Citation:Vyachov S.S. Skin itching associated with cholestasis // RMG. 2014. №8. P. 622.

Cholestasis is detected with many diseases of the liver and biliary tract, which lead to an extra-piece biliary obstruction and / or intrahepatic disruption of the excretion of bile. In part of the patients, the most painful and concern is a symptom associated with cholestasis, is a skin itch, which can have a different degree of intensity, ranging from light, moderate (leading to sleep disturbance) and ending with heavy, in which the familiar rhythm of the life of patients is completely violated.

The pathogenesis of the skin ferrous ferment is not studied in detail, but at present there are several basic hypotheses, including accumulation of bile acids and an increase in the excitation of opioid receptors.

Bile acids

One of theories involves an increase in the level of bile acids in the skin of patients with cholestatic diseases, which leads to the appearance of skin itching. Observations of followers of this theory demonstrate that a decrease in the amount of bile acids in the surface layers of the skin in this group of patients is associated with the intensity of the itch, although the accuracy of this methods used to determine this methods remains dubious. Other studies show the possibility that the reception of bile acid induces and enhances the skin itching.

There are, however, three studies, results that do not contradict the main role of bile acids as a cause of the skin:

• random reduction in leather itch, despite the continuing cholestasis and the presence of high levels of bile acids in the plasma;
• lack of itching in many patients with cholestasis and elevated levels of bile acids in plasma;
• the obvious disadvantage of the correlation between the presence and severity of the skin serbos and the concentration of bile acids in the skin of patients with chronic cholestasis in most of the thoroughly conducted studies devoted to this problem.

Moreover, cholestiramine and cholestipol are preparations used to treat cholestatic skin, also lead to a decrease in itching in patients with uremia and true polycythemia, i.e., states that are not associated with delayed salts of bile acids.

The relativity of the hypotheses is descended by the fact that the elevated level of bile acids in the plasma due to hepatotoxicity affects the skin itching to a greater extent than their direct effect on the nerve endings. Purified bile acids damage hepatocyte membranes, allowing the content of cells (most of which can cause skin itch) to flow into the overall blood flow.

Endogenous opioids

More and more values \u200b\u200bare attached to the role of endogenous opioids in the pathogenesis of the skin cholestatical itch. The purpose of opiates with agonistic activity to opioid μ receptors can enhance the skin itching in healthy people, presumably due to the central action. It is more important that the endogenous level of opiates increases (according to an unclear mechanism) in patients with chronic liver diseases, and many studies show a decrease in cholestatic skin ferrifers in patients receiving antagonists of opioid receptors.

Lysophosphatic acid and autoaxin

Preliminary studies confirm the importance of the role of lysophosphatide acid (LFC) with cholestatic skin itch. LFC refers to phospholipids formed under the action of auto-pastes, which clears the choline group from lysophodylcholine. In comparison with the control, patients with cholestatic itch have a significantly higher serum level of the concentration of the FFC and the activity of auto-pastes. Moreover, the injection of the exhibition is induced by combing reactions in mice. These studies require confirmation, but indicate the potential role of auto-paste inhibitors as an option of a therapeutic strategy.

Treatment

A selection with a skin, associated with cholestasis, may be the treatment of the main disease of the liver and biliary tract. With extrahepatic biliary obstruction in cases in which the main therapy is impossible, usually biliary drainage is very effective in the cessation of the skin. In case of intrahepacine cholestasis in cases where basic therapy is impossible, some drugs can be applied, which makes it easy to facilitate the symptoms of the itch.

It is enough to evaluate the effectiveness of drug therapy in the clinical studies, since the symptoms of the ferrous are very subjective and can intensify and weaken spontaneously. However, researchers now have modern equipment for monitoring the activity of the skin toil, which allows you to register the intensity of combing, regardless of major body movements, thus take into account the behavioral methodology in clinical studies of itch. Nevertheless, clinical studies are most small and use different scales to evaluate the itch, so limitedly comparable to each other.

In light cases itching can be monitored with nonspecific measures such as warm baths, softening and soothing means. However, many of these funds often do not have the effect with a moderate and severe itch or itching, accompanied by exclirations. In such cases, the following treatment options are used.

Derivatives of bile acids

Cholestyramine and cholestipol are effective as the first line of drugs in the treatment of moderate and heavy cholestatic itch on the basis of their favorable safety profile and the results of clinical studies. Clinical controlled studies on their use are quite a lot.

These drugs are not absorbed and contain basic polyterminins that bind anions in the intestinal lumen. They also reduce the level of bile acids by inhibiting the reabsorption of bile acids by about 90%. Nevertheless, only binding of bile acids, unfortunately, cannot explain their effect, and more powerful sequesters of bile acids (cholerelas) are ineffective in the cholestactic itch compared with placebo in controlled studies. They also reduce itching with necholetic disorders, such as uremia and true polycythemia, confirming that they act on other mechanisms of itch.

Effective dose of cholestiramine is in the range from 4 to 16 g / day. In addition, efficiency can be increased by appointing a dose before and after meals in patients with intact bubble bubble and increased secretion of itigenous substances, which may accumulate in the bustling bubble over the night period. However, adherence to treatment is the main problem of using bile acid derivatives. These drugs are relatively unpleasant to taste, can provoke constipation and enhance the absorption of various drugs, including digoxin, warfarin, propranolol and thiazide diuretics.

Rifampicin

Some research results demonstrate a decrease in cholestatic serium at a dose of 300 to 600 mg of rifampicin per day. It was originally assumed that rifampicin can reduce itching due to competing with bile acids for the seizure in the liver, thus minimizing the toxicity of bile acids against hepatocytes. In contrast, rifampicin can induce microsomal enzymes, which enhances 6-alpha hydroxylation and consistently glucuronization of toxic salts of bile acids. However, these effects are not confirmed, and the interaction mechanism remains unclear.

Although the toxicity of rifampicin was not detected in these preliminary studies, caution should be taken when using rifampicin in cholestatic states due to sometimes emerging hepatitis and severe idiosyncratic reactions.

Antagonists of opioid receptors

The use of opioid antagonists, such as injectional naloxone (used bolus 0.4 mg, followed by the introduction of 0.2 μg / kg / min. During the day), oral administration (from 60 to 120 mg / day), oral naltrexone (from 12, 5 to 50 mg / day), often associated with partial relief of cholestatic ferry. This is illustrated by controlled cross-study on 29 patients, which showed a decrease in the need for a combination by 27% and a significant decrease in the perception of itching. A similar study on 16 patients randomized to Naltrexone groups or placebo showed that Naltrekson was associated with a significant decrease in the symptoms of itching during the daytime (changing the intensity of itching -54% against -8%) is also effectively as at night (-44 % against -7%). Resistant improvement was observed after 2 months. According to the results of the third placebo-controlled cross-study, comprising 20 patients. In 9 patients, it was noted a decrease in itching by more than 50%, and 5 patients the symptoms of itch were completely stopped.

Opioid antagonists are usually well tolerated, with the exception of limited "cancellation syndromes", which are most often resolved independently within 2 days. These problems are more apparent when taking Nalmefen, which is currently available only for experimental use. The occurrence and intensity of the "cancellation syndrome" can be reduced by cautiously initiating intravenous administration (T. C. Naloxone is administered intravenously at a rate of 0.002 μg / kg / min and the rate of administration gradually rises until the therapeutic dose) and transition to subsequent oral therapy. In addition, opioid antagonists can lead to uncontrolled pain syndrome in patients with pain of different genes (for example, postherpetic neuralgia). By the time the role of endogenous opioids during cholestatic ferry will be better studied, the use of these drugs, including for oral administration, will become more common in clinical practice.

Ursodeoxycholic acid

Ursodeoxycholic acid (UPHK) of natural origin is bile acid appointed exogenous, it changes the pool of bile acids to more hydrophilic. It remains unclear whether this effect is caused by competition with intestinal absorption of endogenous bile acids or an increase in the hepatic clearance of endogenous bile acids. UDHK is used in the treatment of some forms of cholestatic liver diseases, including primary biliary cirrhosis.

The effect of UDHK in relation to itching, however, remains unclear. Two large clinical studies on primary biliary cirrhosis, for example, did not show the reduction of itching at dosage of UDHK from 13 to 15 mg / kg / day. For comparison: therapy of high doses (30 mg / kg / day, divided into 3 receptions) in other studies showed a significant facilitation of the symptoms of itching. In the studies conducted later, itching has disappeared in 6 of 7 patients in less than 1 month.

Other funds

In the treatment of itching can be used and many other drugs, however, the number of studies carried out with their use is very limited and includes only a small number of patients.

The joint use of colchicine and methotrexate significantly reduces itching in a controlled double-blind study, which includes 85 patients with primary biliary cirrhosis, which led a diary to evaluate the itch. Phenobarbital showed the effect in a number of studies.

Clinical examples and small controlled studies confirm the possible efficiency of selective selection inhibitors of serotonin reverse seizure. Sertraline (from 75 to 100 mg / day) was effective according to the results of a retrospective analysis of a group of patients with primary biliary cirrhosis, which were part of the UDHK study with methotrexate and without it, as well as in a small randomized placebo-controlled cross-study study of patients with itching at various diseases Liver. Paroxetine showed a good result in patients with severe non-physical itching (most of which had non-liver diseases of the causes of itching).

Phototherapy using ultraviolet (UV-B) had an effect in a number of studies. The mechanism of decreasing itch is unclear, although the hypothesis involves a disruption of skin sensitivity to substances causing itching, or a change in bile acid pool by mobilizing skin bile acids. In our experience, phototherapy did not have an effect more than 80% of patients with primary biliary cirrhosis that did not respond to the therapy of cholestiram.

Some studies demonstrate to facilitate the symptoms of itch after plasmapheresis in patients with cholestasis. However, clinical experience is quite controversial and heterogeneous. This technique is too multivariate for evaluation and hardening for routine use. But Plasmapheresis can play a role in the event that the remaining methods are ineffective, as well as in patients with cirrhosis of the liver to reduce itch.

Propofol is a sedative anesthetic, prescribed 3 patients intravenously in subgipnotic doses. There was a significant decrease in itching without disabling the sedation. The estimated mechanism is associated with the inhibition of ventral and dorsal horns of the spinal cord, modulated opioid-like ligands.

