THE MAIN POINTS OF TREATMENT OF PATIENTSWITH MECHANICAL JAUNDICE

Abstract

Introduction. Structural changes in the liver and cholemia due to MJ lead to the development of endotoxicosis, which in
turn leads to a violation of the antitoxic function of the liver, prolonged MJ reduces the function of the nephron. All this leads
to the development of renal-hepatic insufficiency. Thrombohemorrhagic changes develop in the vascular bed, leading to the
development of DIC syndrome. Despite the achievements of intensive therapy and surgery of the biliary tract, with
mechanical jaundice, mortality also occurs.
The purpose of the study. Analysis of modern concepts concerning hemostatic disorders in mechanical jaundice and
practical recommendations on therapeutic strategies.
Search strategy: to achieve this goal, an analysis of scientific publications in evidence-based medicine databases
(PubMed) was carried out using specialized search engines (Google Scholar) from 2005 to 2020. All studies and reviews
devoted to this topic were analyzed by the authors and classified according to their methodology - retrospectively,
prospectively, descriptively or comparatively. Inclusion criteria: research of high methodological quality: meta-analysis,
systematic review and cohort studies, as well as publications with clearly formulated and statistically proven conclusions in
English and Russian. Exclusion criteria: summary of reports, reports in the form of abstracts, advertising articles.
Results. Coagulopathy, sepsis and renal insufficiency remain the main problems in patients with mechanical jaundice.
The main preventive strategies include the elimination of coagulopathy by parenteral administration of vitamin K and the
replacement of clotting factors, an adequate volume load to ensure euvolemia and the appropriate use of antibiotics. Patients
with established complications of cholangitis and renal insufficiency require urgent decompression of the biliary tract. In
patients with mechanical jaundice, risk stratification is important for making informed therapeutic decisions. Patients with
unacceptable concomitant diseases may be suitable only for non-surgical palliative therapy. For those patients who are
candidates for biliary tract resection, the issue of preoperative drainage is controversial.
Conclusion. Currently, patients with mechanical jaundice can be operated with a lower mortality rate, and the percentage of
complications can be minimized with relatively simple clinical interventions. The presented review, based on literary sources, is a
recommendation for the management of patients with mechanical jaundice in order to prevent complications.