Hepatobiliary Pathology Research Articles

Correlation of Inflammatory Bowel Diseases with Liver Involvement Severity in Autoimmune Hepatobiliary Pathology: Cross-Sectional Study

Background. Inflammatory bowel diseases (IBD) often occur with hepatobiliary system involvement, including autoimmune ones. The role of IBD in development and severity of liver fibrosis in children remains unknown.Objective. The aim of the study is to study the correlation of IBD with the presence and severity of liver fibrotic changes and its malfunction at hepatobiliary system autoimmune disorders in children.Methods. The study included patients hospitalized with isolated (control group) autoimmune hepatobiliary disorders (HBD) (autoimmune hepatitis, primary sclerosing cholangitis, overlap syndrome, autoimmune cholangitis, primary biliary cholangitis) or in combination with IBD. The presence and severity of liver fibrosis was evaluated via invasive (estimation of inflammation activity and liver fibrosis via the METAVIR scale, areas of collagen IV deposition in liver biopsy slides) and non-invasive methods (transient liver elastography, collagen IV levels, liver enzymes activity).Results. Patients with autoimmune hepatobiliary disorders associated with IBD (n = 41) were comparable to those in control group (n = 44) by gender and age. Patients with IBD were more likely to be diagnosed with autoimmune hepatitis and primary sclerosing cholangitis. Furthermore, patients with IBD had higher frequency of moderate fibrosis, higher gamma glutamine transferase activity, and lower albumin concentration in comparison with patients of control group. We haven't revealed any other differences between both groups on other indicators.Conclusion. IBD are associated with relatively high incidence and severity of liver fibrotic changes in autoimmune HBD compared to isolated autoimmune HBD cases. However, these differences may be due to the differences in autoimmune HBD structure and, subsequently, its treatment.

Association of autoimmune hepatobiliary pathology with inflammatory bowel diseases in children

Introduction. Hepatobiliary pathology (HBP) occurs in approximately 30% of patients with inflammatory bowel disease (IBD). However, the features of its course in the pediatric cohort of patients remain insufficiently studied. Purpose: to study the features of the course of autoimmune forms of HBD in children with IBD. Materials and methods. A comprehensive clinical, laboratory and instrumental examination was carried out in 84 children with autoimmune forms of HBP in combination with IBD (HBP+IBD), which made up the main group, and 79 patients with isolated forms of IBD included in the comparison group. Results. The prevalence of autoimmune HBP in IBD children was 10.2%. Primary sclerosing cholangitis (PSC) was diagnosed in 64.3% of cases, which was mainly associated with ulcerative colitis. The incidence of autoimmune hepatitis (AIH) was 8.3%. In the structure of the overlap syndrome, the most frequent combination was AIH+PSC (15.5%). The debut of the disease was manifested by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, haemicolitis. With HBP+IBD, there was an increase in serum concentrations of alanine (ALT) and aspartate aminotransferases (AST), total protein, γ-glutamyl transferase (GGT), alkaline phosphatase, direct bilirubin and IgG. Approximately with the same frequency in PSC, antibodies to saccharomycetes (ASCA) - 80% and antibodies to the cytoplasm of neutrophils (ANCA) - 75% were detected. In AIH, antinuclear antibodies (ANA) and antibodies to liver and kidney microsomes (anti-LKM1) were detected in 100%. HBP-IBD equally (28.6%) revealed moderate fibrosis and cirrhosis, no fibrosis in 20.6%, moderate fibrosis in 15.9% of cases, mild fibrosis in 6,3%. Cirrhosis of the liver in 55.6% of cases was the outcome of the course of PSC, in 16.7% - AIH, in 27.8% was associated with the course of the overlap syndrome. Conclusion. Various forms of autoimmune HBP occur in 10.2% of cases, are more often associated with UC, are represented by PSC and AIH, occur in males, at the onset signs are clinically presented by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, and haemicolitis.

