Personal site of Ph.D Roman G. Myazin

Chronic Toxic Hepatitis

Patient T, 54, (case report 3468/148) entered the gastroenterology department of Volgograd Regional Clinical Hospital №1 on February, 18, 2002 with complaints of permanent aching pains in the right hypochondrium wih the irradiation to the left hypochondrium independently of food intake, nausea, sense of bitternes, constipation.

The diagnosis on admission to hospital: «Chronic toxic hepatitis, the stage of exacerbation».

From the anamnesis: during 10 years (from 1988 till 1998) the patient had worked at the Industrial Association «Chemistry-prom» and had a constant contact with mercury. In the winter of 1999 the above-named symptoms appeared for the first time, and the patient appealed for medical aid to the Gastroenterology Department (GED) of Volgograd Clinical Hospital (VCH) №7 where the diagnosis was formed: «Toxic hepatitis owing to chronic mercury intoxication». It was detected the increase of thymol test level up to 30 units.  In VCH №7 the patient underwent a course of infusion therapy in the combination with hepatoprotectors which had a positive dynamics. In the same year of 1999 the patient was assigned the II disability group due to the occupational desease. Later on the patient underwent the courses of inpatient treatment twice a year. In January, 2002 the patient had sharp pains in the right hypochondrium, and she was hospitalized to the GED of Volgograd Regional Clinical Hospital (VRCH) № 1. The patient has been suffering from the idiopathic hypertension of the II stage for 8 years.

Objectively: dermal integuments are of usual staining, scleras are subicteritious, the lower edge of the right lobe of liver comes 4 cm out of the right costal margin edge, it is sharp, the palpation is painful. The spleen isn’t palpable. According to the results of the abdominal cavity ultrasound investigation: the liver tissue is of usual echogenicity, has a small-grained structure, homogeneous. The anteroposterior size of right lobe of liver is 14,1 cm, of left lobe of liver - 7,9, of caudate lobe of liver – 3,4.

Liver biopsy: more than a half of hepatocytes in the punctate are with manifestations of ballooning degeneration. In the punctate were found adipose cysts round which a great number of leucocytes is visualized. It was detected a moderate number of Mallory’s hyaline corpuscles situated in the central parts of lobes.

Conclusion: the clinical presentation of chronic nonspecific reactive hepatitis owing to prolonged intoxication.

Common blood analysis: Er – 4,7´1012, Hb - 140 g/l, colour index – 0,9, reticulocytes -10 %, Tr - 270´109, Le - 4,8´109, b -1, e - 1, band neutrophils - 1, s – 59, l – 32, m - 6. ESR – 11 mm/h. Blood clotting time – 5 min. Blood glucose – 5,7 mmol/l. Whole protein – 82 g/l, albumins – 47 %, a1-globulins – 3 %, a2 – globulins – 12 %, b-globulins – 18 %, g-globulins – 20 %, A/G coefficient -0,89.

Coagulogramma: plasma recalcification time – 162 sec., trombotest rate – V, prothrombin index – 64 %, plasma fibrinogen – 3 g/l, fibrinogen B – low positive.

 Clinical urine analysis: yellow, transparent, reaction – acid, relative density – 1016, glucose – not detected, protein –not detected, Le – 1-2 within eyesight, Er – not detected, plano epithelium cells – not detected, cylinders –not detected.

Biochemical tests: MDA – 17,8 mkmol/l, DC – 1,45 u., Cat – 24,6 mkmol/ml/min, SOD – 0,6 conv.u/ml, GP – 4,2 mkmol/ml/min, SU – 1,5 u., SG -1,4 u., CPl – 31,5 mg%, NAG – 24,76 nmol/ml/min, SDG -96 mkmol/l/h, TDG –  102 mkmol/l/h, total bilirubin – 22,0 mkmol/l, thymol test -12 u., ALT – 0,32 mkkat/l, AST – 0,19 mkkat/l.

For the purpose of detoxification the patient underwent according to the scheme the course of 5 intravenous drip infusions of Natrii Hypochloriti into the cubital vein with the concentration of 300 mg/l as 400 ml injections daily. The patient underwent the procedures successfully. 3 weeks after the finishing of the course of treatment all above-named investigations were made once again. During Natrii Hypochloriti treatment and later before the recurring laboratory tests were made, the patient didn’t undergo any other infusion therapy and didn’t take any hepatoprotectors.

For the purpose of treatment of  the idiopathic hypertension of the II stage the symptomatic therapy was used – angiotensin-converting enzyme inhibitor (ednit) 10 mg twice a day in combinatation with diuretics (arifon-retard) 2,5 mg once a day in the morning.

It was detected the reduction of liver size: the lower edge of the right lobe of liver was palpable 1-2 cm out of the right costal margin edge. According to the results of the abdominal cavity ultrasound investigation: the right lobe of liver is 12,6 cm, the left lobe of liver - 7,1, the caudate lobe of liver – 3,0.

 It was detected the full normalization of LPO indices, liver-specific enzymes and standard liver tests with a simultaneous significant increase of AOP enzymes: MDA – 6,83 mkmol/l, DC – 0,7 u., Cat – 29,8 mkmol/ml/min, SOD -2,2 conv. u./ml, GP – 8,9 mkmol/ml/min, SU - 0 u., SG – 0 u., CPl – 28,3 mg%, NAG – 9,3 nmol/ml/min, SDG -58 mkmol/l/h, TDG -60 mkmol/l/h, total bilirubin – 9,0 mkmol/l, thymol test -5 u., ALT – 0,26 mkkat/l, AST – 0,13 mkkat/l.

At the end of the course of treatment the patient noted the disappearance of aching pains in the right hypochondrium, appetite and sleep improved.

The recurring investigations made 3 and 6 months after the finishing of Natrii Hypochloriti treatmant showed the positive dynamics of all investigated clinical-laboratory data.

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