Features of the eye in children with chronic liver disease – 2006
Features of the eye in children with chronic liver disease – 2006
Partially translated from Russian.
Features of the eye in children with chronic liver disease topic dissertations on WAC 14.00.09, PhD Karagulyan, Natalia
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Contents PhD thesis Karagulyan, Natalia
LIST TAKEN Text Reduction
Chapter I. LITERATURE REVIEW
1.1. Chronic liver disease in children
1.2. Current data on the eyes are affected with chronic liver bolznyah
Chapter II. PATIENTS AND METHODS
2.1. Characteristics of clinical material
2.2. Clinical – laboratory and instrumental methods
2.3. Ophthalmic Methods
Chapter III. Eye lesions in children with chronic hepatitis B
3.1. Chronic viral hepatitis B and C, autoimmune hepatitis and cryptogenic chronic hepatitis —————–
3.2. Comparative characteristics of ocular symptoms in patients with autoimmune hepatitis and cryptogenic chronic stage of chronic hepatitis or cirrhosis
Chapter IV. Eye involvement in children with metabolic liver disease
4.1. Wilson’s disease
4.2. Glycogen disease
4.3. Gaucher disease
Chapter V. STATE visual functions and SLEZOPRODUKTSII CHILDREN WITH CHRONIC DISEASES
5.1. Results of the study of refraction, visual acuity and intraocular pressure
5.2. The results of electrophysiological and psychophysical methods of investigation
5.3. Results of the study a total slezoproduktsii
Chapter VI. Hepatitis-OPHTHALMOLOGICAL CORRELATION AND ROLE eye symptoms in diagnosis and prognosis of chronic liver disease have
Introduction dissertation (part of the abstract) on “Features of the eye in children with chronic liver disease”
The relevance of
The problem of chronic liver disease is a leader in the general human pathology (Sh. Sherlok, 1999, KP Meyer, 1999; AS Lok, 2002, VF Uchaikin, 2003.; Nisevich NI, 2003). In recent years there has been an increase in the number of patients with liver disease in children. Etiologic polymorphism difficult differential diagnosis and prognosis of chronic liver disease in children, severe outcomes – make this problem very relevant for pediatric (Chitkara, 2000; A. Yuce, 2000; Kaganov BS, 2002; Cherednichenko TV, 2003; DT Abdurakhmanov, 2004).
Relationship of liver disease with abnormal eye was seen in the late 19th century (AB Natanson, 1895). However, the state of the eyes focused study in chronic liver diseases hereditary, viral and unknown etiology has been actively carried out only in recent years. Found that 84-100% of adult patients with chronic liver disease revealed ocular symptoms. These include microcirculation disturbance of the conjunctiva, iris, and lens opacity of the cornea, as well as vascular and degenerative changes of the fundus (J. Hoffman, 1995; IM Logan, 1998; OD Gupalo, 1998; JL Gollan, 1998 , V. Kushnir, 2001; J. Know, 2001; A. Yuce, 2003).
A number of eye symptoms are reversed against pathogenetically substantiated therapy correlate with the severity and nature of the underlying disease and provide essential aid in differential diagnosis and prognosis of chronic liver disease. At the same time, clearly demonstrated that the presence of chronic liver disease is an aggravating factor for various eye diseases, contributes to the early development of age-related cataracts, aggravates the inflammation leads to a substantial disruption of visual function (JI.JL Gromashevskiy, 1998;
0.S.Slepova, 1999; GJ Brewer, 1999; S Hayasaka, 1999; M. Liu, 2002; T. Cohen, 2002).
Focused study of the state of eyes and the visual analyzer in chronic liver disease in children has not yet been carried out. Available publications devoted primarily describing ocular symptoms in certain diseases (Wilson’s disease, Gaucher’s disease, Alagille syndrome, etc.). Most of the work describes the individual cases of rare diseases (M. Hingori, 1999; S. Rahman, 2000, C. Chang, 2000, V. Kamath, 2002; J. Dahlstrom, 2003; R.Quiros-Tegeria, 2004). However, given the multiple ocular symptoms in metabolic liver disease in children, a high frequency of violations by the vision of adult patients with chronic liver disease – a comprehensive analysis of the state of the eyes in children of patients with chronic liver disease, it is very important.
To study the features of the eye in children with chronic liver diseases of different etiologies
1. To study the features of the eye in children with chronic viral hepatitis
2. Examine the state of the eye in children with autoimmune hepatitis and cryptogenic chronic hepatitis
3. Determine the spectrum of eye lesions in children with metabolic liver diseases (Wilson’s disease, glycogen disease, Gaucher’s disease)
4. Explore the relationship between the severity of eye changes and the severity of liver disease (chronic hepatitis or cirrhosis)
5. Determine the value of ocular symptoms as diagnostic and prognostic markers of disease process in chronic liver disease in children
For the first time in a purposeful and complex, a large clinical material, investigated the spectrum of eye symptoms of chronic liver disease in children.
