Analytical review of pathogenetic, structural and functional changes in the liver caused by cholestasis (clinical, functional and morphological study)

The structural and functional changes in the liver among 120 patients with non-neoplastic cholestasis treated in the regional and central city clinics of Veliky Novgorod from 2017 to 2019 have been studied. According to the duration of cholestasis, two groups of patients were identified: the first one was 75 people with 10–14 days of cholestasis and the second one was 45 people with 3–6 weeks of cholestasis; the groups are comparable in gender and age. Primary and repeat liver biopsies have been studied before and after decompression. The digital data have been processed by the methods of variation statistics according to the Fisher-Student's. In patients of the first group, centrilobular bilirubinostasis and accumulation of bile acids in hepatocytes, stellate reticuloendotheliocytes, bile vessels and ducts were observed. Hepatocytes underwent degeneration and necrotic changes (functional cell mass was 12.356 ± 0.928). In patients of the second group with prolonged cholestasis, cholestatic processes, hepatocyte necrosis increased (functional cell mass was 6.517 ± 1.012), and false bile ducts were formed. Periportal fibrosis, incomplete septal cirrhosis, and later secondary biliary cirrhosis developed. With repeated biopsies in the first group, after decompression, there was a decrease in bilirubinostasis, the general structure of the hepatic lobule was moderately restored. In the second group of long-term cholestasis, sclerotic changes, fibrotic processes, histiolymphocytic infiltration, and proliferating biliary epithelium remained in the portal tracts. Thus, monitoring the state of liver tissue during primary and repeated biopsies provides an objective control of changes in liver histology before and after decompression and allows determining the effectiveness of the treatment, which is of paramount importance for the prognosis of the disease and the choice of tactics for conservative and prompt treatment.

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