Androgens (such as nourgeandrolone, methyltestosterone, stanozolol) increase the content in serum bile acids and worsen jaundice, also they paradoxically facilitate the symptoms of itching in patients with cholestasis. The mechanism of this impact remains unclear, but many side effects limit the use of similar drugs.

Delta-9-tetrahydrokannabinol facilitates the symptoms of itching in some observations.

The molecular adsorption system of blood circulation (devices for gemofiltration) was also effective in several series of observations.

Bien transplantation

Heavy skin itching, refractable to other means of therapy, can be a relative indication for liver transplant in patients with severe cholestasis. Functioning liver transplant compensates for the main disease and contributes to the rapid resolution of itching.

Standards of the American Liver Study Association (AASLD, 2009)

Recommend the following approach to treating itching with cholestasis associated with liver disease. Therapy begin with sequestrances of bile acids. They are prescribed from 2 to 4 rubles / day before or after receiving UDHK. In patients with itching, refractory for the treatment of bile acid sequins, as the next step of therapy, it can be used: rifampicin (from 150 to 300 mg 2 p. / Day) or oral administrators of opiates, such as Natrekson (50 mg / day). Sertraline (from 75 to 100 mg / day) can be used in the ineffectiveness of the remaining methods (Fig. 1).

1. Treatment of sebum, associated with cholestasis, must first of all be concentrated on therapy of the main disease of the hepatobiliary system. A fundamentally different tactics for the treatment of extrateplicate biliary obstruction and intrahepatic cholestase - the main leading states leading to the development of itching.

2. The optimal treatment of the skin ferry under cholestasy is not finally determined, although some studies have studied a number of treatment opportunities (in brackets indicated a class of proof). As the main criterion for choosing therapy, the severity and intensity of itching is used.

• For the correction of itching, general measures are recommended, such as warm baths with a reception or without antihistamine (class 2C).
• To correct moderate and severe itch or light itch, with ineffectiveness of common events, cholestyramine or cholestipol (class 2B) is recommended. Effective dose of cholestyramine - from 4 to 16 g / day. Efficiency can increase when appointing before or after meals in patients with intact bubble.
• For the correction of itching in patients who did not respond to cholestiramine and cholestipol, reefampicin 150 mg 2 p. / Day (class 2B) is recommended.

It is sometimes used in the first line of therapy. At the patients who did not respond to rifampicin, phenobarbital (90 mg once overnight) is recommended, although drowsiness (class 2c) is possible during the first week of reception.

• For the treatment of itching in patients with liver disease, UDHK is recommended in high dosage 25-30 mg / kg / day, divided into 3 receptions. For the treatment of itching in patients with primary biliary cirrhosis, it is recommended to add the purpose of colchicine and methotrexate to UDHK - for non-responding patients (class 2C).
• For the treatment of heavy itch and not responded to other therapy, opioid antagonists (class 2B) are recommended.

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Content

The disorder of the outflow of bile in the body affects the internal organs and skin cover, causing the skin of the body of the body in diseases of the liver. Having found such a symptom, you should immediately contact the doctor, for the right diagnosis and appointment of appropriate treatment. To remove the manifestations of itching in this case, can medicines, a diet and compliance with some hygiene rules.

What is itching body

It is possible to define this concept as follows: itching the body is a feeling of discomfort, which causes the desire to comb skin. It may occur over the entire surface or on certain areas of the dermis. Skin itch is not a separate disease, and is a sign of the ailments of internal organs, epidermis. A list of diseases that cause uncomfortable sensations of this species is very wide.

Causes of skin with liver disease

The feeling of itching and the formation of rashes on the skin can be provoked by a few liver. Often, these phenomena arise under the influence of the disease, the same as cholestasis and hepatitis S. Specialists identify the following causes of the skin with liver disease:

Cholesteas

The development of this pathology is due to biliary diseases or oncological neoplasms, under which a failure of bile outflow failure. The burning and itching at cholestasy appear as a result of bile acids in the bloodstream. By the nature of the course, the disease may be intrahepatic or extrahepted, there is also a chronic or sharp form. The cholestatic itch is accompanied by digestive disorders, sleep disorders (insomnia), fever, general weakness, malaise and pain in the head.

Itching with hepatitis with

A common symptom is itching during hepatitis C - the manifestation occurs at about about a quarter of the contaminated. According to doctors, the phenomenon arises due to the accumulation of toxic substances, which in the liver diseases cannot be effectively removed from the body. With violations of the filter organ, bile acids and bilirubin occurs. Increased level of these substances provokes the yellowing of the skin and eye scool, itching and rash when hepatitis S.

Symptoms of hepatic serpent

In case of liver diseases, many pathological changes appear on the skin of the body. It is important to quickly recognize them, because it is more effective to treat the disease in the early stages. In addition to unpleasant sensations, the symptoms of the hepatic ferry are believed:

• uncharacteristic for a specific person skin color: it can become paler or darkness;
• raising sweating;
• the appearance of edema of the face and limbs;
• pain in the right hypochondrium;
• peeling of the skin;
• combing and cracking on the body;
• on the skin can form a blue shade strips;
• rash.

Hepatic spots

The rash with liver disease can manifest itself in several forms:

• The formation of glassware - occurs when the synthesis of immunoglobulin synthesis is liver. As a result, an immune imbalance is observed, which provokes the stains of this species.
• Papulas and allergic spots are a reaction to a decrease in the liver function responsible for detoxification.
• Violation of the synthesis processes in the liver provoke the appearance on the skin of small bruises. In patients with such a disease, an increased risk of treatment with hematomas occurs.
• Spots can be extensive and look like red palms. The phenomenon can go to the feet. Such redness is accompanied by high temperature.
• The vessels protruding over the skin (vascular stars) are localized in the area of \u200b\u200bthe back, hands, neck and face.
• The rash with hepatitis is a yellow plaque, which are concentrated in the footsteps, upper and lower extremities, eyelids, armpits.

Hepatic stains of red, which are disappearing during palpation, and then return, are parmaral erythema.

• It occurs as an allergic reaction to the transferred hepatitis.
• A small streak may form on a large finger or maizinz. The rash of this type is called "Hepatic Palms".

How to distinguish the usual itching from the liver

You should know how to distinguish the usual itching from the liver, so as not to be mistaken in the diagnosis. The uncomfortable sensations of the body caused by the diseases of the liver are intensive in nature, it appears at night. They are accompanied by rash, the formation of vascular asterisks, bruises, bad well-being, pain in the side of the right and jaundice. Itching the skin of the body in diseases of the liver is different from allergic because antihistamines (tavergil, citrine) do not demonstrate its effect.

Treatment of hepatic ferry

To eliminate the body skin, symptomatic therapy is used to eliminate the body of the body. If you are watching this phenomenon for a long time, you should seek medical care so that the rash does not give complications. Treatment of hepatic ferry will be able to easily be faster in the early stages. To relieve it, follow some recommendations:

• Do not overheat the skin, give up visiting the bath, sauna. If the covers began to be hidden when it was hot on the street or indoors, take a cool shower.
• Choose underwear, clothing from natural materials to reduce annoying effect.
• Refuse bad habits: smoking, alcohol.
• Treat the skin on the affected areas with ointments, gels having a cooling effect to improve your condition.
• Try to avoid overloads of emotional and physical nature that provoke the strengthening of sebum seizures.
• If the itching of the body in diseases of the liver was caused by the toxic effects of drugs, cancel their reception.

Treatment of the skin of the skin of the body drugs

Therapy with drugs is carried out for the treatment of the disease that provokes itching. Ultrasound, biopsy, general and biochemical blood test are prescribed for the diagnosis. These methods will help determine the degree of inflammatory processes, the localization of the illness. After the necessary studies are prescribed treatment, which depends on the disease that causes itching and other manifestations.

In addition to medicines, surgical methods can be used. If cholestasis was caused by a collection of bile outflow, which occurred at the overlap of the ducts and caused intoxication with bile acids, a special drainage is installed. Such a device will help to derive an excess substance from the gallbladder, will contribute to the rapid removal of the symptoms of intoxication.

Treating the skin of the skin of the body drugs is carried out by means of the following categories:

• antagonists of opioid receptors (Naltrekson, Naloxone);
• bile acid derivatives (cholestipol, cholestyramine);
• drugs of ursodeoxycholic acid in large doses.

To relieve the skin of the body, the following drugs can be assigned to the bodies of the liver:

• sorbents (coal activated, enterosgel) - acting in the intestine, help to remove toxic substances from the body;
• vitamins of the fat-soluble group (A, E, K, D);
• anti-inflammatory drugs - help reduce inflammation in the place of damage to the tissues of the gland;
• immunostimulating drugs - help with a weakened immunite;
• probiotics - contribute to the normal functioning of the intestine;
• antibacterial, antiviral agents - participate in the elimination of pathogenic flora.

Proper nutrition

The component of the successful struggle of the skin of the skin with the diseases of the liver is the proper nutrition. Experts recommend to clean the fried foods, greasy and sharp, which harm the filter organ. It is necessary to eat fractionally - the five-volume meal is considered optimal. It is not recommended to overeat, because excessive food intake loads the liver. Doctors prescribe patients using a special diet number 5.

Diet at cholestuza

Dietary table No. 5 is shown in the following diseases:

• chronic hepatitis forms;
• in the acute flow of hepatitis, a cholestasy can be used at the final stage of treatment;
• cirrhosis of the liver;
• disorders of the work of biliary tract;
• jelly disease.

It is forbidden to use such a system of nutrition to people suffering from disorders of the stomach or intestines. The main principle of the diet is the minimum consumption of fats. It is eliminated by a dish, one of the components of which is purr, cholesterol, essential oils and oxalic acid. Salt consumption must be limited or not to apply at all. Prepare food preferably with cooking or baking.

The basis of the diet on such a diet should be vegetables and fruits. These products contain many pectins and fiber. The right drinking mode involves the use of a large amount of water on an empty stomach. The daily volume should be at least 1.5 liters of clean water. Such a diet can not be an alternative treatment, but is an integral part of complex therapy. In the chronic flow of the disease, the power system helps minimize the risk of exacerbations.

