Acta Medica Medianae (Jan 2008)
FOLLOW-UP OF BIOCHEMICAL PARAMETERS IN PATIENTS WITH EXTRAHEPATHIC CHOLESTASIS
Abstract
In cholestasis, due to impossibility of gall flow into duodenum, there occurs subsequent return of gall constituents to hepatocytes and circulation. Extrahepatic cholestasis is the result of mechanic obstacle of gall flow through ductus hepaticus, choledochus or papilla Vateri, leading to the occurrence of manifest icterus. In cases leading to liver damage, hydrophobic gall salts and non-conjugated bilirubins have the most important toxic effects. The aim of this study was to follow up biochemical parameters, enzyme activity gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (AF), bilirubin concentration, total proteins and albumins in blood plasma in patients with different types of extrahepatic cholestasis.The study included 90 subjects divided into four groups. The first one was control, while the three other groups were formed according to the type of extrahepatic obstruction: the control group (20 healthy subjects), I group (20 patients with intraluminar extrahepatic obstruction –ILH), II group (20 patients with intraluminar obstruction-IMH), III group (30 patients with extraluminarly induced extrahepatic obstruction-ELH).Significant increase of activity of GGT and AF in plasma of cholestatic patients was present in comparison to the control group (p< 0,001). In plasma of cholestatic patients in the third group, GGT activity increased in comparison to the first group of patients (p<0,05), while in the first group AF activity decreased in comparison to the second group (p<0,05) and third group (p<0,01) of patients with extrahepatic cholestasis. The levels of total direct and indirect bilirubin in plasma of cholestatic patients increased (p<0,001) when compared to the control group. Concentration of direct and indirect bilirubin in plasma of cholestatic patients of II and III group significantly increased in comparison to the same values in the first group of cholestatic patients. The level of albumin in plasma of cholestatic patients significantly decreased in comparison to the control group. There is a negative correlation of moderate intensity between values of direct bilirubin and albumin in patients with IMH and ELH.Significant increase of cholestasis markers (GGT and AF) and bilirubin levels in blood plasma was noticed in patients with extrahepatic cholestasis. The most intense increase was present in patients with ELH. Cholestasis leads to significant disorders of synthetic function of the liver that are manifested by decrease of albumin concentration in plasma and are the most prominent in the patients with intraluminar and extraluminar cholestasis.
