Diagnosis and treatment of intrahepatic cholestasis in chronic diseases of the liver

Abstract

Aim. To improve diagnosis of intrahepatic cholestasis (IHC) basing on clinicobiochemical picture in chronic hepatic diseases (CHD) of different etiology with cholestasis and to develop a differential approach to treatment. Material and methods. We examined 875 CHD patients with IHC with evaluation of the levels of the enzymes, biliary acids (BA), lipids, characteristics of hemostasis and phosphocalcium metabolism in blood. We also studied correlations and changes of the above parameters in IHC of different etiology. A comparative analysis of efficacy of mono- and combined treatment of CHD patients with IHC was made. Results. We revealed correlations between the levels of the enzymes, bilirubin, lipids and BA concentration in blood serum; unfavourable prognostic value of aggravating cholemia; no correlations between content of serum BA, duration of IHC and intensity of skin itching (SI). We propose to establish "the degree of IHC severity" with 4 degrees of this severity. Characteristics of impairment of hemostasis and phosphocalcium metabolism in IHC of different etiology depending on the degree of IHC severity are presented. Efficacy and universality of combined treatment with ursodeoxicholic acid and ademetionin in moderate and severe IHC of different etiology are shown. Conclusion. Introduction of the definition "the degree of IHC severity" allowed us to classify IHC by severity. This enables adequate assessment of the patient's condition, prognosis the risk of complications and their severity, a differential approach to treatment and, finally, improvement of the disease outcome prognosis.

Keywords

• intrahepatic cholestasis
• phosphocalcium homeostasis
• ursodeoxicholic acid
• ademetionin