• vegetable, dairy or fruit soups without adding roasted;
• baked or boiled non-fat varieties of meat or fish;
• pasta;
• salads, stew and other vegetables dishes;
• sweet types of fruits, berries;
• natural juices, bums from herbs, green tea;
• bran or wholegrain bread.

The nutritionists have a list of products that are allowed to eat in limited quantities with a liver itchine:

• Low or low fatty dairy products. Maximum daily consumption should be 200 g.
• Eggs can be equipped with 1 pc. per day. If you wish to make an omelet, use only proteins for its cooking.
• Homemade jam, which does not contain artificial additives and preservatives.
• Among the sweets, choose a shell, marshmallow or marmalade for 70 g per day.
• In moderate quantities allowed to use spices.

In case of liver disease, it is impossible to use:

• fatty meat, smoked, canned, sub-products;
• sharp, fat, fried dishes;
• mushrooms and legumes;
• sweets, especially chocolate and ice cream;
• alcohol-containing and sweet carbonated drinks;
• onions, garlic, sorrel, radishes, cauliflower;
• cocoa, coffee.

Stock Foto Spots on skin with liver disease

Almost all diseases associated with violation of the excretion of bile on the biliary ways, provoke the occurrence of the skin. Often, he is one of the first, and sometimes leading cholestasis symptoms, sharply lowering the quality of the patient's life.

It is believed that in the pathogenesis of the development of the skin, several components can be involved:

• Increased in the blood (and, accordingly, in the skin of patients) concentration of bile acids. It has been established that no irritation of nervous fibers plays the greatest role here, but the total hepatotoxicity of bile acids due to their damaging effect on the cell shells of hepatocytes. This in turn leads to the content of the contents of destroyed hepatocytes into the overall blood flow.
• Improving the level of endogenous opioids, and irritation with μ receptors. It is at that that the therapeutic effect of using opioid receptor antagonists is founded.
• The effect of auto-pastes and lysophosphatide acid. The essence of this phenomenon is to disconnect choline from the phospholipid compound of lysophosphatidylcholine to form a leisophosphatide acid that causes itching. Therefore, the use of its inhibitors has a pronounced therapeutic effect.

How to treat patients with skin itch during cholestasy?

The optimal option of therapy is to eliminate the direct causes of cholestasis (liver disease and biliary tract), as well as additional (if necessary) the use of groups of the following drugs. In some cases, it is enough to organize a good biliary drainage, but with internal stakes have to contact drug therapy:

• Cholestipol and cholestiramine (derivatives of bile acids) belong to the first line of drugs appointed with a temperate and severe skin itch. They reduce the concentration of bile acids by lowering their reabsorption in the intestinal lumen (absorption inhibition reactions and the binding of anions). But there are other, even until the end of the mechanisms of their actions (for example, a decrease in itch under uremic, polycythmical diseases, etc.). The optimal dosage is sufficiently wide and is 4-16g per day. But it should be borne in mind that these drugs can cause constipation, increase the absorption of thiazide diuretics, propanazole, warfarin, digoxin.
• Ursodeoxycholic acid - bile acid of natural origin. The mechanism of its impact is not fully established, but it is believed that it transfers part of bile acids into hydrophilic forms, which facilitates their further elimination from the body. Most often used with primary biliary cirrhosis. The dosage can vary individually from 15 to 30 mk / kg per day (in three receptions).
• Rifampicin participates in competitive seizure with bile acids hepatocytes, thereby reducing their toxic effects, and also causes glucuronization and 6-alpha hydroxylation of fatty acid compounds. Assign it usually at a dose of 300-600 mg per day.
• The appointment of opioid receptor antagonists may be in the form of injections (naloxone), oral preparations (naplex 60-120 mg per day, Naltrekson - 12.5-50 mg per day). Preparations of this group are usually transferred well, but the reception can stretch them in time to 2 months before fully relieved symptoms. Also, one of the negative side effects of these drugs may be the emergence of uncontrolled pain syndromes of various genes (arthritic, vertebral, neurological, herpes, etc.).
• The joint use of methotrexate with colchicine significantly reduces the intensity of the ferrous with biliary cirrhosis
• A good effect gives a phenobarbital (it can also be prescribed to patients for the night in the form of a Corvalol, Wolkordin, etc.)
• The appointment of selective inhibitors of serotonin reverse seizure (SIRES) - sratrolin, fluoxetine, prose, paroxetine - 75-100mg / day. These same drugs are often effective and with itching other genesis.

Other treatment methods for cholestuz can include:

• Phototherapy (ultraviolet rays - UV-B).
• Plasmapheresis.
• Purpose of propofol - sedative anestka in a subgipnotic dose.
• The appointment of androgens (Stanozolol, Methyltestosterone, Northordrolone and others).
• Use of delta-9-tetrahydrokannabinol.
• Liver transplantation with severe liver damage with pronounced cholestasis

In each case, it is necessary to individually select the drug, but still there are certain criteria for the purpose of treatment, depending on the severity of the itch (it is not always directly proportional to the severity of the cholestasis).

It is usually a light degree to a lightly at first to reduce by appointing antihistamine preparations, warm fitted.

With a moderate and pronounced skin, a cholestipol or cholestyramine is prescribed, in the absence of effect - rifampicin, phenobarbital (up to 90mkg) at night can also be additionally prescribed ursodeoxychole acid. If the above-mentioned means are ineffective, colchicine with methotrexate is added. In the absence of effect, opioid antagonists are prescribed.

Under the cholestasis (cholestasis; Greek Chole bile + stasis standing) understand the decrease or complete cessation of bile outflow due to the violation of its education, excretion and / or elimination. The pathological process can be localized on any segment from the sinusoidal hepatocytic membrane to a duodenal pacifier.

Recall that the formation of bile occurs in several stages: 1) the seizure of the blood of a number of its components (bile acids, bilirubin, cholesterol, etc.) at the level of the baso-cell membrane of hepatocytes; metabolism, as well as the synthesis of new components and their transport in the cytoplasm of hepatocytes; 2) the selection of bile through the canalicular (biliary) membrane of hepatocytes into the biliary tubules; 3) Further formation of bile in biliary traits, and ultimately, and in the intestine.

In functionality, cholestasis means a decrease in the sewage current of the bile, the liver excretion of water and organic anions (bilirubin, bile acids). With a pronounced cholestasy, "reverse admission" can occur in hepatocyte (and in most cases in blood) substances that should be allocated with bile. As a result, bile accumulates in hepatocytes and hypertrophied kravel cells (the so-called cellular billarinosptases) and in extended channels (canalicular bilirubinostases). With an extra-erased cholestasy, bile is in the extended interdolt bile ducts (duktular bilirubinostaz) and the liver parenchyma in the form of "bile lakes".

Cholestasis that exists within a few days causes potentially reversible ultrastructural changes. The persistent cholestasis with concomitant inflammation and the reaction of connective tissue leads to an irreversible cholestase, and after months / years to the development of biliary fibrosis and cirrhosis.

Classification and main causes of cholestasis. Distinguish between and intrahepatic cholestasis (Table 1). In the first case, we are talking about a mechanical jaundice at which obstruction and / or mechanical damage to extrahepatic bile ducts occurs. Interested cholestasis is due to a violation of the formation and transport of bile in hepatocytes or damage to intrahepatic bile ducts (or a combination of these mechanisms). Intrahechen cholestasis is divided into intrapulous cholestasis, due to the lesion of hepatocytes (hepatocellular) and tubules (canalicular), and the extralobulous (duktular) associated with the damage to intrahepatic bile ducts.

The pathogenesis of cholestase in mechanical obstruction is obvious and does not require a detailed consideration.

As for the intracrehensive cholestasis, its development has a multifactoric character. The main causes and development mechanisms are presented in Table. 2.

As can be seen from the table. 2, the pathogenesis of the intrahephene cholestasis is of a multifactorious character:

• violation of the functions of basolateral, sinusoidal and canalicular membranes. The basis of this phenomenon can be a disorder of hepatobiliary transport, such as mutations of protein-conveyor genes and acquired dysfunctions of transport systems that determine the violation of the canalicular or cholangiocellular secretion;
• the change in the composition and flowability of plasma membranes of hepatocytes affects the activity of enzymes and receptors. The membrane fluidity is determined by the ratio of phospholipids to cholesterol. Reduced membrane fluidity is usually associated with an increased cholesterol content, which takes place in drug cholestasis (estrogens, anabolic steroids);
• violation of the hepatocyte cytoskeleton, which lead to the disappearance of microvones on the apical surface of hepatocytes, a decrease in the reduction of the canalicular membrane, as well as the cause of the increased permeability of the intercellular tight contacts and lead to the reverse current of the bile in sinusoids; The detergent effect of bile acids, the accumulation of which leads to damage to the cell membranes, the accumulation of cytosolic calcium, activation of intracellular hydrolauses and the necrosis of hepatocytes. Bile acids inhibit the regeneration of hepatocytes, fibrogenesis activate the expression of class III antigens of the main histocompatibility complex, predisposing to the development of autoimmune damage. In addition, they contribute to the accumulation of free radicals, which, in turn, launch the activation of the Caspases, which ultimately leads to apoptosis of the cells of the biliary epithelium.

Note that most of the factors listed above lead to a decrease in the activity of S-adenosyl methyl oxyththytase, as a result of which the products of S-adhemethilation are disturbed. The latter exacerbates the flow of biochemical processes in hepatocyte; In hepatocellular membranes, the phospholipid content is reduced, the activity of Na + -K + -atfase and other carrier proteins is falling, which also affects the fluidity of the membrane, capture and eliminating bile components. The cellular reserves of thiols and sulfates (glutathione, taurine, etc.) are reduced, which are the main detoxification substances, and also have a pronounced antioxidant effect. Their deficit determines, ultimately, the cytolysis of hepatocytes in the cholestasis of any genesis.

Clinical manifestations of cholestasis of the same type and do not depend on the etiology and mechanisms of its development. They are due to the following factors: 1) a decrease in quantity or absence of bile in the intestines; 2) excessive admission of bile elements in blood; 3) the impact of bile components on hepatic cells and tubules.