The Lasting Effects of COVID‐19 on The Progression of Non‐Alcoholic Fatty Liver Disease

It is estimated that around 30% of the Western population has non‐alcoholic liver disease (NAFLD); a spectrum of pathology (not attributed to alcohol/substance intake) initiated by steatosis and progression towards inflammation and irreversible fibrosis (non‐alcoholic steatohepatitis, or NASH). With inflammation being a key component of the transition to NASH, it raises the question of whether the ongoing COVID‐19 pandemic, which has notoriously induced hyperinflammatory states, may influence the progression of NAFLD. Specifically, it remains unclear if potential chronic sequelae of COVID‐19 in recovered patients may increase predisposition for NASH. Since NASH maintains a high risk for hepatocellular carcinoma, liver failure, and need for liver transplant, potential additive effects of COVID‐19 could prove critical to study. Thus, the objective of this study was to conduct a literature review to examine if COVID‐19 could have chronic sequelae that affect the progression of NAFLD pathogenesis. It was hypothesized that severe cases of COVID‐19 could induce systemic inflammation, metabolic changes, and lasting gut microbiome alterations that lead to inflammatory and fibrotic changes of the liver, similar to those seen in NASH.A scoping review of literature was conducted utilizing the PubMed database. Studies that examined hepatobiliary pathology, gut microbiome, systemic inflammation, metabolic changes, drug‐induced liver injury, and hypoxia seen in COVID‐19 were included. Human studies of adult cohorts, animal models, and in vitro experiments were included. Genetic components of NAFLD were not examined. Exclusion criteria also encompassed any studies not referencing the hepatobiliary, GIT, portal system, or systemic circulation.Findings indicated a frequent trend of elevated liver enzymes, mild steatosis, Kupffer cell hyperplasia, and hepatobiliary congestion. It was found that direct cytopathic effects on hepatocytes was unlikely, but direct viral insult of cholangiocytes was a potential complication. High serum levels of IL‐1, TNF‐a, and MCP‐1, in COVID‐19 were found as potential risk factors for NASH development. Hypoxia, altered lipid metabolism, and iatrogenic drug‐induced liver injury were also proposed as potential precipitators of NASH development. Notably, lasting changes in gut microbiome were also frequently observed, and correlate closely with those seen in NASH.It was concluded that future research should target the gut microbiome, hyperinflammation, and hepatobiliary congestion as integral components of potentially accelerated NASH development NAFLD‐comorbid patients following COVID‐19 recovery.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

PERFORMED FACTORS IN THE REHABILITATION OF CARDIAC PATIENTS ON AN OUTPATIENT BASIS

In older people, adequate pharmacological tactics when using modern antihypertensive drugs and their combinations, which provide maximum cardiovascular protection, can increase the duration and improve the quality of life, significantly reduce the likelihood of complications. An increase in the tone of the sympathetic nervous system leads to biliary dyskinesia by hypokinetic type, an increase in blood pressure.
 The aim is to optimize the treatment of patients with high blood pressure, rhythm disturbances, to analyze the possibility of using Poltava's Bischofite mineral compound, dietary magnesium-mineral supplements Bisheffect, in the complex treatment of hypertension for internal use.
 Matherials and methods. 68 patients with arterial hypertension with concomitant hepatobiliary pathology, which was confirmed by clinical and instrumental research methods, were under observation. The patients’ mean age was 47.9 ± 2.9 years. The analysis of heart rate variability was carried out during a test with physical activity on a bicycle ergometer with “Cardiolab+” equipment (“XAI-Medica, Kharkiv, Ukraine). In addition, daily monitoring of blood pressure was carried out using the ABPM-04 - Meditech apparatus.
 Result. By the end of the first week of treatment, most patients (82.34%) noted a significant improvement in well-being. During bicycle ergometry, autonomic nervous system stabilisation, blood pressure normalisation, a decrease in the number of extrasystoles, the sleep and the stool normalisation were recorded. The reason for the failure of standard antiarrhythmic therapy in this group of patients was determined based on the studies. Such a problem was observed due to dysfunction of the autonomic nervous system, which is an integral companion of the pathology of the gastrointestinal tract. This concept involves expanding the diagnostic search and stimulates the search for new ways of rhythm disturbances treatment in the pathology of the gastrointestinal tract. Also, the indices of blood pressure variability have decreased. Average 24h blood pressure in patients on the 10th day of treatment decreased by an average of 25-35 mm Hg, and there was a decrease in cranialgia attacks and autonomic disorders. An increase in the blood ejection fraction by 34%, a heart's stroke volume by 19%, and a normalisation of the minute volume (p˂0.05) were revealed, which confirms the positive effect of bischofite-therapy in the complex treatment of cardiac pathology.
 Conclusions. Treatment with standard LEIT-therapy, use of dietary magnesium-mineral Bisheffect supplements resulted in the autonomic nervous system stabilisation, blood pressure normalisation, a decrease in the number of extrasystoles, the sleep and the stool normalisation, increased exercise tolerance.

