DYNAMICS OF CHANGES IN THE VASCULAR BED OF THE DUODENUM IN CONDITIONS OF OBSTRUCTIVE CHOLESTASIS IN COMBINATION WITH DECOMPRESSION OF THE BILIARY TRACT AND THE USE OF ENTEROSORBENTS

Authors

  • S. O. Grabchak I. Horbachevsky Ternopil National Medical University
  • A. D. Bedeniuk I. Horbachevsky Ternopil National Medical University

DOI:

https://doi.org/10.11603/1811-2471.2023.v.i3.14079

Keywords:

obstructive cholestasis, duodenum, architectonics, morphometry, enterosorbent

Abstract

SUMMARY. Obstructive cholestasis, creating an intrahepatic block, is accompanied by an increase in pressure in the portal system and the development of portal hypertension, which significantly affects the vascular bed of the duodenum. The dynamics of changes in the channels of the duodenum in this pathology have not been studied enough.

The aim – to analyze the effectiveness of the use of enterosorbents in combination with choledochoduodenostomy and their effect on functional changes in the vascular bed of the duodenum in obstructive cholestasis.

Material and Methods. From the first day of decompression of the biliary tract, there is an increase in the level of endogenous intoxication, which has a significant effect on the restoration of functional and structural changes in the vascular bed of the duodenum, therefore, in order to reduce the level of intoxication and improve the recovery processes, we studied 23 experimental animals (sexually mature Vietnamese male pigs breed) with 28-day obturation cholestasis, to which 7 days before decompression of the biliary tract, an enterosorbent of the carboline group was added to the diet at the rate of 0.7 g/kg of the animal's weight. On the 3rd day after surgical decompression, the vascular bed of the duodenum was examined in 3 experimental animals, after 7 days – in 3 animals, after 14 days – in 4 pigs, after 28 days – in 4 animals. In this study, we used such methods as x-ray and the analysis of the architecture of the vascular bed of the duodenum was carried out according to the unified method proposed by K. A. Shoshenko to study the stereometric organization of vascular beds, the type of branching was determined on radiographs, the diameters, the length of the "vascular tee", the main and subsidiary branches, the angles of departure of the latter from the main trunks were measured. The obtained digital material was processed by the method of variational statistics using the Student's test, and in other cases - using the Mann–Whitney U-test. The difference between the average values was considered reliable when the probability of the alternative hypothesis was at least 95 %.

Conclusions. Therefore, the conducted studies and the obtained results indicate that the correction of obstructive cholestasis by decompression of the biliary tract in the combined use of enterosorbents has a positive effect on the morphogenesis of the duodenum. After complex correction of 28-day obturation cholestasis, the morphological indicators of arterial trunks of the I, II, III, IV, V orders did not statistically significantly differ from the same quantitative values of control groups of experimental animals. The Kernoghan index of the small-caliber arteries of the duodenum under these experimental conditions did not significantly differ from the control values. At the same time, the condition of the hemomicrocirculatory channel significantly improved. Thus, the diameter of arterioles, hemocapillaries, and venules in the mucous membrane of the upper part of the duodenum was equal to the input index to the simulated pathology.

References

Anokhina, G.A., Kharchenko, V.V., & Dynnyk, O.B. (2018). Rol zapalennya ta metabolichnykh porushen u prohresuvanni khronichnykh zakhvoryuvan pechinky: profilaktyka ta likuvannya [The role of inflammation and metabolic disorders in the progression of chronic liver diseases: prevention and treatment]. Zdorovya Ukrayiny – Health of Ukraine, 15-16 (436-437), 60-62 [in Ukrainian].

Boyko, V.V. (2018). Vybir obiemu operatyvnoho likuvannia u patsiientiv iz zakhvoriuvanniamy hepatykokholedokhu, uskladnenymy mekhanichnoiu zhovtianytseiu [Selection of the scope of operative treatment in patients with hepaticocholedochus diseases complicated by mechanical jaundice]. Mizhnarodnyi medychnyi zhurnal – International Medical Journal, 1(24), 33-38 [in Ukrainian].

Daniv, M.V., Hnatyuk, M.S., Danylevich, Yu.O., & Levandovska, K.V. (2009). Vikovi osoblyvosti remodeliuvannia arterii dvanadtsiatypaloi kyshky [Age-related features of duodenal artery remodeling]. Visnyk Ukrainskoi medychnoi stomatolohichnoi akademii – Bulletin of the Ukrainian Medical Stomatological Academy, 4(28), 189-190 [in Ukrainian].

