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Іванова Л.М., Луговськов Є.О. Стан холединаміки у хворих на хронічний некалькульозний холецистит у сполученні з ішемічною хворобою серця та
02.08.2014, 16:46

Резюме
Іванова Л.М., Луговськов Є.О. Стан холединаміки у хворих на хронічний некалькульозний холецистит у сполученні з ішемічною хворобою серця та ожирінням.
Для хворих на ХНХ у сполученні з ІХС та ожирінням характерними були диспептичний та больовий абдомінальний синдроми, останній частіше зустрічався при гіпо­то­нічно-гіперкінетичному варіанті дисфункції жовчного міхура.
Ключові слова: хронічний некалькульозний холецистит, ішемічна хвороба серця, ожиріння, дисфункція жовчного міхура.

Резюме
Иванова Л.Н., Луговсков Е.А. Состояние  холединамики у больных хроническим некалькулезным холециститом в сочетании с ишемической болезнью сердца и ожирением.
Для больных с ХНХ в сочетании с ИБС и ожирением характерными  были диспептический и абдоминальный болевой синдромы, последний чаще встречался при гипо­то­нически-гиперкинетическом варианте дисфункции желчного пузыря.
Ключевые слова: хронический некалькулезный холецистит, ишемическая болезнь сердца, ожирение, дисфункция желчного пузыря.

Summary
Ivanova L.N., Lugovskov E.A. Status of gall-bladder motility dynamic at patients with chronic noncalculous cholecystitis in combination with ischemic heart disease and obesity.
Dyspeptic and abdominal pain syndromes were characteristic for patients with noncalculous cholecystitis in combination with ischemic heart disease and obesity, in particular abdominal pain syndrome was more frequent at hypotonic – hyperkinetic variant of gall-bladder dysfunction.
Key words: chronic noncalculous cholecystitis, ischemic heart disease, obesity, dysfunction of gall-bladder.

Рецензент: д.мед.н., проф. В.О. Тєрьошин

УДК 616.366-002-036.12:616.12-005.4

ДЗ «Луганський державний медичний університет»

ГЗ «Луганский государственный медицинский университет»

State Establishment "Lugansk State Medical University"

propedevtika2011@yandex.ru, evg-lugovskov@yandex.ru

Diseases of the gallbladder (GB), from which suffers from 20 to 35.5 % of the adult population of Ukraine, refer to the common internal diseases. In the diagnosis of chronic non-calculous cholecystitis ( CNC ) considerable attention is paid to breach of gallbladder motorics [2, 3, 8 , 9]. Feature of Pathology GB  nowadays is a combination of 22.0 % with cardiovascular disorders , including coronary heart disease (CHD ), which is one of the major leading cause of death and disability of the population [1,7 ]. Leading role in the development of CHC and CHD takes the presence of obesity , which is seen as connected pathogenetic link in the development of atherosclerotic lesions, which are implemented through dyslipidemia. The combination of CNC , coronary heart disease and obesity adversely affect for the course and prognosis of comorbidity [6 ]. Due to the frequent presence of CNC combined with coronary artery disease and obesity improvement of diagnosis of this disease is not only a medical, but also social and economic problem [4, 5].
Relationship of academic programs, plans, themes : work performed in accordance with the basic plan for scientific research “Lugansk State Medical University” and this is a fragment of the theme of research on the topic " Rehabilitation of patients with combined therapeutic pathology '( state registration number 0106U0010837).

The aim of the study is to analyze the features of the gall-bladder motility dynamic for the patients with chronic non-calculous cholecystitis in combination with coronary heart disease and obesity.

Materials and methods

 We observed 71 patients with CNC combined with coronary artery disease and obesity between the ages of 23 to 59 years (mean age 42,5 ± 1,7 years). Comprehensive survey of patients included analysis of complaints, medical history, physical , laboratory and instrumental investigations in accordance with the Decree of Ministry of Health of Ukraine № 271 (2005) , number 436 (2006) and the recommendations of the European Society of Cardiology (2011).
Statistical analysis of the data was performed by the use of licensed software packages Microsoft Office 97, Microsoft Excel Stadia 6.1 / prof and Statistica .