The main clinical symptom of cholestasis is the skin itching, which is not always found. With a combination of cholestasis with a jaundice, an appropriate coloring of the skin, darkening of urine and a change in the color of the feces can be marked. On the skin of patients, in addition to traces of breaks (satellites of the skin ferrous), other markers cholestasis can be seen: dry, hyperpigmentation, xanthoma and xantellasma. For a long time, the existing cholestasis, accompanied by steamer, leads to a violation of the suction of fats with the development of a shortage of fat-soluble vitamins, which are most often expressed in the development of hepatic osteodistrophy.

With the formation of biliary cirrhosis, there are also signs of portal hypertension and hepatic cellular insufficiency. Hepatic cell insufficiency develops on average after 3-5 years from the beginning of the occurrence of cholestatic jaundice. In some diseases (such as primary biliary cirrhosis), portal hypertension may be discovered by the formation of cirrhosis, forming a preferablyoid mechanism.

The laboratory diagnosis of cholestase is aimed at identifying the serum of bile components or signs of damage to the canalicular hepatocyte membranes or biliary epithelium.

Laboratory cholestasis markers are: alkaline phosphatase (biliary isoenzyme), leucinopeptidis, gamma glutamylTranspend of gamma, 5'-nucleotidase. An increase in bile acids, bilirubin, cholesterol may also be observed.

Consider the main directions of therapy, operational treatment and non-drug influences on cholestasis and its consequences.

Diet pattern

The deficiency of bile salts in the intestinal lumen dictates the features of the diet with cholestasy. Along with the adequate consumption of protein and calorie, patients are recommended to limit fats to 40 g / day. If necessary, the fat component of food can be assessed by enteral mixtures containing mid-chain triglycerides, which are digested and absorbed in the intestines even with the absence of bile acids. Steatheree determines the need to enrich food with fat soluble vitamins and calcium (or additional appointment in the form of drugs). There are recommendations to limit copper consumption, as it accumulates when cholestasy in the liver, but they are very controversial.

Etheological treatment

Ethiotropic therapy is designed for a limited amount of liver diseases, as a rule, infectious. If we talk about predominantly cholestatic diseases, then the succeeds of surgical interventions aimed at decompression of the biliary system are undoubted.

Biliary decompression

Both laparoscopic and laparotomic operations still do not lose their relevance. Gradually, with the development of minimally invasive technologies, the frequency of "large" operations is reduced. After all, the surround operation is more serious injury for the body; In addition, with endoscopic methods, it is possible for repeated, including minimally invasive interventions. Therefore, in most cases, our European and American colleagues consider endoscopic methods of treating mechanical jaundice as the first line methods. With their help, for example, it is possible to resolve up to 94% of the obturation of bile duct caused by various reasons.

In the clinics where a large number of endobiliary interventions are performed (according to European studies - more than 40 per year), the percentage of complications are significantly lower than in centers that perform fewer manipulations.

The choice of a method for eliminating the obstruction of bile duct depends on the cause that caused jaundice. In principle, the following methods of endoscopic manual can be distinguished:

We will analyze the possibilities of each of the methods.

Papillactomy is used in benign formations of BDS, which caused a disturbance of outflow from bile or pancreatic ducts or having a high risk of malignancy. After removal of the BDS, stenting the choledoch and the main duct of the pancreas, to prevent the edema of the mouth and the development of scar stenosis.

The dissection of the stricture is applied in cases where a benign neucholar stricture is located in the terminal duct department, not higher than the intramural part. In fact, endoscopic papilosophycterotomy (EST) is performed, which can be performed in a standard way, after prejudice, or wearing the shape of suprapapillary choledochotomy. If it is impossible to heat the cholester directly through the mouth, the BDS from the mouth is performed, using the face (needle) papillotoma. This technique is more dangerous and difficult, especially for beginner endoscopists.

In some cases, when Stricks is at the level of the mouth of the BDS or its ampoule, the upper part of the longitudinal fold can empty. In these cases, the protruding part is performed, without dissection directly to the mouth of the BDS. This technique is called suprapapillary choledochotomy.

Virtually any medicinal manipulation on bile ducts, especially if you plan to repeat manipulations (for example, to replace the stents), it begins to facilitate the subsequent access, that is, the execution of the EST.

Sometimes, most often at Holelyatiasis, you can completely eliminate the cause of jaundice. Lithoxtraction can be performed using a sufficiently large number of endoscopic tools. If a large-size consumption, then its lithotripsy is pre-performed. Laser lithotripsy and electro-hydraulic lithotripsy include more exclusive methods of treatment of choledocholitiasis. These techniques are used during cholangioscopy. However, in routine clinical practice, they are rarely used, due to the lot of laboriousness and high cost. According to our data, more than 96% of the concrections, even large sizes, can be extracted endoscopically. To date, the large size of the accrete is not a contraindication to perform endoscopic lithoxtraction.

If the stricture is located above the intramural part of the choledoch, its extension is required. For this purpose, two methods are used in endoscopy: balloon dilatation and bunning. Depending on the selection of stricture, its dilatation can be a final or stage treatment. In most cases, with benign strictures (stricture of a choledoch-choledoor anastomosis, biliodygestive anastomosis, after choledochomy, ischemic strictures in patients after liver transplantation) require several dilatation sessions for 1-2 years. At the same time, temporary endobiliary stents are installed between manipulations in the stricture area to prevent their narrowing.

With malignant strictures, dilatation can be performed as a step of manipulation when stenting or photodynamic therapy.

Stenting bile ducts is performed by plastic or nitinol stents. Both species have their advantages and disadvantages.

Plastic stents quickly quickly for 2-5 months clogged with dense bull content. The blockage of stents again leads to the rise of jaundice and the development of cholangitis. On the other hand, these stents are easily removed and can be replaced with new ones. Recanabilization of plastic stents is possible, but not appropriate.

Nitinol (metallic) self-regulating stents are covered and uncovered. These stents can function significantly longer than plastic (up to 1-2 years), but their extraction and replacement are a much more challenging task. The installation of self-adjusting stents can be recommended in patients with an unfavorable forecast, the estimated life expectancy of which does not exceed 1 year (metastatic lesion of the gate of the liver, the inoperable tumors of the pancreas and bile ducts). Another negative side of Nitinol stents is their high cost.

Photodynamic therapy is a method consisting in intravenous introduction of a photosensitizer that selectively accumulates in tumor tissues. As a result, the volume of education decreases, the blockage of bile ducts is eliminated. The effectiveness and safety of this method with cholangicarcinoma has been proven. The technique is very laborious and expensive, so it has not yet been widely used in clinical practice in the Russian Federation.

With the development of endoscopic ultrasonography (EUS), therapeutic punitive methods are developed under the control of endoscopic ultrasound. So, to eliminate the mechanical jaundice, the literature describes the methods of choledochola and cholesterol under the control of the endoscopic EUS. The method is puncture under ultrasonic control of extended bile ducts or gallbladder through the wall of the duodenum or stomach, followed by their stenting. In fact, bilidigestive anastomoses are formed.

There are situations when the choleret is composed of the pancreas. In this case, the drainage of cysts under EC control can be performed.

A brief overview of endoscopic diagnostic methods and treatment of mechanical jaundice shows significant progress in this direction lately.

Pathogenetic therapy

Ursodeoxycholic acid (UDHK). The only generally accepted drug for the treatment of most chronic cholestatic diseases is UDHK. The ability to treat cholestasis is considered the most valuable property of this medicinal product.

UDHK is a competitor toxic bile acids during absorption in the small intestine, as well as on the hepatocyte membrane and cholangiocytes. It is believed that the positive influence of UDHK on the course of chronic cholestasis is primarily due to a decrease in damage to cholangiocytes with toxic bile acids (due to the suppression of their secretion and reducing the pool by reducing their absorption in the ileum).

In addition, UPCK stimulates the transport of bile acids and organic anions in hepatocytes and cholangiocytes. It affects a number of processes associated with hepatocyte conveyor proteins: their transcriptional regulation; inclusion in the apical membrane; phosphorylation and defospholization in places of action; and also affects the processes of exocytosis (by activating calcium-dependent alpha-proteinkinase) and expression of transport systems in biliary epithelium (bicarbonate choleraz).

Actually, the cytoprotective action of UPHK in cholestasis is determined by its ability, forming double molecules interacting with lipophilic membrane structures, integrated into the cell membrane, increasing resistance to toxic effects of hepatocytes, cholangiocytes and epithelocytes of the gastrointestinal tract.

The immunomodulatory properties of the UPCC are mainly due to the decrease in the pool of toxic bile acids, which, when cholestasy, induce the expression of HLA I and II molecules on the hepatocyte membranes and cholangiocytes, which contributes to their recognition, followed by the destruction of cytotoxic T-lymphocytes. The long-lasting intake of UDCH oppresses the expression of HLA antigens on hepatocyte and cholangiocyte membranes, normalizes the activity of cytotoxic T-lymphocytes, affects the expression of dipeptidylpeptidase-4 and the formation of interleukin-2, reduces the increased content of eosinophils, reduces the synthesis of immunocompetent IGM in combination with a decrease in autoanthetol products.

Additional EDCH effects can serve inhibition of the apoptosis of cholangiocytes and hepatocytes (affecting the yield of cytochrome from the mitochondria in the cytosol and the launch of the CASPAZ cascade) and antioxidant properties, the change in the metabolism of prostaglandins and fatty acids, the effect on the recovery of the liver.

The antifibrotic effect of UPCH is due to a decrease in the content of fibrgenesis activators and the immediate oppression of the activity of star cells. The influence of UDHK on the induction of cytochrome CYP3A4 is assumed, which should be important for the metabolism of bile acids and many xenobiotics.

The variety of EFC effects determines a reliable reduction in the progression of fibrosis under a number of liver diseases.

The most convincingly proven by the positive effect of UDHK with this true cholestatic disease, as the primary biliary cirrhosis. In the combined analysis of the French, Canadian and North American cohort patients with 2-4-year observations, a decrease in mortality and the need for liver transplantation in groups with a moderate and severe course of the disease was noted. "Barcelonian" study of 192 patients who received UDHK for a period of 1.5-14 years showed that the survival rate of the "respondents" at UDHK (the response was estimated at the level of decrease in alkaline phosphatase) was higher than the predicted MEYO model and corresponded to the population.