Primary schlerosing cholangitis in children with inflammatory bowel disease

The article provides an overview of current data on clinical features, modern diagnostic methods and therapeutic strategies for primary sclerosing cholangitis in children with inflammatory bowel disease. Primary sclerosing cholangitis can be asymptomatic for a long time, acquiring a progressive character with liver cirrhosis. The disease is one of the most important risk factors for the development of cholangiocarcinoma. The article presents a diagnostic algorithm for increased transaminases in the serum of the children with inflammatory bowel disease, with an emphasis on various variants of hepatobiliary pathology including primary sclerosing cholangitis. The widespread application of the pediatric scale SCOPE (Sclerosing Cholangitis Outcomes in Pediatrics index) will allow us to timely diagnose and prescribe treatment for a patient with primary sclerosing cholangitis at an early stage improving the prognosis of the disease.

Indications and Complications of Hepatic Resection Patients at Sher-I-Kashmir Institute of Medical Sciences: An Observational Study.

Aim: This study aimed to determine the indications and demographic profile of hepatic resection at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), the performed types of hepatic resection, as well as assess the details of the operation and perioperative complications of hepatic resection.Methods: This is a prospective, retrospective observational study. The retrospective study period was from January 2005 to August 2015 and the prospective study period was from 2015 till 2017. Prospective patients were clinically evaluated by medical history and clinical examination and also underwent various investigations. The patients were scored on Child-Pugh and American Society of Anesthesiology (ASA) scores for risk stratification and prepared for surgery, which included segmentectomy to major liver resection. The retrospective data were obtained from the Medical Records Department (MRD). Statistical analysis was done on SPSS software 25.0 version (Armonk, NY: IBM Corp.).Results: This study included 122 patients with a male to female ratio of 1:1.59. The patients' age was between 1 and 73 years. The patients' most common complaint was right upper quadrant abdominal pain. The main established clinical diagnosis was oriental cholangiohepatitis (OCH) (36.9%) followed by carcinoma of gallbladder (CaGB) which accounted for 37 cases (30.4%). Liver metastases including solitary masses and multiple lesions were 10 cases (8.2%). Fifty-five patients underwent left lateral segmentectomy (45.1%) and mostly for OCH. Standard wedge resection was done in 30.7% of cases and for all cases of CaGB. The mean blood loss was 146.5 ml. A total of 37 patients had complications. Wound infection was the most common complication, occurring in 10 patients (8.2%).Conclusion: Patients with hepatobiliary pathology, necessitating liver resection are now routinely admitted to the Department of Surgical Gastroenterology in SKIMS, Srinagar. Patients are carefully evaluated and operated with a confirmed definitive diagnosis. The overall surgical outcome does not differ from India's best centers.

Hepatobiliary continuum: non-alcoholic fatty liver disease, cholelithiasis ... what else?

