[Cholesterosis of the gall bladder and atherogenic dyslipidemia: etiology, pathogenesis, clinical symptoms, diagnosis and treatment].

OBJECTIVE

To detect specific morphological signs of hepatic lesion in patients with cholesterosis of the gall bladder and atherogenic dyslipidemia in the presence of steatohepatitis.

METHODS

Atherogenic dyslipidemia was detected in 150 patients with steatohepatitis. Ultrasound investigation diagnosed cholesterosis of the gall bladder in 51.3% patients. The protocol included the following examinations: analysis of the disease history, physical examination, laboratory, device and morphological tests. Thirty patients received therapy with ursodesoxycholic acid medicine for 3 months.

RESULTS

Basic clinical symptoms of gall bladder cholesterosis (GBC) and its risk factors are defined. The biochemical blood test registered elevated levels of transaminase, alkaline phosphatase and bilirubin. All the patients had an atherogenic type of dyslipidemia. According to USI, a focal-reticular form of GBC prevailed. Histologic examination of the liver detected the following alterations: fat infiltration, portal and intralobular infiltration, hydropic dystrophy, binuclear hepatocytes, lobular hepatitis, fibrosis of the portal tracts, periductular fibrosis, ductual proliferation, ductual epithelium detachment. Histologically, the walls of the gall bladder contain foam cells in the mucous and submucous layer. The same changes were seen in the wall of the hepatic artery as well as cholesterol polyps, epithelial destruction. Ursosan treatment resulted in a significant lowering of total cholesterol.

CONCLUSIONS

GBC seems to be a chain of successive conditions: lipid disbolism at the level of hepatocyte, development of steatosis, steatohepatitis, fibrosis, involvement of all anatomo-morphological structures of the liver including the biliary tract, GBC.