Diseases of the liver and biliary tract

Primary biliary cirrhosis of the liver

Primary biliary cirrhosis of the liver is an autoimmune liver disease that begins as a chronic, destructive, non-venous cholangitis, which lasts for a long time without significant symptoms, leading to the development of prolonged cholestasis and only at later stages to the formation of liver cirrhosis.

Cirrhosis of the liver

Liver cirrhosis is a chronic polyetiological diffuse progressive liver disease, characterized by a significant decrease in the number of functioning hepatocytes, increasing fibrosis, restructuring of the normal structure of the parenchyma and vascular system of the liver, the appearance of regeneration nodes and the development of subsequent hepatic insufficiency and portal hypertension.

Acute drug-induced hepatitis

Acute drug hepatitis develops only in a small proportion of patients taking drugs, and manifests itself approximately 1 week after the start of treatment. The probability of developing acute drug hepatitis is usually not predictable. It does not depend on the dose, but it increases with repeated use of the medicine.

Hepatotoxicity of paracetamol

In adults, necrosis in the liver develops after taking at least 7.5-10 g of the drug, but it is difficult to estimate the dose of the drug, since vomiting develops rapidly, and the history data are unreliable.

Carbon tetrachloride hepatotoxicity

Carbon tetrachloride can enter the body by accident or as a result of admission with a suicidal purpose. In this case, it can be gaseous (for example, during dry cleaning or when filling a fire extinguisher) or mixed with drinks.

List of hepatotoxic drugs

Drinking alcohol significantly increases the toxicity of paracetamol: significant damage to the liver is possible with only 4-8 g of the drug. Obviously, the reason for this is the induction of alcohol P450-3a (P450-II-E1), which plays an important role in the formation of toxic metabolites. In addition, it is involved in the oxidation of nitrosamines in the position of alpha.

Diagnosis of medicinal lesions of the liver

Medicinal liver damage is most often caused by antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), cardiovascular and neuro- and psychotropic drugs, i.e. In fact, all modern medicines. It should be assumed that damage to the liver can cause any medicine, and if necessary, contact the manufacturers and the organizations responsible for the safety of the drugs used.

Risk factors for liver damage

Disturbance of the metabolism of drugs is dependent on the degree of hepatic-cell insufficiency; it is most pronounced in cirrhosis. T1 / 2 drug correlates with prothrombin time, serum albumin level, hepatic encephalopathy and ascites.

Metabolism of drugs in the liver

The main system that metabolizes drugs is located in the microsomal fraction of hepatocytes (in the smooth endoplasmic reticulum). It includes monooxygenases with a mixed function, cytochrome C-reductase and cytochrome P450. The cofactor is the reduced NADPH in the cytosol. The drugs are subjected to hydroxylation or oxidation, which provide an increase in their polarization. An alternative reaction of phase 1 is the conversion of ethanol to acetaldehyde using alcohol dehydrogenases, which are detected mainly in the cytosol.

Chronic drug hepatitis

Symptoms of chronic active hepatitis can cause medications. Such drugs include oxyphenysatin, methyldopa, isoniazid, ketoconazole and nitrofurantoin. The most common are elderly women.

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