Vіsnik Naukovih Doslіdžen' (Aug 2017)
POLYORGANIC INSUFFICIENCY DEVELOPMENT IN PATIENTS WITH LIVER CIRRHOSIS WITH PORTLA HYPERTENSION
Abstract
Treatment of patients with liver cirrhosis (LC) is one of the complex problems of surgery. The results of surgical treatment of LC are disappointing, which indicate the need to investigate the pathogenetic mechanisms of this pathology The aim of the study – the comparative determination of blood plasma and ascetic liquid (AL) chemical properties in patients with LC during its different stages of manifestation for the patients’ individual tactic of treatment choice. Materials and Methods. Blood plasma and AL general bilirubin level, other biochemical markers of endotoxicosis, lipid metabolism components were determined in 262 patients with LC complicated by ascites, randomized on 4 groups depending on severity of a disease. Sodium, potassium, calcium, magnesium, phosphorus and chloride ions concentration were determined additionally in blood plasma, AL and urine. Results and Discussion. The analysis of the received results revealed relative safety of liver and kidneys compensatory and regulatory mechanisms in patients with the first stage of LC manifestation. Liver function moderate activation with blood plasma and AL moderate intoxication development were observed in patients on the stage of subcompensation. Kidneys’ functions during this stage of pathology were reduced. The expressed liver dysfunction with both cholestatic and cytolytic syndromes development that reflected regulatory mechanisms failure was registered in a stage of decomensation. The revealed dysfunction of kidneys were characterized by potassium-uresis and sodium-uresis decrease. Lipid metabolism disturbances promoted hepatocytes’ cellular membranes further damage a clinical state aggravation. Patients in terminal stage showed blood system, respiratory organs and kidneys progressive disturbances, pulmonary, heart failure and electrolytic imbalance development. Conclusions. Authors conclude that organs and systems pathological disregulation develops in patients with the LC complicated by ascites with liver primary damage accompanied with protein and lipid metabolism disturbances, kidney dysfunction, endotoxicosis development, toxic metabolites transudation into AL. These disturbances should be considered at a choice of individual tactics of such patients treatment.
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