The relationship between metabolic non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) is complex and seemingly interrelated. There is no doubt that there is an increased risk of cholelithiasis in patients with NAFLD, which is primarily associated with general pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (hepatic X-receptor, farnesoid X-receptor (FXR) and membrane bile acid receptors (TGR5)). At the same time, the effect of gallstone disease on the course of NAFLD is assumed, although the pathogenetic factors of this association are still insufficient. There are accumulating data on an increased risk of other pathologies of the biliary tract in patients with NAFLD, in particular, of gallbladder polyps and tumors of the biliary tract. Recently there have been convincing data on the role of cholecystectomy in the progression of NAFLD, which may be due to disruption of endocrine balance and signaling function of bile acids, as well as the development of bacterial overgrowth in the small intestine. General therapeutic approaches to the treatment of interrelated hepatobiliary pathology may include new generation insulinsensitizers, FXR agonists, and ursodeoxycholic acid. The link between NAFLD and the pathology of the biliary tract is complex and multifaceted, and its further study opens up prospects for the development of new methods of treatment.

Удосконалення діагностики й лікування гепатобіліарної патології в підлітків з ожирінням

Актуальність. Серед підлітків сьогодні спостерігається зростання захворюваності на ожиріння, з яким часто пов’язана патологія гепатобіліарної системи. Проведення своєчасної діагностики й лікування порушень стану печінки, у тому числі неалкогольної жирової хвороби печінки, і функціональних розладів біліарного тракту запобігає розвитку тяжких ускладнень при ожирінні. Мета: оцінити структурно-функціональний стан гепатобіліарної системи методом динамічної ехографії й оптимізувати лікування розладів гепатобіліарної системи в підлітків з ожирінням. Матеріали та методи. Під спостереженням перебувало 27 підлітків 12–17 років з ожирінням. Проводилося комплексне клінічне й лабораторно-інструментальне обстеження, що включало динамічну ехографію з використанням препарату Хофітол. Вивчалися терапевтичні можливості призначення Хофітолу. Результати. Проведені дослідження показали, що в підлітків з ожирінням переважали скарги на підвищений апетит, біль у животі, нудоту. При біохімічному аналізі крові були виявлені ознаки помірної атерогенної дисліпідемії. У 88,8 % пацієнтів за даними ехографії спостерігалися ознаки стеатогепатозу. Гіпокінезія жовчного міхура зустрічалася в 92,6 % хворих, у переважної більшості мав місце гіпотонічно-гіпокінетичний тип функціональних розладів. Комплексне лікування з використанням препарату Хофітол упродовж 1 місяця привело до позитивних змін: поліпшилося самопочуття, зменшилися диспептичні прояви, больовий синдром; у 52,0 % хворих зменшились розміри печінки, у 32,0 % — відбулася нормалізація ехогенності печінкової паренхіми; у 28,0 % підлітків покращилася скорочувальна функція жовчного міхура. Висновки. У більшості підлітків з ожирінням визначаються ознаки стеатогепатозу й функціональні розлади біліарного тракту за гіпотонічно-гіпокінетичним типом. Динамічна ехографія з використанням препарату Хофітол дозволяє оцінювати функцію як жовчного міхура, так і сфінктерного апарату. За наявності в підлітків з ожирінням ознак стеатогепатозу й функціональних розладів біліарного тракту за гіпокінетичним типом є обґрунтованим призначення в складі комплексної терапії препарату Хофітол.

CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

Показатели цитокинов у детей с гепатобилиарной патологией в сочетании с паразитозами

Актуальность. Гепатобилиарная патология (ГБП) у детей имеет тенденцию к неуклонному росту, а сама патология характеризуется рядом особенностей, отсутствующих у взрослых. Цель: исследовать особенности цитокинового профиля у детей с гепатобилиарной патологией на фоне паразитозов. Материалы и методы. Основную клиническую группу составили 54 ребенка в возрасте от 8 до 18 лет с ГБП. Группу сравнения составили 25 практически здоровых детей, сопоставимых по возрасту и полу с основной клинической группой. Результаты. Поражение гепатобилиарного участка преобладало у детей младшего школьного возраста. У 64,8 % пациентов с ГБП были диагностированы гельминтозы или лямблиоз. Уровень интерлейкина-4 (IL-4) у детей с ГБП превышал уровень у детей группы сравнения почти в 11 раз, фактора некроза опухоли альфа (TNF-α) — в 6 раз. Самая высокая концентрация IL-4 и TNF-α зарегистрированa у пациентов с ГБП на фоне токсокароза и аскаридоза. Выводы. В структуре ГБП у детей преобладали функциональные расстройства билиарного тракта. У детей с ГБП и сопутствующими паразитозами (особенно аскаридозом и токсокарозом) уровни IL-4 и TNF-α достоверно выше показателей у детей без сопутствующего паразитоза.