Dose UDHK 13-15 mg / kg / day with most cholestatic diseases has an advantage over a biochemical response and cost in comparison with low and high doses. The exception is the fibrosis, where doses of 20-30 mg / kg / day are recommended. With primary sclerosing cholangitis, recommended doses are not defined.

There are data on the positive effect of UDHK on drug cholestasis, including those determined by one of the most often causing hepatotoxicity of drugs - amoxicillin / clavinary.

The European Association for the Study of Liver Diseases (EASL, 2009), in the treatment of cholestatic diseases, recommends the obligatory purpose of UDCK as basic therapy under a number of liver disease: primary biliary cirrhosis, primary sclerosing cholangitis, fibrosis, progressive type 3-type cholestasis (PFIC 3), The intrahepatic cholestasy of pregnant women and discusses her appointment during medicinal cholestase and a benign family cholestasy.

Today, the original drug UPHK - URSO (Japan) is absent in Russia. In this situation, when choosing generic preparations, widely represented on the domestic pharmaceutical market, first of all, the ratio of "price / quality" should be guided. The domestic drug UDHK Urdox appeared in recent years on our clinical impressions is not inferior to generic forms previously registered in our country.

S-adenosyl-L-methionine (SAME) Also applied under a number of liver diseases as an anticholentic agent. His participation in sulfatization processes, including bile acids and taurine, leads to a decrease in the pool of toxic free bile acids, which improves the excretion of them from hepatocyte and contributes to their kidney elimination. Participation in the synthesis of structural proteins and phospholipids ensures the stabilization of cell membranes and mitochondria and thereby improve the operation of transport systems. Experimental data are available that SAME reduces apoptosis induced by bile acids, albeit to a lesser extent than UDHK.

The effectiveness of SAME was shown in patients with chronic cholestasis of various genes. In randomized clinical studies, it demonstrated the ability to increase the life expectancy of patients with alcoholic liver cirrhosis. EASL (2009) discusses its appointment with an intrahepatic cholestase of pregnant women as a preparation of the second line. In the experimental work, SAME prevented cholestasis caused by estrogens. In a randomized study, which included 72 patients with psoriasis, shows the possibility of SAME to prevent the hepatotoxic effect of cyclosporine A, which inhibits the transport of bile acids and reduces the biliary glutathione. The antidepressive effect of the SAME is determined by the increase in serotonin level, which can bring it closer to effects with the cholestaz-induced skin ferrine-induced sneakers.

Glucocorticosteroids (GKS) Reduce the level of bilirubin with a liver-cell jaundice (prednisone test), but do not affect the cholestasis itself. Their appointment can reduce symptoms like skin itching. At the same time, the GCS reception leads to a sharp decrease in bone mineral density, increasing the risk of osteoporosis, and also increases the risk of developing other adverse events.

Nuclear receptor agonists.In 2011, the success of the II phase of the clinical study of the drug of a new class - obtacholic acid (Obeticholic Acid (int-747)), which is a phariesoid X-receptor agonist (FXR)) announced. Monotherapy by this preparation in 59 patients with primary biliary cirrhosis for 12 weeks led to a significant decrease in alkaline phosphatase compared to placebo. This is the most likely candidate for the place of a new effective drug in the treatment of primary biliary cirrhosis.

Bien transplantation It remains the only method of treating patients with the progressive course of the disease and the development of hepatic decompensation or malignancy. In earlier stages of chronic cholestatic diseases, disabling weakness, resistant skin itching, heavy osteoporosis can be considered as indications for inclusion in the waiting list.

Treatment of extrahepatic manifestations

The main extrahepatic manifestations of cholestasis are fatigue and skin itching.

Skin treatment. The European and American associations on the study of liver diseases are unanimous in the choice of drugs for the treatment of cholestatic skin itch.

I line: sequesters of bile acids (cholestiramine - 4 g 4 times / day).

II line: Rifampicin (150-300 mg / day with a possible increase in dose to 600 mg / day).

III Line: Opiato oral antagonists (Naltrekson 50 mg / day).

IV line: sertraline (75-100 mg / day).

Sequestrants of bile acids (cholestiramine) are used for many decades, although, as for most "old" drugs, there is no worthy evidence base for their application. In the Russian Federation, cholestiramine, unfortunately, is missing recent years.

Rifampicin is the inductor of the X-receptors of pregrien, regulating biosynthesis, detoxification and transportation of toxic bile acids, therefore, with rifampicin cholestasis, it may not only have a symptomatic, but also the pathogenetic effect. The effectiveness of rifampicin is also preserved with prolonged use (2 years). Cases of hepatotoxicity of rifampicin in cholestatic liver diseases are relatively rare. However, its appointment requires compulsory biochemical control of liver indicators.

Opiates oral antagonists (naltrexone) are likely to act on itchy by reducing opioergic neurotransmission, and the selective inhibitor of serotonin serotonin inhibitory inhibitor is allegedly affecting the perception of itching.

Antihistamine preparations, phenobarbirts and ondansetron are no longer recommended for the treatment of cholestatic itch due to low efficiency and side effects.

An extracorporeal techniques include extracorporeal methods: albumin dialysis, plasma refoise.

Physiotherapy: Ultraviolet irradiation for 9-12 minutes daily in some cases allows you to reduce skin itching and hyperpigmentation.

Tiredincreasing with the progression of the disease is one of the important problems under a number of cholestatic diseases. For its treatment, there are no specific therapy yet.

In order to reduce the fatigue EASL, it recommends the treatment of related states (hypothyroidism, anemia, diabetes, depression), the exclusion of factors contributing to autonomous dysfunction and sleep disorders (excessive purposes of hypotensive drugs, the evening use of caffeine), the use of methods of psychological support.

The use of modafinil (analleptic, originally developed for the treatment of narcolepsy), used in pilot studies for the treatment of fatigue during primary biliary cirrhosis was presented.

Treatment of complications of chronic cholestasis

The specific complication of chronic cholestatic diseases is the deficit of fat-soluble vitamins and osteoporosis.

Osteoporosis.The prevention of osteoporosis implies primarily the exception of additional risk factors for its development (smoking, low physical activity, etc.), hormone-plating postmenopausal women.

Traditionally, in chronic chronicle, the constant use of calcium preparations (1000-1200 mg / day) and vitamin D (400-800 IU / day) are recommended, although the effectiveness of this has not been proven by EASL. With pronounced bone pains, the course parenteral administration of calcium gluconate in a dose of 15 mg / kg per day can be effective.

In the development of pronounced osteoporosis, and even more spontaneous fractures, bifosphonates are recommended, primarily alendronate, on the effectiveness of which there is a sufficient evidence base. There are data and on the use of parenteral bifosphonates. The results of the use of the sodium fluoride and the selective modulator of raloxifene estrogen receptors with hepatogenic osteoporosis are limited and contradictory.

Lack of fat-soluble vitamins. The appointment of vitamin D is considered primarily as the prevention of osteoporosis. Oral use of vitamins A, E and K is recommended, as a rule, with a clinically pronounced steamer or with a decrease in their blood concentrations. Parenteral vitamin K forms are prescribed for the prevention of bleeding (for example, when conducting invasive procedures on the background of cholestasis).

In conclusion, let's say that a deep understanding of the mechanisms for the development of cholestasis and the identification of its reasons can serve as a key in therapeutic and / or surgical tactics of conducting a similar category of patients.