Obtained results and discussion

In patients with CNC combined with coronary artery disease and obesity identified the following options disturbance of motor function of the kinetic GB: hypertonic - hyperkinetic dysfunction with an accelerated rate of emptying GB , high reactivity sphincter apparatus in combination with its high bandwidth ( 41 patient - 57.4 %) , hypotonic - hyperkinetic dysfunction with severe hypertonicity of sphincter of Oddi with signs of decline in contractile ability GB (20 patients - 28.7 %) and hypotonic - hypokinetic dysfunction with reduction in bandwidth sphincter apparatus on a background a significant reduction in contractile function GB (10 patients - 13.9 %). Thus, hypertonic - hyperkinetic variant usually met in patients with disease duration of 5 years , hypotonic - hyperkinetic - 5 to 10 years, hypokinetic - hypotonic - more than 10 years, that is dependent on the duration of the disease. The clinical picture of the disease also depends on the version of dyspeptic syndrome. Thus, when hypertonic - hyperkinetic variant prevailed in patients with pain syndrome ( 32 people - 79.3 %), which was characterized by the occurrence of sudden pain in the right upper quadrant of the irradiation zone to the right shoulder and right shoulder. Dyspeptic syndrome in these patients manifested by nausea and vomiting ( 27 people - 66.3 %).
Patients with hypotonic - hyperkinetic variant dysfunction GB pain was mixed, i.e. on the background of persistent pain occurred paroxysmal episodes. Dyspeptic manifestations in these patients were found significantly more often ( p < 0.01) , were presented by stagnation of bile, decreased appetite  (11 patients - 54.2%) , bitter and dry mouth (10 patients - 48.1 %) .
For the patients with hypokinetic - hypotonic option GB pain dysfunction independent of body position and had monotonous character. Diarrheal syndrome manifested by complaints on flatulence (9 patients - 88.6 %) , constipation (9 patients - 89.1 %) , anorexia (7 patients - 73.4 %), bitter and dry mouth ( 7 patients -70 , 0%). Patients with this variant dysfunction GB determined by periodical subfebrilitet (5 persons - 52.4 %), increased physical and mental fatigue (9 persons - 87.9 %).
For the objective examination of skin- visceral , irritative symptoms ( Ker , Murphy, Obraztsova, Grekova - Ortner ) and symptoms that suggest the aggravation CNC ( McKenzie , Boas , Aliyev ) were positive for the patients with all variants GB dysfunction (70 patients - 98.3% ), while for the  patients with hypokinetic - hypotonic variant were positive signs of right-sided jet syndrome ( point Yonash , Musset , symptoms BAKERS Karavanova ).
Conclusions
1. For patients with CNC combined with coronary artery disease and obesity characterized by abdominal pain and dyspeptic syndromes , the last one  often met with hypotonic - hyperkinetic variant GB dysfunction .
2. In the future we plan to explore the types of dyslipidemia for the patients with comorbidity .

Література

  1. Звенигородская Л.А. Клинико-диагностические особенности заболеваний органов пищеварения у больных с сопутствующей патологией сердечно-сосудистой системы / Л.А. Звенигородская, Л.Б. Лазебник, Ю.В.  Та­ран­чен­ко // Экспериментальная и клиническая гастроэнтерология. - 2003. - № 5.- С. 139-140.
  2. Москаленко В.Ф. Заболевания гепа­тобилиарной системы (распро­страненность, нерешенные проблемы) / В.Ф. Москаленко, Н.B. Харченко, М.В. Голубчиков // Зб. на­ук. праць співр. КМАПО ім. П.Л. Шу­пика. – 2000. – Вип. 9, кн. 4. – С. 5–10.   
  3. Попова Ю.С. Болезни печени и желчного пузыря. Диагностика, лечение, профилактика /  Ю.С Попова. – СПб.: Крилов, 2008.- 192 с.
  4. Фирсов Л.Ф. Холецистит - симптомы и лечение [Електроний ресурс] / Л.Ф.Фирсов // Лікар.-2009. - Режим доступу до журналу: www.likar-info.ua /articles/ 2009/ 01firsov.htm.    
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  6. Щербиніна М.Б. Особливості поширеності та захворюваності населення України на холецистит і холангит / М.Б. Щербиніна, М.І. Бабець // Сімейна медицина.-2008.-№1.- С. 126-129.
  7. Fox K. Guidelines on the management of stable angina pectoris. The Task Forse on the Management of Stable Angina Pectoris of European Society of Cardiology / K. Fox // Europ. Heart J. – 2006. - Vol. 27, № 11. - Р. 1341-1381.
  8. Cholecystitis, biliary tract surgery an pancreatitis: [Ed. overview] // Obstet. Gynecol. - 2004. - Vol. 104. - P. 17-24.
  9. Schirmer B.D. Cholelithiasis and cholecystitis / B.D. Schirmer, K.L. Winters, R.F. Edlich // J. Long Term Eff. Med.implants. - 2005. - Vol. 15 (3). - P. 329-338.      
Категорія: 5 (119) | Додав: siderman | Теги: ischemic heart disease, chronic noncalculous cholecystitis, obesity, dysfunction of gall-bladder
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