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Medicinal damage of a liver - Diseases of digestive organs at children

Table of contents
Diseases of digestive organs at children
Oral cavity
Diseases of teeth
Malformations of the sky and soft tissues of an oral cavity
Diseases of a mucous membrane of an oral cavity and gums
Diseases of lips and language
Sialadens
Digestive tract
Basic reasons of gastrointestinal frustration
Gullet
Atresia and esophageal and tracheal fistula
Guttural and tracheal and esophageal crevice, inborn stenosis of a gullet
Other diseases of a gullet
Stomach and intestines
Peptic ulcer
Inborn hypertrophic pyloric stenosis
Inborn impassability of intestines
Inborn impassability of a duodenum
Disturbances of turn of intestines
Inborn impassability of a small bowel
Inborn megacolon
Diverticulums and duplikatura
The acquired impassability of intestines
Intestines invagination
Foreign bodys of a stomach and intestines
Motive frustration. stomach and intestines
Anomalies of a structure of anorectal area
Infectious diseases of intestines
Nonspecific ulcer colitis
Illness Krone
Necrotic coloenteritis of newborns
The coloenteritis connected with treatment by antibiotics
Gastrointestinal symptoms of anaphylactoid purpura, gemolitiko-uraemic syndrome
Intolerance of food proteins
Eosinophilic gastroenteritis
Absorption disturbance syndromes
Malabsorption
Immunodeficiency and intestines
Syndrome of "a congestive loop"
Syndrome of a short small bowel
Gee's disease
Sprue after acute enteritis
Tropical to a spr
Whipple's illness, intestines lymphangiectasia, Uolmap's illness, idiopathic diffusion defeat of mucous
Enzymopathies and disturbances of mechanisms of transport of nutrients
Irritable colon
Acute appendicitis
Diseases of an anus, direct and large intestine
Tumors of a digestive tract at children
Hernias of a digestive tract at children
Exocrine part of a pancreas
Pancreatitis
Embryonic development of structure and function of a liver
Diagnosis of diseases of a liver
Cholestatic states at babies
Parenchymatous jaundices at children of chest age
Disturbances of a metabolism of a liver and zhelchevydelitelny system
Anomalies of a structure of bilious ways
Cysts of bilious channels
Cholestasia and diseases of a liver connected with completely parenteral food
Medicinal damage of a liver
Ray's syndrome
Chronic hepatitis
Wilson's illness — Konovalova
Indian juvenile cirrhosis
Damages of a liver at chronic colitis
Cirrhosis and chronic liver failure
Portal hypertensia and varicosity of a gullet
Fatty infiltration of a liver
Cholecystitis
Peritoneum diseases
Peritonitis
Peritoneum hernias

As principal organ in which drugs are metabolized the liver is especially subject to the damaging action of medicines and toxins. The probability of damage of a liver increases when at the same time apply 2 drugs. The matter is that one medicine can block the microsomal fermental systems necessary for a metabolism of another. Besides, changes in a liver can be caused by medicinal reactions of 2 types: predictable, depending on a dose, and unexpected, not depending on a dose (idiosyncratic). Potentially gepato-toxic drugs are listed in tab. 12-17.
Direct, depending on a medicine dose, the type of damage is caused by direct action of chemical compounds on cells of a liver, a microsome, a mitochondrion and the canalicular device. Hepatotoxins have the damaging effect by competitive oppression, involvement by means of essential metabolites in reactions unusual for them, and also owing to other disturbances of metabolic and secretory functions of hepatic cells. Such drugs as acetaminophenum or antimetabolites, cause a necrosis of hepatocytes owing to what there comes the decompensation of function of a liver. The chronic illness of a liver, from fibrosis and a periportal inflammation to extensive cirrhosis can become an effect of a direct hepatotoxic.
Indirect, not depending on a medicine dose, the type of injury of a liver meets seldom. It reflects the individual reaction caused by hypersensitivity to drugs or formation of unusual metabolites. Often serve as a releaser formation of covalent bonds with fabric macromolecules and the subsequent development of antibodies. Characteristic signs of medicinal hypersensitivity include the sensitization lasting 1 — 4 week period, recurrence of dysfunctions of a liver at repeated drug intake, the high frequency of the accompanying allergic manifestations (rash, fever, an eosinophilia and formation of granulomas in a liver). The morphological changes caused by idiosyncratic reactions are expressed by a cholestasia, an infiltratsiy parenchyma of a mononuklearama and eosinophils, a diffusion hepatocellular degeneration and a necrosis. At a cholestatic form the content of serumal aminotransferases while the level of an alkaline phosphatase sharply increases slightly increases.
Table 12-17, Gepatotoksichny substances


Medicine

Mechanism of toxic action

Leader
clinical
syndrome

Analgetics
Atsetamzhnofen (paracetamol) Acetylsalicylic acid Propoksifen

Straight line
The same Indirect

OG, HAG, MG
OG
X

Anesthetics
Halothane

The same

OG, MG

Antibiotics
Eritromioinestolat

Indirect (straight line)