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11. Bachs L., Pares A., Elena M. et al. Effects of Long-Term Rifampicin Administration In Primary Biliary Cirrhosis // Gastroenterology. 1992. V. 102, No. 6. P. 2077-2088.
12. Benz C. Angermuller S., Kloters-Plachky P., Sauer P., Stremmel W., Stiehl A. Effect of S-Adenosylmethionine Versus Tauroursodeoxycholic Acid on Bile Acid-Induced Apoptosis and Cytolysis in Rat Hepatocytes // EUR. J. Clin. Invest. 1998. V. 28 (7). P. 577-583.
13. BOIX J., Zuniga V. L., DE VEGA MORENO V., Domenech E., Gassull M. A. Endoscopic Resection Of Ampullary Tumors: 12-year Review of 21 CASES // SURG. Endosc. 2009. V. 23. P. 45-49.
14. Bianci G., Bugianesi E., Ronchi M. et al. Glutation Kinetics in Normal Man and in Patients with Liver Cirrhosis // J. Hepatol. 1997. V. 26 (3). P. 606-613.
15. Browning J., Combes B., Mayo M. J. Long-Term Efficacy of Sertraline As a Treatment for Cholestatic PRURITUS in Patients with Primary Biliary Cirrhosis // AM. J. Gastroenterol. 2003. V. 98. P. 2736-2741.
16. Cheng C., Sherman S., Fogel E. L., MCHENRY L., Watkins J. L., Fukushima T., Howard T. J., Lazzell-Pannell L., Lehman G. A. L. Endoscopic Snare Papillectomy for Tumors of the Duodenal Papillae // Gastrointest. Endosc. 2004. V. 60. P. 757-764.
17. Davids P. H., Groen A. K., Rauws E. A.et al. Randomised Tial of Self-Expanding Metal Stem Versus Polyethylene Stents for Distal Malignant Biliary Obstruction // LanCet. 1992. V. 340. P. 1488.
18. Dumoulin F. L., Gerhardt T., FUCHS S. et al. Phase II Study of Photodynamic Therapy and Metal Sent As Palliative Treatment for Nonresectable Hilar Cholangiocarcinoma // Gastrointest. Endosc. 2003. V. 57. P. 860.
19. EASL. Clinical Practice Guidelines: Management of Cholestatic Liver Diseases // Journal of Hepatology. 2009. V. 5. P. 237-267.
20. Fiorelli G.S-ADENOSYLMETHIONINE IN THE TREATMYL OF INTRAGEPATIC CHOLESTASIS OF CHRONIC LIVER DISEASE: A FIELD TRIAL // CURRENT THERAPEUTIC REESEARCH. 1999. V. 60 (6). P. 335-348.
21. Frezza M., Surrenti C., Manzillo G., FIACCADORI F., Bortolini M., Di Padova C.Oral S-ADENOSYLMETHIONINE IN THE SYMPTOMATIC TREATMENT OF INTRAHEPATIC CHOLESTASIS. A Double-Blind, Placebo-Controlled Study // Gastroenterology. 1990. V. 99 (1). P. 211-215.
22. Fumex F., Coumaros D., Napoleon B.et al. SIMILAR PERFORMANCE BUT HIGHER CHOLECYSTITIS RATE WITH COVERED BILIARY STENTS: Results from a Prospective Multicenter Evaluation // Endoscopy. 2006. V. 38. P. 787.
23. Ian Gan S., De Jongh M., Kapla M. M. Modafinil in The Treatment of Debilitating Fatigue In Primary Biliary Cirrhosis: A Clinical Experience // Dig. DIS. SCI. 2009. V. 54 (10). P. 2242-2246.
24. Harewood G. C., Baron T. H., Rumalla A. et al. Pilot Study To Assess Patient Outcomes Following Endoscopic Application Of Photodynamic Therapy for Advanced Cholangiocarcinoma // J. Gastroenterol. Hepatol. 2005. V. 20. P. 415.
25. Hintze R. E., Abou-Rebyeh H., Adler A. et al. Magnetic Resonance Cholangiopancreatography-Guided Unilateral Endoscopic Sent Placement for Klatskin Tumors // Gastrointest. Endosc. 2001. V. 53. P. 40.
26. Isayama H., Komatsu Y., Tsujino T.et al. A Prospective Randomised Study of "Covered" Versus "Uncovered" Diamond Stems for the Management of Distal Malignant Biliary Obstruction // GUT. 2004. V. 53. P. 729.
27. Kaassis M., Boyer J., Dumas R. et al. Plastic or Metal Stems for Malignant Stricture of the Common Bile Duct? Results of a Randomized Prospective Study // Gastrointest. Endosc. 2003. V. 57. P. 178.
28. Katsinelos P., Vasiliadis T., XIARCHOS P.et al. UrsodeOoxycholic Acid for the Treatment of Amoxicillin-Clavulanate Potassium-Indra-Hepatic Cholestasis: Report of Two Cases // EUR. J. Gastroenterol. Hepatol. 2000. V. 12. P. 365-368.
29. Lindor K. D., Gershwin M. E., Poupon R. et al. PRIMARY BILIARY CIRRHOSIS // HEPATOLOGY. 2009. V. 50 (1). P. 291-308.
30. Mato J. M., Camara J., De Fernandez P. J., Caballeria L., Coll S., Caballero A.et al. S-ADENOSYLMETHIONINE IN ALCOHOLIC LIVER CIRRHOSIS: A RANDOMIZED, PLACEBO-CONTROLED, DOUBLE-BLIND, MULTICENTER CLINICAL TRIAL // J. Hepatol. 1999. V. 30. P. 1081-1089.
31. Nam Q. N., Kenneth F. B., Janak N. S. Cholangioscopy and Pancreatoscopy // Gastrointestinal Endoscopy. 2009. V. 70 (6).
32. Neri S., Signorelli S. S., Ierna D., Mauceri B., ABATE G., Bordonaro F., Cilio D., Malaguarnera M.Role of Ademetionine (S-ADENOSYLMETHONINE) IN CYCLOSPORIN-INDUCED CHOLESTISIS // Clinical Drug Investigation. 2002. V. 22. P. 191-195.
33. Pares A., Caballerial L., Rodes J. et al. Long-Term Effects of Ursodeoxycholic Acid In Primary Biliary Cirrhosis: Results of a Double-Blind Controlled MultiCentric Trial // J. Hepatol. 2000. V. 32 (4). P. 561-566.
34. Poupon R. E., Lindor K. D., CAUCH-DUDEK K. et al. Combined Analysis of Randomized Controlled Trials of Ursodeoxycholic Acid In Primary Biliary Cirrhosis // Gastroenterology. 1997. V. 113 (3). P. 884-890.
35. Prince M. I., Burt A. D., Jones D. E. HEPATITIS AND LIVER DYSFUNCTION WITH RIFAMPICIN THERAPY FOR PRURITUS IN PRIMARY BILIARY CIRRHOSIS // GUT. 2002. V. 50 (3). P. 436-439.
36. TERG R., CORONEL E., SORDA J. et al. Efficacy and Safety of Oral Naltrexone Treatment for PRURITUS OF CHOLESTASIS, A CROSSOVER, DOUBLE BLIND, PLACEBO-CONTROLLED STUDY // J. Hepatol. 2002. V. 37 (6). P. 717-722.
37. Zein C. O., Jorgensen R. A., Clarke B., Wenger D. E., Keach J. C., ANGULO P., LINDOR K. D. Alendronate Improves Bone Mineral Density In Primary Biliary Cirrhosis: A Randomized Placebo-Controlled Trial // J. Hepatol. 2000. V. 32. P. 561-566.

A. Yu. Baranovsky *, doctor of Medical Sciences, Professor
K. L. Rahelielson *,
N. V. Semenov *, Candidate of Medical Sciences, Associate Professor
E. G. Solonicin **, candidate of Medical Sciences

* GBOU VPO SZGMU. I. I. Mechnikov Ministry of Health and Social Development of Russia,
** FGBU GKB № 122 them. L. G. Sokolova FMBA Russia, St. Petersburg

Itching can be accompanied by the appearance of "liver stars", various rashes and pigmentation of the skin (the so-called "liver stains").

What causes itching the skin

Causes of itching

Itching the skin arising from the disease of the liver can be both at any skin place and all body. The blackens that affect the nerve ending of the skin. This happens for the following reasons:

Itching, tormenting the skin, is a symptom of liver disease. Also to the liver volatile:

1. Poisoning organism substances. Chemical compounds and metals, such as bilirubin or copper, can be poisonous for the body in large doses.
2. Viral diseases. Most often, the body itches when hepatitis. The accumulation of salts and bilirubin occurs, which penetrate the blood, which provokes the occurrence of itching.
3. Alcohol. The use of drinks containing alcohol leads to the death of hepatic cells and cirrhosis.
4. Pharmacy medicines. Chemotherapeutic events, antibiotics, drugs affecting the hormonal background - all this negatively affects the liver. Particularly adversely reflected on the organ of phenothiazine, phenobarbital, erythromycin, as well as anabolic steroids.

Cholesteas

The main cause of the skin ferrous with the disease of the liver - cholestasis, incorrect circulation of bile acids, penetration of poisoning substances into the overall blood flow. Most often, palms of hands and feet are beginning - so acids are distinguished through the pores of the epidermis.

Why are these connections so important to the body? The mission of the acids is as follows:

1. Dispersion of fats and promoting their suction.
2. Elimination of foodstuffs in the gastrointestinal tract and as a result, getting rid of constipation.
3. Absorption fat-soluble vitamins.
4. Normalization of cholesterol in the blood.
5. Maintain intestinal microflora with elimination of malicious bacteria.

When the liver works correctly, acids come out with bile, without falling into the blood due to its toxicity. With damage to the organ, the biliary duct is compressed and closed, - for this reason, the acid penetrate into the bloodstream, which provokes the occurrence of spindles on the body. Basically, this happens under cholangitis, biliary disease and cholecystitis.

If you take a challenge problem, it fails in the disinfecting activities of the body, and the infection can be penetrated through the wounds, which threatens the appearance of uluses and rash.

How to determine that the cause of itch is a liver disease

If there is a liver, itching is "to blame" in the emergence of the desire, itching is quite strong and without a certain localization. It is more often manifested at night, and attempts to rack the clagging belly, or the hand remain without a result. Antihistamines also do not help, although they are quite effective to eliminate allergy attacks.

Hurt right side

In addition to itching about problems with the liver signals the following symptoms:

1. Yellow either a little blushing leather.
2. Increases sweating.
3. Different rashes are formed, for example, telegangectasia or acne.
4. The bouts of heartburn and nausea appear.
5. There is a strong stencil smell of sweat.
6. Hurt right side. There are faults in the activities of hepatocytes.
7. Cal becomes unstable, can torment constipation or diarrhea.
8. There is a burning mind and legs, as well as the desire to scratch them.
9. The tongue is covered with a white chain, they are formed on it and cracks.

To determine if the patient has a problem in the field of liver, the doctor can send a patient for surveys:

1. Ultrasound liver, pancreas and gallbladder;
2. CT, if the disease is running either when a diagnosis is clarified if other methods did not help;
3. Analysis of blood reducibility;
4. Blood fence on biochemical and general examination.

Treatment of itching with liver diseases

Treatment methods

In case of diseases of the liver, caused by the sophisticated itching, the following means are assigned:

• Disinfecting, facilitating blood purification by neutralizing malicious substances. The most popular is activated carbon.
• Antiflogistic - eliminating inflammatory processes. Treatment of cholecystitis and cholangitis rarely costs without them.
• Antiseptic and antiviral.
• Connecting bile acids, bilirubin and other malicious substances in human blood.
• Strengthening the immune system.
• Weakening the effect of bile acid on the liver cell - hepatocytes, for example, rifampicin, and improving its circuit: These include metronidazole.
• Hepatoprotectors - to strengthen and update liver tissues, as well as protection against poisoning the organism substances, such as medical drugs or harmful, low-quality food, alcoholic beverages.

Also, the liver disease affecting the skin is treated:

• Methods of operational intervention.
• Vitamin therapy and intake of probiotics.
• Cancellation of pharmacy medicines provoking the emergence of cholestasis.

Preventive measures

In order not to carry out the treatment of the skin ferrous, you need to treat your health carefully, and also pre-protect the liver. This is recommended for this:

1. Do not allow overheating of the skin - do not walk in the bath or sauna and do not neglect the cold shower in the hot season.
2. Remove underwear from synthetic tissue.
3. Get rid of bad habits that include smoking and drinking alcoholic beverages.
4. Apply gels or ointments, cooling skin cooling cells. Often, such drugs contain phenol or menthol that have anti-face impact on the skin.
5. Do not overload yourself to physical exertion and excessive emotions that can lead to stress.
6. Stop taking drugs if they provoke skin irritation.

Proper nutrition

In addition, it is necessary to conduct treatment and observe prophylactic measures, it is worth thinking about the diet. The following products are useful for unintention.

