Aholia
The content of the article:
- Causes
- Forms
- Signs
- Diagnostics
- Treatment
- Consequences and complications
Aholia (acholic disease, acholic state) is one of the most striking symptoms of a number of biliary tract diseases, characterized by the cessation of the flow of bile from the gallbladder into the duodenal lumen.
With acholia, bile does not flow from the gallbladder into the lumen of the duodenum
Causes
The main reasons leading to the development of acholia:
- violation of the process of bile formation by liver cells;
- violation of the neuro-humoral mechanism of regulation of bile secretion;
- damage to the muscular membrane of the walls of the biliary tract;
- pressure on the walls of the biliary tract by neighboring organs, which leads to a decrease in their lumen and a decrease in motor function;
- mechanical blockage of the lumen of the bile duct with cicatricial stricture, tumor or stone;
- the formation of a biliary fistula that opens outward.
Normally, getting into the lumen of the duodenum, bile emulsifies fats, promotes the absorption of fat-soluble vitamins (A, D, E, K), suppresses the vital activity of putrefactive microorganisms, activates the activity of pancreatic and intestinal digestive enzymes.
With acholia, lipase, the enzyme responsible for dissolving fats, is not activated. As a result, the process of digestion and absorption of fats is disrupted. Approximately 70-80% of fats coming from food are excreted from the intestines with feces unchanged (steatorrhea is observed).
With acholia, the lipase enzyme is not activated, which is responsible for the breakdown of fats
Undissolved fats envelop particles of food masses, preventing the action of amylolytic and proteolytic enzymes on them, which disrupts the breakdown and assimilation of carbohydrates and proteins.
Impaired absorption of fat-soluble vitamins in acholia leads to hypovitaminosis. In particular, vitamin K deficiency is manifested by increased bleeding associated with disorders of the blood coagulation mechanism.
The termination of the flow of bile into the intestines promotes the activation of putrefactive microflora, which causes flatulence and general intoxication.
Forms
Depending on the stage of acholia, there are several types:
- preacholia;
- latent acholia;
- chronic (obvious) acholia.
By the intensity of the severity of clinical symptoms:
- easy;
- medium;
- heavy.
Depending on the patient's condition:
- compensated;
- subcompensated;
- decompensated.
Signs
Prolonged absence of bile flow into the duodenum is accompanied by impaired breakdown and absorption of nutrients, which is clinically manifested by the following symptoms:
- persistent constipation;
- a sharp decrease in weight, up to cachexia;
- lack of appetite;
- fetid light stool;
- dark urine (due to urobilin staining);
- itching of the skin;
- jaundice;
- hemorrhages on the skin;
- night blindness;
- bone mineralization disorders;
- general deterioration in health.
In some cases, against the background of acholia, hallucinations and delusions may occur.
Jaundice is one of the signs of acholia
If acholia lasts more than three months, then the symptoms described above are joined:
- pain in the hands;
- wobbly gait;
- thickening of the wrists;
- increased fragility of nails;
- tooth decay;
- severe osteoporosis;
- kyphoscoliosis;
- menorrhagia (in women);
- decreased libido.
Diagnostics
Diagnosis of acholia is carried out on the basis of:
- medical examination;
- collected anamnesis;
- biochemical blood test;
- fecal and blood lipid profiles;
- Ultrasound of the liver and biliary tract;
- fistula sounding.
Ultrasound examination of the liver and biliary tract can diagnose acholia
Treatment
Acholia therapy should be aimed at eliminating the cause that caused it, with the restoration and normal outflow of bile. For this purpose, carry out:
- restoration of patency of the biliary tract by surgery;
- fight against intoxication;
- compensation for the loss of bile;
- infusion therapy, which normalizes water and electrolyte balance;
- antibacterial therapy;
- treatment of liver failure;
- elimination of hypovitaminosis;
- correction of hemostasis and hemodynamic disorders.
In the treatment of acholia, diet therapy plays an important role. The diet of patients should consist of easily digestible and high-calorie meals. It must include vegetables and non-acidic fruits, vegetable fats. Alcohol, strong tea and coffee, fresh bread and pastries, animal fats, fatty and fried foods are prohibited. Food for acholia should be taken strictly at the same time 5-6 times a day in small portions.
The menu of a patient with acholia should consist of easily digestible and high-calorie dishes.
Consequences and complications
In the absence of timely treatment, acholia can lead to serious consequences:
- damage to the cardiovascular system;
- toxic encephalopathy;
- severe endotoxemia.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
