Clinical and laboratory studies in mechanical jaundice non-tumor etiology

The analysis of clinical data of 457 patients who were treated for obstructive jaundice of non-neoplastic etiology was carried out. Depending on the duration of jaundice, all patients are divided into two groups: 1 — with cholestasis duration up to 10 days; 2 — with jaundice up to 3-6 weeks. All patients underwent a general blood test with the determination of the number of platelets according to Fonio, the indices of homeostasis, hemostasis, endogenous intoxication; parameters of the rheological properties of blood were studied. The functional state of the liver was assessed by the results of biochemical blood tests. It was revealed that with obstructive jaundice against the background of lipid metabolism disorders and endogenous intoxication, an increase in the viscosity, aggregation ability of erythrocytes, a decrease in their deformability, coagulation potential and an increase in the fibrinolytic activity of blood are observed. An increase in the fibrinolytic activity of the blood indicates the risk of bleeding in the postoperative period, and a decrease in thrombotic complications. All these changes are more pronounced in patients of the second group with prolonged obstructive jaundice, when, along with cholestatic, cytolytic processes develop and progress. Therefore, in terms of prevention and timely treatment of disorders, it is of great importance to identify, with the help of laboratory studies, the hidden mechanisms of the development of complications. Preoperative complex, conservative therapy should be aimed at correcting violations of the aggregate state of the blood and liver functions.

1. Andreev G.N., Tashev I.A., Apel'baum L.S. Diagnostika i lechenie khronicheskikh diffuznykh zabolevaniy pecheni [Diagnostics and treatment of chronic diffuse liver diseases]. Velikiy Novgorod, Vikont Publ., 2003, 162 p.

2. Andreev G.N., Ablaev N.R., Arkhipov T.S., Ibadil'din A.S. Gepatologiya i klinicheskaya biokhimiya [Hepatology and clinical biochemistry]. Veliky Novgorod, 2009, p.533.

3. Vetshev P.S. Mekhanicheskaya zheltukha: prichiny i diagnosticheskie podkhody: lektsiya [Mechanical jaundice: causes and diagnostic approaches: lecture]. Annals of Surgical Hepatology, 2011, vol.16, no. 3, pp.50-57.

4. Malkov I.S., Shaymardanov R.Sh., Korobkov V.N., Filippov V.A. Metody intensivnoy terapii v lechenii pechenochnoy nedostatochnosti pri mekhanicheskoy zheltukhe [Methods of intensive therapy in the treatment of liver failure in obstructive jaundice]. Proc. of Conference “Obstructive jaundice is a vital issue in abdominal surgery”. Kazan, 2014, pp.23-28.

5. Ioffe I.V., Poteryakhin V.P. Dinamika izmeneniy biokhimicheskikh pokazateley krovi u bol'nykh pri obturatsionnoy zheltukhe, obuslovlennoy kholedokholitiazom, pod vliyaniem plazmafereza [Dynamics of changes in biochemical parameters of blood in patients with obstructive jaundice due to choledocholithiasis, under the influence of plasmapheresis]. Clinical Surgery, 2010, vol.4, pp.19-20.

6. Davydov V.G., Boychuk S.V., Shaymardanov R.Sh. et al. Molekulyarnye mekhanizmy apoptoza i nekroza gepatotsitov. Osobennosti gibeli gepatotsitov pri obstruktivnom kholestaze [Molecular mechanisms of apoptosis and necrosis of hepatocytes. Features of hepatocyte death in obstructive cholestasis]. Russian Journal of Gastroenterology, Hepatology, Coloproctology, 2006, vol.XVI, no.5, pp.11-19.

7. Lewis S.M., Bain, B.J., Bates I. et al. Dacie and Lewis practical haematology. London, 2001, Churchill Livingstone (Rus. ed.: Prakticheskaya i laboratornaya gematologiya. Moscow, GEOTAR-Media Publ., 2009, 672 p.).

8. Meditsinskie laboratornye tekhnologii [Medical laboratory technologies] / ed. by A.Karpishchenko. Saint Petersburg, Intermedika Publ., 2002, vol.2, 408 p.

9. Hugenholtz G.C.G., Macrae F., Adelmeijer J. Procoagulant changes in fibrin clot struc-ture in patients with cirrhosis are associated with oxidative modifications of fibrinogen. J. Thromb. Haemost., 2016, vol.14(5), pp.1054-1066. DOI: 10.1111/jth.13278

10. Togaybaev A.Ya., KurguzkinA.A. et al. Sposob diagnostiki endogennoy intoksikatsii [A method for diagnosing endogenous intoxication]. Lab. Delo, 1988, no. 9, pp. 22-25.