• Soups on a vegetable basis. The first dishes on meat, mushroom and fish broth are prohibited.
• Sunflower and butter.
• Non-fat dairy products, such as cottage cheese or sour cream, cheese.
• Lean meat from the bird, for example, chicken - boiled or baked, low-fat beef. Fat meat and fat is better to keep banned.
• Different cereals.
• Honey and sugar.
• Bread and remaining baking based on rye or wheat flour. But boreholes from the dough are contraindicated.
• Vegetables, berries, fruits (exception - too acidic kinds). Cannot be eaten by radishes, radish, green onions. Also, the ban remains sorrel and spinach.
• Juices, kisins, jams from natural products, without adding chemicals.
• Larovable tea and coffee with cow milk. It is forbidden to use black coffee and cocoa.

• Egg dishes, such as scrambled eggs or omelet. However, 1 egg per day can be used without harm to health.
• Fatty fish grade.
• Canned food, marinades, caviar.
• Ice cream, chocolates, various cakes and cream cakes.
• Spicy seasonings, such as mustard.
• Alcohol.

Medical preparations

Treatment of skin ferrous with liver diseases can be carried out using the following tools:

1. Activated coal - absorbs harmful and dangerous acid and connections for the body.
2. Enterosgel - absorbs annoying substances, does not have a negative effect on the mucous membrane.
3. Attoxil - frees the body from poisoning enzymes. It has antiseptic, disintellation and healing effect.
4. Carsyl - based on Silimarine, manifests antitoxic and hepatoprotective properties.
5. Holdexan is a hepatoprotector, increases immunity, leads choleretic processes to normal.
6. Cholestyramine - struggles with liver disease in various etiology.
7. Hepabena is based on flimsy extract, improves liver operation, reanimates the affected tissues of this organ, accelerates bile outflow.
8. Cycvalon - has an anti-inflammatory, analgesic, choleretic property, stabilizes the chair.
9. Galstina - homeopathic remedy, produces treatment and restoration of bile ducts and liver.
10. Exthol - hepatoprotective medication, removes excess cholesterol from bile.
11. Phosphoglie - based on glycyrrhizic acid, manifests an anticipal and cytoprotective effect, and also eliminates allergic reactions.
12. Uroofalc - hepatoprotective agent, conducive to dissolving bile stones: Conductors.
13. Hofitol is a phytopreparation that manifests a choleretic property, reanimates liver cells.
14. Esssential Forte - Updates liver tissue texture.
15. Heptral - hepatoprotector, increases the content of adhemationine, has a choleretic property.

It must be remembered that itching during liver diseases is just a symptom. Therefore, to eliminate skin irritation, you need to find the root cause of illness and start treating the liver.

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Itching the skin is an unpleasant phenomenon that is not only physical, but also psychological discomfort. Usually its appearance is associated with dermatological diseases or allergic reactions, but in fact it is not always true, because sometimes itching can appear due to disorder of the functions of the internal organs, in particular, liver. How to distinguish the so-called liver itching from usual, and how to get rid of this problem?

Itching skin with liver diseases

Why is the skin with the liver diseases?

Skin covers with violations of the liver function Itching due to the stagnation of bile and often appear together with the jaundice, but sometimes it happens that itch is the first and only sign of the liver problems.

Symptoms of diseases of the liver

It arises due to the impact on the nerve ending of the skin of bile acids, which, with the normal functioning of the organ in the blood, do not fall.

This happens in a number of diseases, which includes:

Biliary cirrhosis of the liver

How to distinguish the usual itching from the liver?

The sebum itch, which is caused by impaired liver functions, is quite intense, painful and occurs at night. Combing does not bring relief, and in addition to itching, the patient has such symptoms such as rashes, vascular stars, bruises, jaundice, dyspeptic disorders and pain in the right hypochondrium. Another difference is that the reception of antihistamine drugs in this case practically does not give the desired effect.

Differences of the hepatic ferry from the usual

How to get rid of itching?

To cure itching, which occurs when the liver disorders are impossible, since it is not a disease, but a symptom. If it does not disappear for a long time, you should immediately consult a doctor, otherwise the disease can go too far. In suspected such pathology, it is necessary to undergo an ultrasound, as well as to pass the generally illicnic and biochemical blood test.

But it is possible to alleviate itching with the help of some drugs, diet and simple hygiene rules.

If a person is tormented by a permanent skin itch, the following rules should be followed:

• avoid overheating of the skin, do not visit the bath and sauna, and at the hot season to take a cool shower;

Do not overheat the skin

We use creams with phenol and menthol

Medications

In addition, with the skin itching and related diseases, antiviral, antibacterial and anti-inflammatory drugs are needed, as well as vitamins and probiotics. It is important to note that self-treatment during violations of the liver function can significantly worsen the patient's state, so any drugs should be taken only after consulting a doctor.

Food

To reduce the manifestations of the hepatic tooth and at the same time, clean the liver from slags and toxins, you should pay special attention to food - a special diet is needed with a reduced amount of oily, fried and acute foods (table No. 5).

Diet with liver itchide

Bread from rye and wheat flour, products from a non-propelled test

Dough

Non-fat sour milk (cottage cheese, sour cream, cheese)

Cupcakes and Cakes with Cream, Ice Cream, Chocolate

First dishes on vegetable broth

Scrambled eggs, omelet, boiled boosted eggs

Butter creamy and vegetable (no more than 50 g daily)

Soups on meat, fish and mushroom decoctions

Beef without fat, chicken and other types of lean bird meat in boiled or baked

Fat meat, fat

Eggs (no more than 1 pc. Per day)

Canned food, smoked foods, caviar

Fruits and berries (except very acidic)

Sorrel, spinach, green onions, radishes, radish

Sugar, honey, jam

Sharp spices, mustard, horseradish

Natural juices, compotes and fruit and berries

Black coffee, cocoa

Fastening tea, coffee with milk

Finally, it is important to note that the above-mentioned means are able to reduce the intensity of the hepatic tooth, but not to eliminate it completely. This requires complex therapy, and most importantly - the treatment of the primary disease, which caused the cause of unpleasant sensations.

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Itching the skin of the body: the causes associated with the liver

What body of our body is the laboratory for disinfecting the human body? That's right, this is a liver. It processes toxins that fall into our stomach with poor-quality food and water. These hazardous substances are destroyed and derived from the human body. Also, the liver produces bile, which is involved in the process of digestion, synthesizing hormones and vitamins. If a malfunction occurs in this body, there are serious health problems in general. Itching body in the diseases of the liver is one of the leading symptoms, but people often do not pay attention to it, beyond with an allergic reaction.

What is itching

Itching is called a pathological desire to comb clerics or mucous membranes. It can be local and general. Local skin itch is schania only some parts of the body. Most often, it is localized on the head, in the area of \u200b\u200bthe rear pass, under the mouse or in groin, on the hands of hands. The common nature is striking almost the whole body. It is not easy to get rid of obsessive combing, because first it is necessary to determine the cause. Itching body with liver diseases is a fairly common phenomenon that requires an immediate response.

Variety of reasons

The main causes of the skin can be considered inflammatory and infectious diseases of the skin. However, there are other processes and diseases provoking itching:

• stress caused by stress;
• neurological diseases;
• allergic reactions;
• liver diseases (cholestasis, cirrhosis, hepatitis and other);
• blood disease;
• helmintosis (diseases caused by pathogenic worms - helminty);
• hormonal disorders and others.

Due to the large number of reasons, it is very difficult to put the correct diagnosis based on the patient's complaints. Therefore, the persons who are concerned about the skin itching, the doctor will recommend to undergo a comprehensive examination, including a number of instrumental and laboratory research methods.

Liver cirrhosis - cause skin

Skin itching during cirrhosis of the liver at the initial stages of the disease is the only symptom. Such itching worries the patient for several months to the emergence of initial signs of jaundice. Then general weakness, sweating, stupid pain in the liver area are added to skin combing. When progressing cirrhosis, a number of complaints arise:

• increasing body temperature;
• jaundice;
• stool impairment (diarrhea alternating with constipation);
• feeling of bitter taste in the mouth;
• nausea or vomiting bile.

Why occurs skin itching during cirrhosis of the liver? Against the background of jaundice, the number of bile components in the blood increases. These harmful substances (bile acids, bilirubin, copper compounds), penetrating the bloodstream, poison the body. If a person comes to a doctor in time, the diagnosis will be installed at an early stage of the disease. Adequate treatment in such a situation will prevent the beginning of irreversible processes.

Cholestasis - the beginning of all problems

In case of violation of the synthesis and outflow of bile, a state is developing, called cholestasis. This process is not a disease and with timely appeal to the doctor well treats. Skin itching at cholestasy is a symptom of all diseases of the liver associated with jaundice (hepatitis, cirrhosis, psoriasis). He arises due to the blockage of bile ducts under the action of drugs or infections. Sometimes cholestasis syndrome develops during pregnancy.

Conduct cholestasis and some other diseases and conditions:

• intestinal dysbiosis;
• some hereditary pathologies;
• poisoning poisoning and drugs;
• alcoholic liver disease.

It is necessary to treat in time

The body of the body in the disease of the liver can become generalized and cause the presence of combs that will become an entrance gate for infections. Therefore, it is necessary to urgently get rid of an unpleasant symptom.

Since skin itch is caused by an excess of bile salts, then they need to withdraw them from the body. There are several methods.

• To begin with, the patient, as a rule, is prescribed the reception of drugs, which stimulate the withdrawal of bile acids into the intestine.
• Diet No. 5 will help to establish their metabolism.
• If there is a mechanical jaundice, then the laboratory or surgical intervention is shown. It is aimed at eliminating the reasons that prevent the normal bile outflow (bile stones, tumors, the narrowing of bile ducts).

How to remove this skin with cholestasy? Fully getting rid of this symptom will not be able until the cause of the liver and biliary tract will be eliminated. But to reduce itching will help limited psycho-emotional loads, a healthy lifestyle, fulfilling all the appointments of the doctor.

Other liver diseases with the symptoms of itching

Acute viral hepatitis

Cause skin itching can acute viral hepatitis. The patient complains about the violation of the chair, severe nausea, pain in the hypochondrium on the right. The feeling of the unbearable itch lasts until several months. Treatment is based on the patient of nutritional rules and their knowledge of a healthy lifestyle. Alcohol and tobacco products, acute and oily food, carbonated drinks and tea are excluded. Medical treatment includes the use of hepatoprotectors that stimulate the proper functioning of hepatic cells.

