Objective. The aim of the study was to analyse neurological pathology in patients with liver and gall bladder diseases. Material and methods. Within the period from January 2008 to April 2011 in the Department of Internal Diseases, the III and IV Departments of Abdominal Surgery and the Anesthesiology Surgery Reanimation of Vilnius City University Hospital were examined 99 patients (58 women and 41 men) with liver and gall bladder diseases, who had nervous system disorders. Their age – 30-93 years (the average-65,6 years). All the patients underwent the following tests: neurological examination, general and biochemical blood tests (liver pigments, enzymes, ammonia, glucose, electrolytes, protein fractions in blood serum, coagulogram, lipidogram, acid-base balance, H Bs Ag antigen, HCV antibodies), biochemical and cytological analysis of serous and cerebrospinal fluid, histological and microscopic analysis of biopsy and postoperational tissues, ultrasonography of internal organs. Some of them underwent oesophagofibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, computer tomography of abdominal organs, cerebral (spinal) computer tomography or magnetic resonance tomography. Results. Neurological pathology in patients with liver and gall bladder diseases were analysed for the first time in Lithuania. Hepatic encephalopathy were diagnosed in 44(44,5%) of patients, hepatic coma – 3(3,1%), cerebrovascular disorders – 21(21,2%), brain tumor – 4(4,0%), purulent meningitis – 1(1,0%), spinal epiduritis – 1(1,0%), hepatic mielopathy- 2(2,0%), Guillain – Barre syndrome – 1(1,0%), hepatic polyneuropathy – 11(11,1%), hepatic plexopathy – 2(2,0%), hepatovisceral syndromes – 9(9,1%). 5(5,1%) out of 6(6,1%) patients (all women), who suffered from stroke, had been ill with acute form or exacerbation of chronic calculous phlegmonic or gangrenous cholecystitis, subhepatic abscess and empyema of the gall bladder had also been diagnosed. All cases of previously diagnosed strokes and minor strokes occurred in patients with cholelithiasis. Increased gamma globulin levels were established in liver disease patients with polyneuropathy (29,7 ± 3,8%), gamma globulin levels in liver disease patients without polyneuropathy were 18,7 ±1,1% respectively ( p<0,01). The clinical cases have been presented. The review of the newest scientific literature about neurological pathology of patients with liver and gall bladder diseases was performed. The study data were compared with the data of the literature. Conclusions. Hepatic encephalopathy is the most common neurological manifestation in patients with liver diseases. Its clinic is polymorphic and depends on the liver disease severity and duration. Hepatic mielopathy is rarely complication of chronic liver diseases. This complication might occur in patients with hepatitis, portal hypertension, caused by liver cirrhosis, and after portacaval anastomosis. Connection between hepatic polyneuropathy and protein metabolism disorders (increased gamma globulin levels) has been established. Hepatovisceral disorders manifest in cholecystocoronary and hepatorenal syndromes. The pathology of liver and gall bladder might be counted as a risk factor of ischemic stroke among the elderly patients with cerebral and coronary atherosclerosis.
Article in Lithuanian
Keyword(s): liver and gall bladder diseases; neurological pathology
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