Features of mechanical jaundice course caused by complications of bile disease

The OBJECTIVE was improving the results of diagnostics and assessment of the severity of patients with mechanical jaundice (MJ) at various stages of its development.

METHODS AND MATERIALS. The basis of clinical and laboratory research was the data of 537 patients who were admitted during the period from 2010 to 2019. Principles of separation at the stage of the course of mechanical jaundice of non-tumor Genesis.

RESULTS. Analysis of clinical and laboratory studies showed characteristic signs of various complications of cholelithiasis, accompanied by mechanical jaundice. Then, on this basis, specific symptoms characteristic of each stage of mechanical jaundice of non-tumor Genesis were determined.

CONCLUSION. The course of mechanical jaundice, which develops with complications of cholelithiasis, has a phase-stage character, beginning with extrahepatic cholestasis, then-joining hepatocytolysis and ending with cholangitis. Initially, cholestasis and cytolysis are functional, which is confirmed by biochemical tests, so these processes are labile and reversible. This makes it possible to effectively use biliary decompression methods and infusion therapy with detoxification during treatment. Cholangitis is characterized by destructive morphological manifestations, so it is verified by specific clinical symptoms and laboratory tests characteristic of inflammatory-septic reactions and progresses to sepsis. Differentiation of stages of mechanical jaundice allows to personify surgical and conservative treatment of such patients.

1. Demko A. E., Shljapnikov S. A., Osipov A. V. Lechenie bol’nyh s ostrym holangitom v stacionare skoroj pomoshhi s primeneniem principov, rekomendovannyh tokijskimi protokolami. Al’manah Instituta khirurgii im. A. V. Vishnevskogo. 2017;1:792.

2. Kojchuev R. A., Medzhidov R. T. Uluchshenie rezul’tatov khirurgicheskogo lechenija zhelchnokamennoj bolezni oslozhnennoj gnojnym holangitom. Al’manah Instituta khirurgii imeni A. V. Vishnevskogo. XVIII S’ezd Obshhestva jendoskopicheskih khirurgov Rossii. Moscow, 17–19 fevralja 2015. Tezis 503. (In Russ.).

3. Shevchenko Ju. L., Vetshev P. S., Stojko Ju. M., Levchuk A. L., Bardakov V. G., Stepanjuk I. V. Optimizacija diagnosticheskogo algoritma i povyshenie jeffektivnosti maloinvazivnyh khirurgicheskih vmeshatel’stv pri mehanicheskoj zheltuhe. Annaly khirurgicheskoj gepatologii. 2008;4:96–101. (In Russ.).

4. Gal’perin Je. I. Rukovodstvo po khirurgii zhelchnyh putej. Pod redakciej Je. I. Gal’perina, P. S. Vetsheva. 2-e izdanie. Moscow, Vidar-M, 2009: 568. (In Russ.).

5. Archer S. B., Brown D. W., Smith C. D., Branum G. D., Hunter J. G. Bile Duct Injury During Laparoscopic Cholecystectomy. Results of a National Survey. Ann. Surg. 2001;234(4):549–558.

6. Mehanicheskaja zheltuha. Klinicheskie rekomendacii. Rossijskoe obshhestvo khirurgov, Associacija gepatopankreatobiliarnyh khirurgov stran SNG, 2018:115. Available at: http://zodorov.ru/associaciya-gepatopankreato-biliarnih-hirurgov-stran-sng-rossij/ (accessed:06.12.2019).

7. Fedorov V. Je., Zaharova N. B., Logvina O. A., Masljakov V. V. Ocenka stepeni tjazhesti pri ostrom holecistite i mehanicheskoj zheltuhe v svete nacional’nyh rekomendacij (obzor literatury). Jeksperimental’naja i klinicheskaja gastrojenterologija. 2019;163(3):97–104. (In Russ.).

8. Kukosh M. V., Fedorov V. Je., Logvina O. A. Jepidemiologicheskie osobennosti techenija neopuholevoj mehanicheskoj zheltuhi (sravnitel’nyj kliniko-staticheskij obzor). Medicinskij al’manah. 2019;60(3–4):102–109. (In Russ.).

9. Popov D. N., Tancev A. O., Nikitina T. O., Korol’kov A. Ju. Gibridnye khirurgicheskie vmeshatel’stva v lechenii holangita i biliarnogo sepsisa na fone hlecistoholedoholitiaza. Vestnik khirurgii im. I. I. Grekova. 2019;178(3):51–53. (In Russ.).

