Acute liver damage in Hyperemesis gravidarum — case report

Hyperemesis gravidarum (HG) involves severe, persistent, intractable nausea and vomiting, which subsequently leads to weight loss>5% of weight until pregnancy, in the absence of other causes, accompanied by dehydration, nutritional deficiency with ketosis, abnormalities electrolyte and/or acid-base balance disorders. in the paper we present the case of a 26-year-old woman, G2N1, in week 10 of gestation, who developed in the context of HG severe abnormalities, namely acute liver damage, with hepatopriv syndrome (Prothrombin after Quick 53%, INR -1, 42, total protein 46.91 /l, cholestatic syndrome (total bilirubin 39 mcmol/l) and cytolytic syndrome (ALT — 140.25 IU / L and AST -125.42 IU / L); alkalemia (arterial pH 7.51) , hyponatremia (serum sodium 132 mmol/l), hypokalemia (serum potassium 2.72 mmol/l). The diagnosis of HG, complicated by acute liver failure, has been confirmed. All laboratory symptoms and abnormalities were resolved by targeted administration of intravenous fluids, antiemetic treatment, and prophylactic antithrombotic treatment.

Complications of pancreatitis: features of the course and tactics of treatment

The aim of this article is to draw attention of gastroenterologists, surgeons and primary care physicians to the features of the course of pancreatitis complications, which tend to have an acute course and are a complex process that causes medical errors and life tragedies. The importance of complications of pancreatitis such as cysts, pseudocysts, fistulas, cholestatic syndrome, portal hypertension syndrome, bleeding from varicose veins of the esophagus, stomach and erosive-ulcerative secondary gastroduodenal processes is emphasized. Attention is focused on the mechanisms of development of these complications, features of the clinical course, management tactics of such patients, depending on the location of the complications, which is important for the treatment strategy (conservative or surgical). The peculiarities of the clinical picture of the syndrome of compression of neighboring organs, thrombosis of the hepatic and splenic veins, biliodigestive bleeding, including hemobilia, bleeding from the large and small duodenal papilla, are directly related to the analytical approach regarding the diagnosis of these complications. Angiographic techniques are considered to be the most effective diagnostic techniques, which include celiacography, upper mesentericography, percutaneous and transhepatic portography. It is indicated that on their basis, techniques for stopping bleeding have been developed, namely endovascular catheter hemostasis.

Acute Drug-Induced Cholestatic Syndrome in Basedow Graves’ Disease

Introduction: Graves’ disease (GD), an autoimmune disorder caused by high levels of auto-antibodies against the thyroid-stimulating hormone receptor, is considered the most common cause of thyrotoxicosis, characterized by features such as goiter, ophthalmopathy and dermopathy. In our country, the administration of antithyroid drugs (ATD) is the first line of treatment in this disease. Side effects are rare but some of them, such as agranulocytosis or liver damage, may become serious.Case presentation: We report the case of a 20-year-old female patient who was diagnosed with GD after being previously diagnosed with viral hepatitis A. Treatment was initiated with methimazole 30 mg/day, and three weeks later she developed intense hepatic cytolysis and cholestatic syndrome, therefore the ATD was stopped. A suspicion of autoimmune liver disease was raised, and a liver biopsy was performed in order to establish the diagnosis. The next therapeutic option for hyperthyroidism was radioactive iodine (RAI). Three months following RAI, the patient presented severe hypothyroidism, thereupon treatment with levothyroxine was initiated.Conclusions: Although severe acute liver injury is rare, mild liver dysfunction is quite common in patients with GD. The overproduction of thyroid hormones, or the treatment with ATD through immune mediated processes or drug reactions, represent possible mechanisms responsible for liver damage.

Results of surgical treatment of patients, suffering hepatic cirrhosis and cholestatic syndrome

Objective. Determination of the surgical treatment efficacy in patients, suffering hepatic cirrhosis (HC), in presence of cholestatic syndrome (CHS). Маterials and methods. Results of surgical treatment of 1117 patients, suffering HC with suspicion on biliary calculous disease and obturation jaundice, in 52 of whom choledocholithiasis was diagnosed, were analyzed retrospectively. Results. Of 52 patients, suffering HC and CHS due to choledocholithiasis, in 43 a one-stage surgical tactics was used, and in 9 – a two-staged one. Of 43 patients, complicated by choledocholithiasis, in whom a one-stage surgical tactics of treatment was applied, 27 were operated using open access and16 - laparoscopically. Choledocholithiasis was eliminated in 12 of 16 patients laparoscopically, and in 4 patients a conversion was performed. Conclusion. Оne-stage tactics of surgical treatment in patients, suffering HC and CHS, is considered effective due to possibility to perform a majority of operative interventions laparoscopically with minimal rate of complications and lethality.

Liver dysfunction in pathogenesis of burn disease and its correction with succinate-containing drugs

Current information on the effects of extensive and deep burns upon the liver functions as well as some novel methods of its correction with succinic acid derivates are reviewed. The liver is the main target organ for extensive burn injuries. Manifestations of cytolytic and cholestatic syndrome were observed already on the first days of the disease. To correct these conditions a comprehensive layout of the infusion of intensive therapy is needed. In burn disease it is impossible to restore the circulating blood volume only by infusion of plasma-substituting solutions. Thus, these cocktails must contain drugs, stabilizing metabolic disorders and reducing the concentration of proinflammatory cytokines. Complex intensive therapy in case of burns should also include correction of energy production within the cells without increasing oxygen transport. Substrate antihypoxic drugs are used in order to reduce the need of tissues for oxygen, stabilization of cell membranes and reduction of lipid peroxidation. Succinic acid is a substrate antihypoxic drug capable of detoxification, antihypoxic, antioxidant and hepatoprotective effects. Its derivates modify cellular respiration, compensate for metabolic acidosis, reducing lactate, pyruvate and citrate concentration, normalize histamine and serotonin concentration, improve microcirculation without affecting systemic hemodynamics. All of these effects are pathogenetically substantiated in the treatment of patients with burns. Data regarding the use of drugs on the basis of succinic acid in the treatment of patients with extensive deep burns, critical and supercritical burns during various periods of burn disease, their influence on the severity of multiple organ dysfunction in these patients, the presence of hepatoprotective effect are reported in a few of publications and their conclusions are so far ambiguous enough.