CC BY
2«COyyOMUM-JMTMaL» 2023 / MEDICAL SCIENCES
13
UDC: 616.366-002
John Elorm Dzemekey
student
Bukovinian State Medical University, Chernivtsi
Dudka Tetyana
PhD, Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases, Bukovinian State Medical University, Chernivtsi
Dudka Inna
PhD, Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases, Bukovinian State Medical University, Chernivtsi DOI: 10.24412/2520-6990-2023-12171-13-14 EARLY DIAGNOSIS OF CHANGES IN THE GALLBLADDER IN PATIENTS WITH COPD
Summary:
The paper deals with the results of the research which show the presence of typical signs of chronic non-stone cholecystitis in patients suffering from chronic obstructive pulmonary disease (COPD) as well. Frequency of origin of diseases of gall-bladder is analysed in patients with lung pathology.
Keywords: chronic obstructive pulmonary disease, chronic non-stone cholecystitis, gallbladder, gallbladder dyskinesia, sphincter of Oddi, ultrasonographic examination.
Introduction. COPD patients often have a multitude of other chronic conditions that can influence the prognosis of COPD and complicate the disease management [5]. Patients with COPD often die prematurely after suffering for many years due to COPD or its comorbid conditions [4]. Nowadays the problem of development and progressing of inflammatory and dysmetabolic diseases of the gallbladder - chronic non-stone cholecystitis (CNC), cholelithiasis is one of the most important problems in modern internal medicine having general medical and social value. Different authors describe the development of gastric ulcer, gastric and duodenal erosions, chronic gastritis, duodenitis, reflux esophagitis and sliding hiatal hernia, duodenogas-tric reflux, changes in the liver, inflammation of the biliary tract and pancreas in the patients with chronic inflammatory diseases of the lungs and bronchi [2, 6]. Chronic non-stone cholecystitis (CNC) combined with COPD, according to some authors, is known for the prevalence of aseptic inflammation in the gallbladder (GB), interrelation of exacerbations with COPD exacerbation, more torpid [3, 7], compared to COPD, and atypical course with less intensive pain syndrome, prevalence of dyskinetic phenomena over the inflammatory ones with formation of hypokinetic dyskinesias of the GB [8]. These studies of comorbidities are crucial because thoroughly understanding the nature and pattern of comorbidity is the foundation for physicians to provide broad yet appropriately targeted and prioritized treatments to enhance the COPD treatment outcome [1].
Material and methods. The study involved 92 patients: 30 patients with COPD (1st group), 30 patients with COPD of comorbid CNC in the acute phase (2nd group), 32 patients with CNC in the acute phase (3rd group) and a control group - 30 practically healthy individuals (PHI) of the respective age.
The diagnosis of chronic non-calculous cholecystitis and its phase was established on the basis of classical clinical symptoms, the results of instrumental
studies (ultrasonographic examination of the gallbladder, multi-moment 6-phase duodenal sounding with microscopy, microbiological and biochemical examination of the gallbladder portion of bile) according to the regulatory act recommended by the Ministry of Health of Ukraine.
Ultrasonographic testing of the liver, the GB and the pancreas was carried out in 100% of patients by means of an ultrasound scanner «Au-4 Idea» (Bio-medica, Italy). To assess the contractility of the gallbladder, dynamic ultrasound was performed to determine the size of the gallbladder, the volume of the gallbladder before and during 180 minutes after the introduction of the stimulus (50 ml of a 25% solution of magnesium sulfate), the contractility was calculated -the coefficient of contraction (CC) of the gallbladder, duration of the latent period of gallbladder contraction (min), duration of gallbladder contractions (min), duration of a full cycle of gallbladder motor activity (min).