Psoriasis

With a psoriasis associated with a liver disease, itching is not a leading symptom. At the beginning of the disease, pink foci appear on the skin of the forehead, around the eyes, knees and elbows. Then these formations are transformed into dense silver flakes that appear practically throughout the body. Rash itch, but there is no pain. With the further development of the disease, constipation appear, belching, heartburn and bitterness in the mouth.

How to remove itching during psoriasis? To solve this problem, it is necessary to treat the underlying disease, and not eliminate its manifestations. In Psoriasis, the doctor recommends a patient compliance with a strict diet, cream and ointment, containing hormones (synaphlated, eloc). Patients should be taken vitamin D, which improves the condition of our skin.

Must take measures

When the whole body is drawn, it is simply impossible to stop in place. How to remove the skin of the skin? One of the primary means is the effect of cold. It can be applied to the item body part of a towel, moistened with cool water or take the invigorating shower. A very good effect has a cold decoction of oats, which should be wiped off the affected areas.

Mazi with a cooling effect, which includes menthol and camphor, are also able to facilitate the state. True, they act shortly. They have to be applied often, which leads to PH-imbalance of the skin.

Antihistamines can also be used. It should be borne in mind that many of them have a sedative effect, which is very undesirable for individuals of individual specialties (drivers, builders and others).

To remove the strong itching, the use of valerian tinctures, which acts on the nerve endings - nerves stop responding to irritation and itching gradually subsides.

By eliminating this unpleasant symptom, remember that itching will not disappear anywhere, if you do not get rid of its cause. Take care of yourself and your liver!

Itching the skin of the body with liver diseases - types of rashes, treatment and diet

The disorder of the outflow of bile in the body affects the internal organs and skin cover, causing the skin of the body of the body in diseases of the liver. Having found such a symptom, you should immediately contact the doctor, for the right diagnosis and appointment of appropriate treatment. To remove the manifestations of itching in this case, can medicines, a diet and compliance with some hygiene rules.

What is itching body

It is possible to define this concept as follows: itching the body is a feeling of discomfort, which causes the desire to comb skin. It may occur over the entire surface or on certain areas of the dermis. Skin itch is not a separate disease, and is a sign of the ailments of internal organs, epidermis. A list of diseases that cause uncomfortable sensations of this species is very wide.

Causes of skin with liver disease

The feeling of itching and the formation of rashes on the skin can be provoked by a few liver. Often, these phenomena arise under the influence of the disease, the same as cholestasis and hepatitis S. Specialists identify the following causes of the skin with liver disease:

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Cholesteas

The development of this pathology is due to biliary diseases or oncological neoplasms, under which a failure of bile outflow failure. The burning and itching at cholestasy appear as a result of bile acids in the bloodstream. By the nature of the course, the disease may be intrahepatic or extrahepted, there is also a chronic or sharp form. The cholestatic itch is accompanied by digestive disorders, sleep disorders (insomnia), fever, general weakness, malaise and pain in the head.

Itching with hepatitis with

A common symptom is itching during hepatitis C - the manifestation occurs at about about a quarter of the contaminated. According to doctors, the phenomenon arises due to the accumulation of toxic substances, which in the liver diseases cannot be effectively removed from the body. With violations of the filter organ, bile acids and bilirubin occurs. Increased level of these substances provokes the yellowing of the skin and eye scool, itching and rash when hepatitis S.

Symptoms of hepatic serpent

In case of liver diseases, many pathological changes appear on the skin of the body. It is important to quickly recognize them, because it is more effective to treat the disease in the early stages. In addition to unpleasant sensations, the symptoms of the hepatic ferry are believed:

• uncharacteristic for a specific person skin color: it can become paler or darkness;
• raising sweating;
• the appearance of edema of the face and limbs;
• pain in the right hypochondrium;
• peeling of the skin;
• combing and cracking on the body;
• on the skin can form a blue shade strips;
• rash.

Hepatic spots

The rash with liver disease can manifest itself in several forms:

• The formation of glassware - occurs when the synthesis of immunoglobulin synthesis is liver. As a result, an immune imbalance is observed, which provokes the stains of this species.
• Papulas and allergic spots are a reaction to a decrease in the liver function responsible for detoxification.
• Violation of the synthesis processes in the liver provoke the appearance on the skin of small bruises. In patients with such a disease, an increased risk of treatment with hematomas occurs.
• Spots can be extensive and look like red palms. The phenomenon can go to the feet. Such redness is accompanied by high temperature.
• The vessels protruding over the skin (vascular stars) are localized in the area of \u200b\u200bthe back, hands, neck and face.
• The rash with hepatitis is a yellow plaque, which are concentrated in the footsteps, upper and lower extremities, eyelids, armpits.

Hepatic stains of red, which are disappearing during palpation, and then return, are parmaral erythema.

How to distinguish the usual itching from the liver

You should know how to distinguish the usual itching from the liver, so as not to be mistaken in the diagnosis. The uncomfortable sensations of the body caused by the diseases of the liver are intensive in nature, it appears at night. They are accompanied by rash, the formation of vascular asterisks, bruises, bad well-being, pain in the side of the right and jaundice. Itching the skin of the body in diseases of the liver is different from allergic because antihistamines (tavergil, citrine) do not demonstrate its effect.

Treatment of hepatic ferry

To eliminate the body skin, symptomatic therapy is used to eliminate the body of the body. If you are watching this phenomenon for a long time, you should seek medical care so that the rash does not give complications. Treatment of hepatic ferry will be able to easily be faster in the early stages. To relieve it, follow some recommendations:

• Do not overheat the skin, give up visiting the bath, sauna. If the covers began to be hidden when it was hot on the street or indoors, take a cool shower.
• Choose underwear, clothing from natural materials to reduce annoying effect.
• Refuse bad habits: smoking, alcohol.
• Treat the skin on the affected areas with ointments, gels having a cooling effect to improve your condition.
• Try to avoid overloads of emotional and physical nature that provoke the strengthening of sebum seizures.
• If the itching of the body in diseases of the liver was caused by the toxic effects of drugs, cancel their reception.

Treatment of the skin of the skin of the body drugs

Therapy with drugs is carried out for the treatment of the disease that provokes itching. Ultrasound, biopsy, general and biochemical blood test are prescribed for the diagnosis. These methods will help determine the degree of inflammatory processes, the localization of the illness. After the necessary studies are prescribed treatment, which depends on the disease that causes itching and other manifestations.

In addition to medicines, surgical methods can be used. If cholestasis was caused by a collection of bile outflow, which occurred at the overlap of the ducts and caused intoxication with bile acids, a special drainage is installed. Such a device will help to derive an excess substance from the gallbladder, will contribute to the rapid removal of the symptoms of intoxication.

Treating the skin of the skin of the body drugs is carried out by means of the following categories:

• antagonists of opioid receptors (Naltrekson, Naloxone);
• bile acid derivatives (cholestipol, cholestyramine);
• drugs of ursodeoxycholic acid in large doses.

To relieve the skin of the body, the following drugs can be assigned to the bodies of the liver:

• sorbents (coal activated, enterosgel) - acting in the intestine, help to remove toxic substances from the body;
• vitamins of the fat-soluble group (A, E, K, D);
• anti-inflammatory drugs - help reduce inflammation in the place of damage to the tissues of the gland;
• immunostimulating drugs - help with a weakened immunite;
• probiotics - contribute to the normal functioning of the intestine;
• antibacterial, antiviral agents - participate in the elimination of pathogenic flora.

Proper nutrition

The component of the successful struggle of the skin of the skin with the diseases of the liver is the proper nutrition. Experts recommend to clean the fried foods, greasy and sharp, which harm the filter organ. It is necessary to eat fractionally - the five-volume meal is considered optimal. It is not recommended to overeat, because excessive food intake loads the liver. Doctors prescribe patients using a special diet number 5.

Diet at cholestuza

Dietary table No. 5 is shown in the following diseases:

• chronic hepatitis forms;
• in the acute flow of hepatitis, a cholestasy can be used at the final stage of treatment;
• cirrhosis of the liver;
• disorders of the work of biliary tract;
• jelly disease.

It is forbidden to use such a system of nutrition to people suffering from disorders of the stomach or intestines. The main principle of the diet is the minimum consumption of fats. It is eliminated by a dish, one of the components of which is purr, cholesterol, essential oils and oxalic acid. Salt consumption must be limited or not to apply at all. Prepare food preferably with cooking or baking.

The basis of the diet on such a diet should be vegetables and fruits. These products contain many pectins and fiber. The right drinking mode involves the use of a large amount of water on an empty stomach. The daily volume should be at least 1.5 liters of clean water. Such a diet can not be an alternative treatment, but is an integral part of complex therapy. In the chronic flow of the disease, the power system helps minimize the risk of exacerbations.

• vegetable, dairy or fruit soups without adding roasted;
• baked or boiled non-fat varieties of meat or fish;
• pasta;
• salads, stew and other vegetables dishes;
• sweet types of fruits, berries;
• natural juices, bums from herbs, green tea;
• bran or wholegrain bread.

The nutritionists have a list of products that are allowed to eat in limited quantities with a liver itchine:

• Low or low fatty dairy products. Maximum daily consumption should be 200 g.
• Eggs can be equipped with 1 pc. per day. If you wish to make an omelet, use only proteins for its cooking.
• Homemade jam, which does not contain artificial additives and preservatives.
• Among the sweets, choose a shell, marshmallow or marmalade for 70 g per day.
• In moderate quantities allowed to use spices.

In case of liver disease, it is impossible to use:

• fatty meat, smoked, canned, sub-products;
• sharp, fat, fried dishes;
• mushrooms and legumes;
• sweets, especially chocolate and ice cream;
• alcohol-containing and sweet carbonated drinks;
• onions, garlic, sorrel, radishes, cauliflower;
• cocoa, coffee.

Stock Foto Spots on skin with liver disease

Video: Itching body with liver diseases

The information presented in the article is familiarized. Article materials do not call for independent treatment. Only a qualified doctor may diagnose and give recommendations on treatment based on the individual characteristics of a particular patient.