Показатели цитокинов у детей с гепатобилиарной патологией в сочетании с паразитозами

Актуальность. Гепатобилиарная патология (ГБП) у детей имеет тенденцию к неуклонному росту, а сама патология характеризуется рядом особенностей, отсутствующих у взрослых. Цель: исследовать особенности цитокинового профиля у детей с гепатобилиарной патологией на фоне паразитозов. Материалы и методы. Основную клиническую группу составили 54 ребенка в возрасте от 8 до 18 лет с ГБП. Группу сравнения составили 25 практически здоровых детей, сопоставимых по возрасту и полу с основной клинической группой. Результаты. Поражение гепатобилиарного участка преобладало у детей младшего школьного возраста. У 64,8 % пациентов с ГБП были диагностированы гельминтозы или лямблиоз. Уровень интерлейкина-4 (IL-4) у детей с ГБП превышал уровень у детей группы сравнения почти в 11 раз, фактора некроза опухоли альфа (TNF-α) — в 6 раз. Самая высокая концентрация IL-4 и TNF-α зарегистрированa у пациентов с ГБП на фоне токсокароза и аскаридоза. Выводы. В структуре ГБП у детей преобладали функциональные расстройства билиарного тракта. У детей с ГБП и сопутствующими паразитозами (особенно аскаридозом и токсокарозом) уровни IL-4 и TNF-α достоверно выше показателей у детей без сопутствующего паразитоза.

Problems of formation of the toxic hepatopathy forming in the conditions of chronic fluoride intoxication of the body

Introduction. Aluminium production is characterized by the accumulation of impurities of various toxic and chemical compositions in the air of working areas, the predominant among which are fluoride compounds. The accumulation of fluorides in the body causes the development of osteoarticular and associated systemic pathology. The aim of the study was to evaluate the hygienic and medico-biological features of toxic liver damage in the conditions of chronic fluoride intoxication of the body. Material and methods. The hygienic working conditions of the workers of the primary professions in aluminium production were evaluated. The analysis of hepatobiliary dysfunction based on clinical and instrumental methods was carried out in 263 subjects with fluoride intoxication and a comparison group of 116 persons. Experimental studies of the morpho-functional liver state in modelling chronic fluoride intoxication were carried out based on toxicological, biochemical, pathomorphological methods with histological analysis of tissues. The toxic properties of sodium fluoride were studied in 117 white laboratory male rats with its peroral route intake into the body. Results. The qualitative composition of the air in the working areas in the electrolysis building was analyzed. The prevalence of pathological disorders of the biliary tract in metallurgists engaged in aluminium production was assessed. Clinical studies revealed a significant prevalence of toxic fluoride hepatopathy, fatty hepatosis, cholecystitis and other disorders in the group of patients with chronic fluoride intoxication. The harmful effect of sodium fluoride on hepatocytes, vessels of the portal tract was shown in an experiment. Hyperfunction of the reticuloendothelial system, Kupffer cell proliferation, irreversible destruction of hepatocytes, necrosis against the background of severe dystrophy, and decreased synthetic activity of the liver were determined. Conclusion. The structure of occupational diseases in the workers engaged in the aluminium production is dominated by hepatobiliary pathology caused by toxic liver damage with fluoride confirmed by experimental data on destructive violations of its morphostructure.

Abdominal imaging in COVID-19.