Gargula, T.I., & Hnatyuk M.S. (2013). Osoblyvosti strukturnoi perebudovy hemomikrotsyrkuliatornoho rusla dvanadtsiatypaloi kyshky pry eksperymentalnii vyraztsi v umovakh dii khlorydu aliuminiiu [Peculiarities of the structural rearrangement of the hemomicrocirculatory channel of the duodenum in experimental ulcers under the conditions of action of aluminum chloride]. Tavricheskiy mediko-biologicheskiy vestnik – Tauride Medical and Biological Bulletin, 1(16), 56-58 [in Ukrainian].

Gargula, T.I. (2017). Remodeliuvannia struktur stinky dvanadtsiatypaloi kyshky pry perebihu yii vyrazky v umovakh kadmiievoi intoksykatsii [Remodeling of the structures of the wall of the duodenum during the course of its ulcer in the conditions of cadmium intoxication]. Bukovynskyi medychnyi visnyk – Bukovynsky Medical Bulletin, 2(82), 28-31 [in Ukrainian]. DOI: https://doi.org/10.24061/2413-0737.XXI.2.82.2.2017.50

Dzygal, O.F., & Grubnik, Yu.V. (2017). Kryterii efektyvnosti vykonannia porto-kavalnoho shuntuvannia u khvorykh z portalnoiu hipertenziieiu [Criteria for the effectiveness of portocaval shunting in patients with portal hypertension ]. Odeskyi medychnyi zhurnal – Odesa Medical Journal, 2. 43-47 [in Ukrainian].

Dzyubanovskyi, O.I., & Gudyma A.A. (2017). Vplyv dekompresii zhovchovyvidnykh shliakhiv na dynamiku protsesiv zhovchoutvorennia i zhovchovydilennia pislia eksperymentalnoho kholestazu riznoi tryvalosti [The effect of decompression of the biliary tract on the dynamics of the processes of bile formation and bile secretion after experimental cholestasis of various durations]. Klinichna khirurhiia – Clinical Surgery, 10(44), 66-69 [in Ukrainian].

Dzyubanovsky, O.I. (2016). Vplyv dekompresii zhovchovyvidnykh shliakhiv na dynamiku protsesiv lipoperoksydatsii, antyoksydantnoho zakhystu i tsytolizu pislia eksperymentalnoho trydobovoho obturatsiinoho kholestazu [The effect of biliary tract decompression on the dynamics of lipoperoxidation, antioxidant protection and cytolysis after experimental three-day obstructive cholestasis]. Visnyk naukovykh doslidzhen – Bulletin of Scientific Research, 4(23), 128-130 [in Ukrainian].

Dzyubanovskyi, O.I., & Gudyma, A.A. (2017). Vplyv dekompresii zhovchovyvidnykh shliakhiv na dynamiku protsesiv zhovchoutvorennia i zhovchovydilennia pislia eksperymentalnoho kholestazu riznoi tryvalosti [The effect of decompression of the biliary tract on the dynamics of the processes of bile formation and bile secretion after experimental cholestasis of different durations]. Klinichna khirurhiia – Clinical Surgery, 10(56), 66-69 [in Ukrainian].

Dunaevska, O.F. (2017). Vyznachennia indeksu Kernohana dlia sudyn selezinky poikilotermnykh tvaryn [Determination of the Kernogan index for vessels of the spleen of poikilotherm animals]. Ukrainskyi zhurnal ekolohii – Ukrainian Journal of Ecology, 4. 25-29 [in Ukrainian].

Hrabchak, S.O., & Bedenyuk A.D. (2021). Osoblyvosti kompensatornykh protsesiv dvanadtsiatypaloi kyshky pry obturatsiinomu kholestazi v poiednanni z dekompresiieiu zhovchnykh shliakhiv ta enterosorbtsiieiu [Peculiarities of compensatory processes of the duodenum in obstructive cholestasis in combination with decompression of biliary tract and enterosorption]. Shpytalna khirurhiia – Hospital Surgery, 1(93), 38-43 [in Ukrainian].

Hrabchak, S.O. (2019). Strukturni zminy mikrotsyrkuliatornoho rusla dvanadtsiatypaloi kyshky pry obturatsiinomu kholestazi [Structural changes of the microcirculatory channel of the duodenum in obstructive cholestasis]. Shpytalna khirurhiia – Hospital Surgery, 4. 59-62 [in Ukrainian].

