Cholestasis syndrome in the practice of an internist

Tsygankova O.V.^{1, 2}, Sokolova T.A.², Latyntseva L.D.², Voevoda S.M.<sup>2

1</sup> Novosibirsk State Medical University
² Federal Research Center of the Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk

At present, the problem of liver diseases of toxical genesis is becoming increasingly important due to the high rates of development of the chemical and pharmaceutical industry, the widespread introduction of biologically active additives (BAA). The latter are not medical products, therefore their prescribing should be necessarily accompanied by an assessment of risk/advantage ratio for a specific patient.  One of the leading manifestations of a toxic liver lesion is the cholestasis syndrome, characterized by an increase in the biochemical parameters of the blood: alkaline phosphatase (FA), gamma-glutamyltranspeptidase (γ-GTP), and direct bilirubin. For the practicing physician, an important stage in the diagnostic search is the specification of the genesis of the disease and exclusion in its differential diagnosis of primary biliary cirrhosis, primary sclerosing cholangitis, hepatitis of the viral etiology, alcoholic liver lesion, and parasitic invasion. 
The article presents a clinical case illustrating the development of toxic hepatitis with the development of the cholestasis syndrome associated with the use of dietary supplements containing wild yam extract in a middle-aged woman. The stages of diagnostic search with subsequent successful hepatotropic therapy are described. Attention is drawn to the development of clinical and laboratory remission of the disease only after the abolition of the etiologic factor of its development - BAA, despite the previous long (within four months) hepatoprotective therapy with essential phospholipids.

Key words: cholestasis, toxic hepatitis, biologically active additive, ursodeoxycholic acid, ademetionine, clinical case.
For citation: Tsygankova O.V., Sokolova T.A., Latyntsev L.D.a, Voevoda  S.M. Cholestasis syndrome in the practice of an internist // RMJ. MEDICAL REVIEW. 2017. № 2. P. 110–112.