Results and discussion. Exploring the functional status of the gallbladder and sphincter apparatus of hepatobiliary system, during duodenal intubation typical features for changes of gallbladder dyskinesia were defined in all groups of patients. In particular, the duration of the first phase, which indicates that the basal secretion of bile in patients of the 3-rd group exceeded the rate in the practically healthy people 42,5% more (p<0,05), while in patients of group 2 - the results was the opposite. The phase was shorter 23,5% less (p<0,05). Changes of patients in the 1-st group had a downward trend (p>0,05 ). Our attention was attracted to the changes of the number of secreted bile: in all monitoring groups were found a significant increase in the volume of secreted bile, which exceeded the rate in respectively 1,9; 1,6 and 2,6 times (p<0,05). In patients of the 1-st - 3-rd groups probable increase in the volume of secreted bile was also found, respectively in 3,4; 4,3 and 4,0 times (p<0,05) compared with normative data. Evidence of gallbladder dyskinesia in patients with chronic non-stone cholecystitis was the changes found
14
MEDICAL SCIENCES / <«g©yL©(MUM~J©U©MaL» 2©23
when analyzing the data of the 4-th phase of duodenal intubation (gallbladder contraction). In particular, the duration of the 4-th phase in patients of the 1-st- 3rd groups was significantly higher than in practically healthy people group, respectively in 1,7; 2,1 and 1,9 times (p<0,05), indicating the presence of hypokinetic gallbladder dyskinesia.
These data of duodenal intubation confirm the results of ultrasonographic examination of the gallbladder with the load of tryout breakfast by the standard method. According to the results obtained in patients of the 2-nd and the 3-rd groups, was established probable increase in size of the gallbladder: length - 43,2% and 25,7%, respectively (p<0,05), width - 29,2% and 17,9% (p<0,05), respectively, while the changes in the length of the gallbladder in patients of the 1-st group were unlikely, and the width was also higher than in the practically healthy people group in 13,6% (p<0,05). In patients of the 2-nd and 3-rd groups were found compression and thickening of the gallbladder wall, particularly in patients of the 2-nd group in 3,1 times, the 3rd group in 2,9 times (p<0,05).
Results of the study of the duration of the latent period of gallbladder contraction coincide with the data of duodenal intubation and indicate to its prolongation in patients of the 1-st, the 2-nd and the 3-rd groups respectively in 1,5; 2,0 and 1,8 times (p<0,05).
Conclusions. The findings, which have been obtained, allow us to state that more severe COPD causes higher degree of gallbladder hypokinetic dysfunction, biliary type hypertonic dysfunction of Oddi's sphincter, the activity in inflammatory process in the gallbladder, besides, the risk of gallstone formation, with predominant bile pigments and calcium in them, is bigger.
References:
1. Chetty U, et al. Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care. Br. J. Gen. Pract. 2017; 67: e321-e328. doi: 10.3399/bjgp17X690605.
2. Dal Negro RW, Bonadiman L, Turco P. Prevalence of different comorbidities in COPD patients by gender and GOLD stage. Multidiscip. Respir. Med. 2015; 10: 24-015. doi: 10.1186/s40248-015-0023-2.
3. Douglas W Mapel, Jenö P Marton. Prevalence of renal and hepatobiliary disease, laboratory abnormalities, and potentially toxic medication exposures among persons with COPD. Int J Chron Obstruct Pulmon Dis. 2013; 8: 127-134. Published online 2013 Mar 15. doi: 10.2147/COPD.S40123
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Accessed December 2020.
5. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int. J. Chron. Obstruct Pulmon Dis. 2015;10: 95-109.
6. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int. J. Chron. Obstruct Pulmon Dis. 2015; 10: 95-109.
7. Minakata Y, Ueda H, Akamatsu K, et al. High COPD prevalence in patients with liver disease. Intern Med. 2010; 49 (24) : 2687-2691.
8. Wacker ME, et al. Direct and indirect costs of COPD and its comorbidities: Results from the German COSYCONET study. Respir. Med. 2016; 111: 39-46. doi: 10.1016/j.rmed.2015.12.001.