Horalskyi, L.P., Khomych, V.P., & Kononskyi, O.I. (2011). Osnovy histolohichnoi tekhniky i morfofunktsionalni metody doslidzhennia u normi ta pry patolohii [Fundamentals of histological techniques and morphofunctional research methods in normal and pathological conditions]. Zhurnal Polissia – Journal of Polissya [in Ukrainian].

Deikalo, I.M., Bukata, V.V., & Chornomydz, A.V. (2011). Zminy v mikrotsyrkuliatornomu rusli pid chas operatyv [Changes in the microcirculatory channel during surgical interventions for adhesion intestinal obstruction]. Shpytalna khirurhiia – Hospital Surgery, 4(85), 15-18 [in Ukrainian]. DOI: https://doi.org/10.26779/2522-1396.2018.04.15

Dzygal, O.F., Hrubnyk, Yu.V, & Savytskyi I.V. (2017). Portokavalne shuntuvannia yak sposib usunennia portalnoi hipertenzii u khvorykh na tsyroz pechinky [Portocaval shunting as a way to eliminate portal hypertension in patients with liver cirrhosis]. Shpytalna khirurhiia – Hospital Surgery, 8, 31-33 [in Ukrainian].

Dzyubanovskyi, O.I., & Gudyma, A.A. (2017). Vplyv dekompresii zhovchovyvidnykh shliakhiv na dynamiku protsesiv zhovchoutvorennia i zhovchovydilennia pislia eksperymentalnoho kholestazu riznoi tryvalosti [The effect of decompression of the biliary tract on the dynamics of the processes of bile formation and bile secretion after experimental cholestasis of different duration]. Klinichna khirurhiia – Clinical Surgery, 10(44), 66-69 [in Ukrainian].

Dunaevska, O.F. (2017). Vyznachennia indeksu Kernohana dlia sudyn selezinky poikilotermnykh tvaryn [Determination of the Kernogan index for vessels of the spleen of poikilotherm animals]. Ukrainskyi zhurnal ekolohii - Ukrainian Journal of Ecology, 4, 25-29 [in Ukrainian]. DOI: https://doi.org/10.15421/2017_82

Zubko, L.Yu. (2018). Osoblyvosti topohrafii pozapechinkovykh zhovchovyvidnykh shliakhiv za danymy kompiuternoi tomohrafii v rezhymi 3D-cor [Peculiarities of the topography of the extrahepatic biliary tract according to the data of computer tomography in the 3D-cor mode]. Klinichna anatomiia ta operatyvna khirurhiia – Clinical Anatomy and Operative Surgery, 1(17), 48-53 [in Ukrainian]. DOI: https://doi.org/10.24061/1727-0847.17.1.2018.8

Kotov, O.V. (2018). Porushennia homeostazu mikroelementiv u dynamitsi prohresuvannia eksperymentalnoi mekhanichnoi zhovtianytsi [Violation of homeostasis of trace elements in the dynamics of progression of experimental mechanical jaundice]. Medychni perspektyvy – Medical Perspectives, 4 (23), 153-154 [in Ukrainian].

Krutovy, O.B., Balik, D.V., & Lyulka, V.I. (2018). Porushennia motorno-evakuatornoi funktsii tonkoi kyshky za tiazhkoi mekhanichnii zhovtianytsi [Violation of the motor-evacuatory function of the small intestine in severe mechanical jaundice]. Kharkivska khirurhichna shkola – Kharkiv Surgical School, 2(44), 73-76 [in Ukrainian].

Kutovy, O.B., Rodynska, G.O., & Balyk, D.V. (2018). Dosvid likuvannia khvorykh iz syndromom tiazhkoi mekhanichnoi zhovtianytsi dobroiakisnoi etiolohii [Experience of treating patients with severe mechanical jaundice syndrome of benign etiology]. Ukrainskyi zhurnal khirurhii – Ukrainian Journal of Surgery, 2, 36-40 [in Ukrainian].

Published

2023-08-23

How to Cite

Grabchak, S. O., & Bedeniuk, A. D. (2023). DYNAMICS OF CHANGES IN THE VASCULAR BED OF THE DUODENUM IN CONDITIONS OF OBSTRUCTIVE CHOLESTASIS IN COMBINATION WITH DECOMPRESSION OF THE BILIARY TRACT AND THE USE OF ENTEROSORBENTS. Achievements of Clinical and Experimental Medicine, (3), 87–93. https://doi.org/10.11603/1811-2471.2023.v.i3.14079

Issue

Section

Оригінальні дослідження