10. Kurbonov K. M., Nazirboev K. R. Metody mininvazivnoj dekompressii zhelchnyh putej pri mehanicheskoj zheltuhe. Vestnik khirurgii im. I. I. Grekova. 2018;177(1):74–77. (In Russ.).

11. Kukosh M. V., Fedorov V. Je., Logvina O. A. Jepidemiologicheskie osobennosti techenija neopuholevoj mehanicheskoj zheltuhi (sravnitel’nyj kliniko-statisticheskij obzor). Medicinskij al’manah. 2019;60(3–4):102–109. (In Russ.).

12. Gal’perin Je. I. Mehanicheskaja zheltuha: sostojanie «mnimoj stabil’nosti», posledstvija «vtorogo udara», principy lechenija. Annaly khirurgicheskoj gepatologii. 2011;16(3):16–25. (In Russ.).

13. Gal’perin Je. I., Momunova O. N. Klassifikacija tjazhesti mehaniches-koj zheltuhi. Khirurgija: Zhurnal im. N. I. Pirogova. 2014;1:5–9. (In Russ.).

14. Stolin A. V., Nishnevich E. V., Prudkov M. I. Diagnostika sepsisa s pozicij koncepcij «sepsis 3» u bol’nyh obturacionnym gnojnym holangitom. Al’manah Instituta khirurgii im. A. V. Vishnevskogo. 2017;1:1046.

15. Stolin A. V., Prudkov M. I. Biliarnyj sepsis u bol’nyh obturacionnym kal’kuleznym gnojnym holangitom. Al’manah Instituta khirurgii im. A. V. Vishnevskogo. 2017;1:936.

16. Aliev S. A., Aliev Je. S. Abdominal’nyj sepsis: sostojanie problemy, integral’nye sistemy ocenki tjazhesti techenija i kriterii prognozirovanija ishoda. Vestnik khirurgii im. I. I. Grekova. 2018;177(5):108–112. (In Russ.).

17. Sepsis: klassifikacija, kliniko-diagnosticheskaja koncepcija i lechenie. Pod redakciej akademika RAN B. R. Gel’fanda. 4-e izdanie, dopolnennoe i pererabotannoe. Moscow, Medicinskoe informacionnoe agentstvo, 2017:408. (In Russ.).

18. Singer M., Deutschman C. S., Seymour C. W., Shankar-Hari M., An nane D., Bauer M., Bellomo R., Bernard G. R., Chiche J. D., Coopersmith C. M., Hotchkiss R. S., Levy M. M., Marshall J. C., Martin G. S., Opal S. M., Rubenfeld G. D., van der Poll T., Vincent J. L., Angus D. C. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762–774.

19. Shankar-Hari M., Phillips G. S., Levy M. L., Seymour C. W., Liu V. X., Deutschman C. S., Angus D. C., Rubenfeld G. D., Singer M. Developing a new definition and assessing new clinical criteria for septic shock for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775–787.

20. Singer M., Deutschman C. S., Seymour C. W., Shankar-Hari M., Annane D., Bauer M., Bellomo R., Bernard G. R., Chiche J. D., Coopersmith C. M., Hotchkiss R. S., Levy M. M., Marshall J. C., Martin G. S., Opal S. M., Rubenfeld G. D., van der Poll T., Vincent J. L., Angus D. C. The Third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.

21. Spronk P. E., Zandstra D., Ince C. Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit. Care Med. 2004;8:462–468.

22. SSC-Guidelines sepsis 2012. Crit. Care Med. J. 2013;41(2):580–637.

23. Bischoff-Ferrari H. A., Dawson-Hughes B., Staehelin H. B., Orav J. E., Stuck A. E., Theiler R., Wong J. B., Egli A., Kiel D. P., Henschkowski J. Multiorgan failure is an adaptive, endocrinemediated, metabolic response to overwhelming systemic inflammation. Lancet. 2004;364(9433):545–548.

24. Sommers M. S. The cellular basis of septic shock. Crit. Care Nurs. Clin. North. Amer. 2003;15:13–25.

25. Sonneville R., Verdonk F., Rauturier C., Klein I. F., Wolff M., Annane D., Chretien F., Sharshar T. Understain brain disfunction in sepsis. Ann. Intens. Care. 2013;3:15–26.

26. Rudnov V. A., Kulabuxov V. V. Version-3: Updated Key Provisions, Po tential Issues and Next Practical Steps. Journal of anesthesiology and resuscitation. 2016;13(4):4–10. (In Russ.).