Initially thought of as a respiratory infection, coronavirus disease-2019 (COVID-19) is now recognized as a complex disease with a wide clinical spectrum, including digestive involvement. While several studies have evaluated chest imaging findings in COVID-19, few papers have looked at the abdominal imaging features of these patients. Liver, biliary, pancreas and bowel involvement have been reported in COVID-19 infected patients. In this review, we aim to summarize currently available data related to abdominal imaging techniques in COVID-19, in accordance with relevant clinical and laboratory workup of these patients. Underlying mechanisms, indications and imaging findings related to COVID-19 are discussed based on published data. Also, practice points for clinicians are highlighted in order to adequately recognize digestive-related injuries of severe acute respiratory syndrome coronavirus 2 infection. While there’s been a steady accumulation of data with respect to abdominal imaging findings in COVID-19, currently available recommendations are based on limited research. There is a wide spectrum of abdominal imaging findings in COVID-19, which includes hepato-biliary, pancreatic and luminal pathology.

A RARE PRESENTATION OF CHOLEDOCHAL CYST IN ADULT.

Choledochal cyst (CC) is a relative rare condition in adult population. Only 20% of CC presents in adult population, of these 80% presents with additional hepatobiliary pathology (1,2). With widespread usage of cross sectional imaging, more cysts are likely being identified incidentally in asymptomatic individuals. The development of cancer arising from cysts increases from <0.7% in first decade of life to >11.4% after 2nd decade of life. Anatomic abnormality pancreaticbiliary maljunction (PBM) is a noted etiologic factor for cyst development and even for development of cancer in cysts. We report a rare adult presentation of choledochal cyst with underlying abnormal pancreaticobiliary maljunction with gall bladder carcinoma.

Патология печени и желчного пузыря у пациентов с воспалительными заболеваниями кишечника

Pathology of the liver and gallbladder is one of the extra-intestinal manifestations of inflammatory bowel diseases (IBD). Targeted examination indicates clinical, laboratory, and structural changes in the liver and gallbladder in 30% of patients with IBD. However, information about the state of the hepatobiliary zone in comparison with the IBD phenotype, the features of the course, and the nature of therapy are few, and their results are contradictory. The aim − to study the frequency of occurrence, to analyze the structural and functional features of the liver and gallbladder in relation to the phenotype, clinical and endoscopic activity of the process, the nature of the course, and the effectiveness of IBD therapy. Material and methods. A simple, open, single-stage, non-randomized study involved 157 patients with ulcerative colitis (UC) and 37 patients with Crohn's disease (CD) who were treated in the Gastroenterology Department of the City Clinical Hospital No. 5 in Saratov in the period of 2016−2019. Complex clinical, biochemical, and instrumental studies were performed (ultrasound examination of the abdominal organs, fibrogastroduodenoscopy and colonoscopy, general morphological examination of colonobioptates). Results. Non-alcoholic fatty liver disease (NAFLD) was verified in 10.8% of patients with UC (3.8% had non-alcoholic steаthohepatitis (NASH), 7% − liver steatosis) and in 27% of patients with CD (NASH – 5.4% of cases, liver steatosis – 21.6%). Dysfunctional disorders and structural changes of the gallbladder were detected in 14.3% of patients with UC and 20.8% with CD. Of these, cholelithiasis was found in 9.5% of patients with UC and 10.8% with CD. When analyzing the association of risk factors for hepatobiliary pathology with a variant of IBD, NAFLD was associated with the type of IBD course (recurrent course for CD), localization of the process (in UC – with left-sided colitis, in CD – with terminal ileitis), an operational history on the intestine in CD, the duration of CD for more than five years, overweight in UC, and the effects of basic therapy (steroid resistance). The pathology of the gallbladder is associated with the duration of IBD for more than three years, the continuous course of UC, and surgical interventions on the intestine in CD. When analyzing laboratory and structural markers of steatosis, it was noted that high values of the steatosis index prevailed in UC (according to J.H. Lee). Abdominal ultrasound revealed mild (41% in UC, 40% in CD) and moderate (47.1% in UC, 50% in CD) liver steatosis more often. When analyzing the clinical features of the hepatobiliary system, it was found that liver pathology was detected by instrumental and laboratory criteria, and gallbladder pathology was characterized clinically by symptoms of biliary dyspepsia in the absence of biliary colic attacks. Conclusion. The features of liver and gallbladder pathology identified during the study can be used to optimize the management of patients with IBD

