulletin of Experimental and Clinical Surgery, 5(4), 722-726.

[24] Tonozuka, R., Itoi, T., Sofuni, A., Itokawa, F., Kurihara, T., Tsuchiya, T. … Moriyasu, F. (2014). Efficacy and safety of endoscopic papillary large balloon dilation for large bile duct stones in elderly. Itokawa Digestive Diseases and Sciences, 59(9), 2299-2307. doi: 10.1007/s10620-014-3156-9.

[25] Trifan, A., Sfarti, C., Cojocariu, C., Dimache, M., Cretu, M., Hutanasu, C., & Stanciuet C. (2011). Increased liver stiffness in extrahepatic cholestasis caused by choledocholithiasis. Hepat. Mon., 11(5), 372-375. PMC3212780.

[26] Tsyrkunov, V. M., Prokopchik, N. I., Andreev, V. P., & Kravchuk, R. I. (2018). Clinical Morphology of liver: Cholestases. Journal of the Grodno State Medical University, 16(4), 468-480. doi: 10.25298/2221-8785-2018-16-4-468-480.

[27] Zaharova, A. V. (2017). Perfection of diagnostic and surgical tactics in patients with obstructive jaundice. Practice Medicine, 67(2), 56-63.
Published
2019-12-19
How to Cite
Shevchenko, B., Zeleniuk, O., Klenina, I., & Babii, O. (2019). Structural and functional state of the liver in patients with extrahepatic cholestasis of non-tumor genesis. Reports of Morphology, 25(4), 36-43. https://doi.org/https://doi.org/10.31393/morphology-journal-2019-25(4)-06