I.K. Churpiy

         Ivano-Frankivsk State Medical University, Ivano-Frankivsk, Ukraine.



Introduction.We performed analysis of the liver in patients with local and diffuse peritonitis. In patients with diffuse peritonitis occurring phenomena liver failure. In the early postoperative period in patients with peritonitis occurring violations excretory, metabolic and liver barrier function that worsens the disease. The presented morphological changes in the liver under local or diffuse peritonitis received during autopsy.

Results. When the local peritonitis in liver develop adaptive-compensatory changes in hepatocytes (preserve the structure of hepatic lobules, the radial location of liver plates, laminar swelling between spaces, focal polymorphonuclear cell infiltration with a predominance of white blood cells, increasing the number of Kupffer cells), while they are absent when patient has a spilled peritonitis.

With diffuse peritonitis dominated dystrophic necrotic processes, almost never occur adaptive-compensatory changes from hepatocytes (vascular walls leakage plasma with perivascular edema, endothelial damage, the emergence of numerous Leukocyte extravasation, edema and inflammatory infiltration along the portal tracts, hydropic degeneration of hepatocytes), indicating that depletion of liver detoxification function and activation of destructive processes.

Reduced liver parenchymal tissue density with diffuse peritonitis due of degenerative and necrotic changes hepatocytes,and increased blood flow and lymph organ swelling spaces Diss.

In patients with local or diffuse peritonitis was observed decrease in functional cell mass, that there was an absolute reduction in the number of hepatocytes with preserved functional capacity per unit volume of liver tissue. Along regressed and nuclear mass index. Significant reduction of nuclear material in hepatic tissue (especially in diffuse peritonitis) should be regarded as an indicator of pronounced imbalance nuclear-cytoplasmic relationships, which are the physiological basis of adequate response to pathogenic influences cell.

Conclusions. Taking into account the data and evaluating the dynamics of changes in hepatocytes dual mass index, which grew at a local peritonitis and significantly decreased when spilled, it is conceivable that in the first case, the regenerative capabilities of the liver intensified, and the second - depleted. This is indicated and functional cell nuclear index - an indicator of nuclear material per one hepatocytes. This morphometric parameters decreased in both study groups, but the diffuse peritonitis regression reached higher values.

The treatment must include drugs for detoxification treatment and  antihepatotoxicity prevention and treatment of liver failure should begin in the preoperative and postoperative continue without waiting for its clinical manifestations.


Key words: peritonitis, hepatic, liver, liver failure.


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  1. Дзюбановський І. Я. Гострий поширений перитоніт. Деякі особливості хірургічного лікування / І. Я. Дзюбановський, В. В. Бенедикт // Галицький лікарськийй вісник. – 2012. – Т.19, № 3 (частина 2). – С. 44 – 46.
  2. Галимов О.В. Профилактика отделенных осложнений после лапароскопических операций / О.В.Галимов, В.О. Ханов, Д.М. Зиганшин, В.З. Ахиляров // Одеський медичний журнал. – 2015. – №2. – С. 15 – 17.
  3. Laparoscopic common bile duct exploration and primary closure of choledochotomy after falled endoscopic sphincterotomy / Y. Zhou, X.D. Wu, R.G. Fan [] // int. J. Surg. – 2014. – Vol. 12, № 7. – Р. 645 – 648.
  4. Гриценко С. Н. Інтенсивна терапія хворих перитонітом з поліорганною дисфункцією / С. Н. Гриценко, С. Н. Корогод // Шпитальна хірургія. – 2013. – № 3. – С. 127 – 128.
  5. Бойко В.В. Комплексне лікування хворих на абдомінальний сепсис із застосуванням релапаротомії / В.В. Бойко, І.А. Криворучко, Ю.В. Іванова, М.С. Павліченко // Клінічна хірургія. - 2012. - №4. - С. 8 – 9.