Лечение описторхозной инвазии у пациентки, перенесшей ортотопическую трансплантацию печени (клинический случай)

The article describes a unique experience of repeated opistorchosis deworming in a patient who underwent orthotopic liver transplantation, which was required due to the development of complications of secondary biliary cirrhosis of parasitic etiology. Difficulties of differential diagnostics of hepatobiliary pathology, proceeding against the background of opistorchosis invasion, are discussed. The recent data on the parasitic morbidity in the territory of Khanty-Mansiysk Autonomous Okrug – Ugra is presented.

Morphometric Analysis of Common Bile Duct: A Cadaveric Study

Introduction: Though human beings look similar in their general anatomical appearances but during the investigation of a particular structure in detail, it is surprising how frequently we meet one sort or another type of variation. Literature reports that accurate dimensions of CBD are debatable. Therefore, determination of a spontaneous abnormality or atypical variation is important and reference range plays a significant role to classify the normal or abnormal duct. Materials and Methods: A total of thirty (30) cadavers were dissected at MGM Medical College Mumbai, India from Jan 2012 to March 2013 for anatomical features of the common bile duct-like their size, variations in the course and termination. Results: The length of the common bile duct varies 35.19 mm to 62.43 mm with Mean ± SD 46.92 ± 7.91 mm and diameter varied between 3.65 mm to 10.31 mm with mean value 6.50 ± 1.77. The correlation between length and diameter of common bile duct is statistically insignificant (p = 0.243) Conclusion: We established a reference range for the CBD length and diameter. Thus, the exact knowledge of the anatomy of the common bile duct is significant for successful hepato-biliary surgery and biliary pathology.

Ассоциация гепатобилиарной патологии и гастроэзофагеальной рефлюксной болезни

The problem of comorbidity with a high risk of polypragmasia is relevant in a large group of patients with diseases in the digestive system. Currently, the problem of comorbidity in patients with gastroesophageal reflux disease (GERD) attracts the attention of specialists due to the high disease prevalence and data indicating its association with other digestive system diseases, primarily of the hepatobiliary system. The article presents the results of clinical and experimental studies revealing the pathogenetic connections of GERD and hepatobiliary pathology accompanied by biliary dyskinesia, factors leading to an impairment of the duodenal propulsive activity. It is noted that the most important components of the esophageal mucosa lesion in duodenogastroesophageal reflux are bile acids, lysolecithin and pancreatic enzymes. The relevance of prescribing drugs that can affect the course of pathogenetically related diseases, which can significantly reduce the risk of polypragmasia, is justified. Such drugs include ursodeoxycholic acid, which, in the conditions of the GERD and hepatobiliary pathology association, contributes to the functional state normalization of the liver and biliary tract, reduces biliary dyskinesia, the severity of duodenal hypertension and duodenogastroesophageal reflux. The next example is the rebamipide cytoprotector, which has a multilateral protective effect against the mucous membrane of the GIT, including the esophagus, gastroduodenal zone, small intestine, as well as liver. The expediency of prescribing rebamipide to patients who are refractory to therapy with proton pump inhibitors is justified. KEYWORDS: comorbidity, hepatobiliary pathology, gastroesophageal reflux disease, ursodeoxycholic acid, rebamipid, proton pump inhibitors. FOR CITATION: Kazyulin A.N., Goncharenko A.Yu., Kalyagin I.E. Association of hepatobiliary pathology and gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):404–412 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-404-412.

Boldo-Induced Hepatotoxicity: A Case of Unexplained Jaundice.

Herbal medicines are commonly used by the public.Peumus boldus leaves consumed as an infusion can be hepatotoxic and may cause otherwise unexplained jaundice or abnormal liver enzyme values, particularly in elderly patients.A detailed clinical history is crucial to establish the consumption of alternative medicines in order to identify possible adverse effects and toxicity.