X

Griseofulvin
Isoniazid
Nitrofurantoin
Oxacillinum
Quinacrinum
Rifampinum

The same
Indirect
The same
Indirect (straight line)

X
OG, HAG, MG
X
X
OG, MG OF X

Streptocides
Tetracyclines

The same Straight line

OG, HAG, HAG MG

Anticonvulsants Difenilgidaptoin (dilantin) Fenatsemid Trimetadion

Indirect
The same

OG, X, MG OF OG, X OG

Diuretics Hlortiazid Metildofa (Aldometum)

Indirect (straight line)

X
OG, HAG

Kvinetazon

Indirect

X

Cytotoxic means and immunosuppressors Azathioprinum (imuran) Hlorambutsil (leykera) 6 Mercaptopurinum Methotrexate Urethane

Direct Indirect Straight line the Same

OG
OG
OG, MG, C
C
OG, MG, C

The hormones and means influencing a metabolism Metiltestosteron Noretandrolon Estrogena's Androgens
Ethinylestradiol M etilestranolon Irogestina Noretidron

""

X, OG OF X, OG
X, OG OF X, OG
OG

Anti-thyroid means Methimazolum Propylthiouracil Tiouratsil Tiomochevina

Indirect the Same

X
OG
X, OG, OG MG

Hypoglycemic means Carbutamidum

»> »

OG

Medicine

Mechanism of toxic action!

Leader
clinical
syndrome

Chlorproramidum

Indirect (prya

X

 

wash)

 

Metageksamid

Indirect

X, OG, HAG

Tolbutamidum

Straight line (indirect)

X

Psychotropic drugs

 

 

Fenotiazina

 

 

Chlorpromazinum

The same

X

Mepasin

» »

X

Perfenazinum

» »

X

Prochlorperazine

Indirect

X, OG, HLG

Promazinum

The same

X

Tioridazip (melleril)

» »

X

Monoaminoxidase inhibitors

 

 

Iproniazidum

» »

OG, HAG

Isocarboxazid

» »

OG

Other psychotropic drugs

 

 

Chlordiazepoxide (librium)

» »

X

Diazepam (Valium)

» »

X

Etkhlorvinol (plaksidit)

» »

X

Imipraminum

» »

X, OG

Meprobamate

» »

X

Other means

 

 

Copper sulfate (for topikalny

Straight line

OG

uses)

 

 

Gland sulfate

The same

OG, HAG

Trimetobenzamid

Indirect

X

Tripelenamiya

The same

X

1 Straight line — the injury of a liver depending on a drug dose. Indirect — the injury of a liver which is not depending on a drug dose (idiosyncrasy).
2 OG — an acute hepatitis; HAG — chronic active hepatitis; MG — fulminant hepatitis (according to N. Zimmerman); X \cholestasia; C — cirrhosis.

On the contrary, at a hepatocellular degeneration and a necrosis the level of aminotransferases increases more than alkaline fos ~ fataza, and the prothrombinopenia is observed.
The idiosyncratic reactions caused by formation of gepatotoksichny metabolites are noted less often. Morphological and biochemical manifestations of this state are similar to those at hypersensitivity reactions. Stage of latency is more variable (from 2 to 52 weeks), allergic symptoms are expressed minimum or in general are absent. Reaction to reception of Iproniazidum and izoniazpd can be an example of reactions of this kind.
The diagnosis of a drug disease is made on the basis of the anamnesis (the instruction on drug intake, temporary communication of a clinical syndrome with the use of medicine). In favor of such diagnosis the rash, fever, an eosinophilia which are shown in parallel with liver dysfunction testify. Proof of toxicity
drug recurrence of symptoms after trial reception of the suspected medicine also serves (only those children who need and to take this medicine further can carry out such test.
Treatment consists first of all in the termination of the drug intake which caused side reactions. High-calorific [80 — 100 kcal/(kg-days)], protein-rich [2 g/(kg-days)] and carbohydrates the diet accelerates recovery process if the decompensation of function of a liver only did not develop. Treatment of a liver failure is described in section 12.101. A cholestasia without hepatocellular insufficiency it is possible to treat holestiraminy (8 — 16 g/days) or phenobarbital [3 — 5 mg/(kg-days)] with the purpose to remove an itch and jaundice. Specific treatment tsisteaniny at poisonings with acetaminophen see in appropriate section.
The forecast depends on how reception of toxic drug is quickly stopped, and from weight of initial damage of a liver. In most cases symptoms disappear in several days, biochemical indicators are normalized within several weeks and the condition of a liver returns to norm without any effects. In more hard cases after initial improvement portal hypertensia can develop. Fulminant hepatitis is rather rare complication.



 
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