The conjugation of endogenous intoxication and hemostatic disorders with the functional status of the liver in obstructive jaundice

Abstract

Background. The treatment of patients with obstructive jaundice is still one of the topical issues, due to the continuing unsatisfactory results. This is largely facilitated by the dysfunction of the liver, the restoration of which, even with the correction of the passage of bile, occurs slowly, which causes the preservation of homeostasis disorders. Detailed knowledge of this issue will form the basis for the development of optimal therapy regimens. The purpose of this research is to study the severity of endogenous intoxication and the state of the hemostatic system in association with the functional status of the liver in patients with non-tumor jaundice before operation and in the early postoperative period. Materials and methods. We examined 36 patients with obstructive jaundice of benign origin who underwent various surgical interventions aimed at restoring the passage of bile into the duodenum. We devided pations into 2 groups: the 1st group (n = 18) – patients with mild obstructive jaundice, the 2nd (n = 18) – severe. The diagnostic complex includes: assessment of the syndrome of endogenous intoxication by the content of toxic products of hydrophilic and hydrophobic nature in the blood; a number of indicators of the functional state of the liver; assessment of the state of the hemostasis system according to thromboelastography data. Results. It was found that in the preoperative time and in the early postoperative period in patients with obstructive jaundice there are pronounced phenomena of endogenous intoxication, disorders in the hemostatic system, which are associated with a disturbance of the functional state of the liver. The expression of these changes is associated with the severity of the pathology. In the mild form of obstructive jaundice, hemostatic changes are recorded in the form of an increase in the clotting ability of blood while maintaining the activity of the fibrinolytic system. In the severe obstructive jaundice, the functional potential of the liver decreases, one of the manifestations of which is the modulation of the hemostasis system in the form of hypocoagulemia and hyperfibrinolysis. Conclusions. The obtained clinical and laboratory information in disorders of homeostasis and functional state of the liver has not only academic, but also applied significance, determining the vector of pathogenetic therapy of patients with mechanical jaundice in the early postoperative period.

Keywords

• mechanical jaundice
• endogenous intoxication
• liver failure
• hemostasis