Lviv clinical bulletin 2016, 2(14)-3(15): 30-40

https://doi.org/10.25040/lkv2016.023.030

Characteristics of Syntropie Comorbid Extrahepatic Lesions in Patients with Liver Cirrhosis Depending on the Portal Hypertension Severity Degree

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M. Abrahamovych, M. Ferko

Danylo Halytsky Lviv National Medical University

Topicality. Liver cirrhosis is one of the most severe diseases in the world, therefore a special attention is paid to its diagnosis and treatment. Today liver cirrhosis is considered to be a chronic diffuse progressive liver disease, which is manifested by restructuring of its parenchyma in the form of nodular transformation and fibrosis due to necrosis of hepatocytes, the forming of shunts between the portal and central veins bypassing the hepatocytes with the occurrence of liver failure and portal hypertension – a key pathogenic factor. It is known that cirrhosis is not limited by the hepatobiliary system, but also extends to other organs and systems that can be considered as a cir­rhotic disease of the body with involvement in the pathological process of various organs and systems of the human body, interpreted as syntropic comorbid lesions that in most cases cause temporary, and in the future – stable inability to work, disability, often – death of the patient.

Despite the fact, that syntropic comorbid lesions of other organs and systems are considered to play an important role in determining the treatment strategy and prognosis of the patients with liver cirrhosis, their characteristics depending on the severity of portal hypertension – a key pathogenic factor in the appearance and increase of the severity of syntropic comorbid lesions, which is portal hypertension, is still not performed.

Therefore, the purpose of our work was to study the frequency of syntropic comorbid lesions of other organs and systems in patients with liver cirrhosis and determine its dependence on the portal hypertension severity degree.

Materials and methods. Into the study in randomized manner with the preliminary stratification by the presence of liver cirrhosis were involved 240 patients with varying degrees of portal hypertension severity [65 women (27.1 %) and 175 men (72.9 %); aged 21 to 78 years, average age – (48.4 ± 0.8 years)], who were hospitalized with the aim of the examination and treatment into created on the basis of the Internal Medicine Department N 1 of Lviv National Medical University and Gastroenterological Department of Lviv Regional Clinical Hospital, Lviv Re­gional Hepatological Center.

All the patients underwent a comprehensive clinical-laboratory and instrumental examination of all organs and systems, according to the requirements of modern medicine and also, improved by us, ultrasound Doppler-flowmetric examination of the abdominal cavity vessels, by our patented method, under which all the patients were stratified into three groups: the first group (portal hypertension of the 1st degree) included 122 persons (33 women (27.0 %) and 89 men (73.0 %)) aged 21 to 78 years (average age 46.4 ± 1.0 years), the 2nd (portal hypertension of the 2nd degree) – 57 patients (14 women (24.6 %) and 43 men (75.4 %)) aged 27 to 66 years (average age 48.2 ± 1.3 years) and the 3rd group (portal hypertension of the 3rd degree) – 61 patients (18 women (29.5 %) and 43 men (70.5 %)) aged 29 to 73 years (average age 50.2 ± 1.3 years).

According to the results of our research, can be affirmed the syntropic involvement of all the organs and body systems of the patients with liver cirrhosis into the pathological process. The frequency of them significantly (p < 0.05) increases with the increase of the portal hypertension severity degree.

Conclusions. Among all syntropic comorbid lesions found in patients with liver cirrhosis, hepatic encephalopa­thy [r = 0.73 (p < 0.001)], “caput medusa” [r = 0.72 (p < 0.001)], varicose veins of the esophagus [r = 0.69 (p < 0.001)], coagulopathy [r = 0.69 (p < 0.001)] and arterial hypotension [r = 0.69 (p < 0.001)] have the most pronounced dependence on the severity degree of portal hypertension. The frequency of them directly proportionally depends on the portal hypertension severity degree.

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