The characteristic ocular changes observed in chronic hepatitis of various etiologies (chronic hepatitis B and C, autoimmune hepatitis, and cryptogenic hepatitis), Wilson’s disease, Gaucher’s disease, glycogen storage disease and biliary cirrhosis. Identify the characteristic features of each of ophthalmic diseases, which can be used for differential diagnosis.
The first to show that the severity of ocular symptoms in chronic kidney disease in children is closely linked to the severity of the underlying disease and the maximum in the stage of cirrhosis of the liver, regardless of its etiology.
First isolated characteristic of CKD in children iridology signs and an infringement slezoproduktsii.
Found that the ocular symptoms in children with CKD are partially reversible and not accompanied by serious violations of view, in contrast to adults, which may be related to the duration of the disease, and on the structural and functional features of the visual analyzer in children.
The main provisions to be defended
1. Changes in the eye characteristic of all chronic liver disease in children and occurs mainly symptoms microcirculation in various structures of the eye and adnexa (bulbar conjunctiva, limb, iris, retina, lacrimal gland).
2. The frequency and spectrum of ocular symptoms vary with CKD of various etiologies, which can be used for differential diagnosis.
3. The frequency and severity of ocular symptoms correlate with disease severity and reach a maximum in patients with CKD, with similar symptoms in cirrhosis of different etiologies: gross violations of microvascular BC with formation of vascular glomeruli mikrogemorragy “avascular zones” bulging contours Autonomous ring angiopathy and retinopathy. These data should be considered when assessing the overall severity of the disease, its prediction and monitoring of treatment.
4. State microvessels BC, iris and fundus reflect pathological changes in the microcirculation of the body, so their analysis is needed to determine the severity, prognosis and treatment.
5. Ocular symptoms of CKD are partially reversible and usually do not result in a gross violation of visual function. However, advanced ophthalmological study suggests the presence of subclinical changes in the function of the retina and the optic nerve, which necessitates the dynamic monitoring of patients.
6. Disruption of the lacrimal glands under the CPU, which turns into a steady decline slezoobrazovaniya, potentially dangerous, and in the absence of adequate treatment can lead to the syndrome of “dry eye.”
7. Eye examination should be a necessary link of children with CKD different etiology and severity.
The practical significance
Given detailed characteristic (frequency, severity, clinical features) eye lesions in CKD different etiologies: hepatitis B and C, and cryptogenic autoimmune hepatitis, Wilson’s disease, Gaucher disease, and glycogenoses biliary cirrhosis.
Allocated characteristic ocular symptoms of each of the diseases studied, which is important for the differential diagnosis of chronic kidney disease in children.
Have established that the frequency and severity of ocular symptoms with the severity of the underlying disease, which can be used to predict and monitor the treatment of CKD.
Specific recommendations on the methodology and timing of ophthalmologic examinations in children with CKD.
The conclusion of the dissertation on “Pediatrics”, Karagulyan, Natalia
1. For the first time in children with chronic liver disease revealed a wide range of eye symptoms, including violation of the microcirculation of bulbar conjunctiva and iris, and the presence of retinopathy, angiopathy, changes in the cornea, lens and optic nerve, as well as dysfunction of the lacrimal gland.
2. In children with chronic viral hepatitis B and C, ocular symptoms occur in half of patients and manifest violation of micro bulbar conjunctiva (35-40,0%), deformation of the iris stroma (25-35%)) and retinal angiopathy (35-40%). For chronic hepatitis B, in addition, is characterized by the probability of lens opacity (16.7%).
3. The most frequent and severe eye are changes in children with autoimmune hepatitis (85.0%), and cryptogenic chronic hepatitis (65%>). In the anterior part of the eye in addition to changes in microvascular caliber is showing signs and severity of microcirculatory disorders (10-20%) and the expansion of the limb (45-50%). Significantly more prevalent disorganization iris stroma (35-50%), retinal angiopathy, including mikrogemorragiyami (20%) and signs of retinopathy (40%).
4. Changes in the eye in children studied metabolic liver lesions are characteristic features of each disease and can be used as additional criteria for differential diagnosis (changes in the cornea and lens with Wilson’s disease, paresis of the eye muscles and partial atrophy of the optic nerve in Gaucher disease, as well as the plethora of retinal vessels and the characteristic yellowish general background fundus combined with redistribution of pigment in glycogen disease.
5. There is a clear relationship between the frequency and severity of violations mirotsirkulyatornyh eye and adnexa with the severity of the underlying disease. With cirrhosis of the liver, regardless of their etiology identified expressed microcirculation of bulbar conjunctiva (50-100%): vascular glomeruli, mikrogemorragii, swelling of the perivascular space, “avascular zone”, the symptoms of angiopathy (50-89%) and retinopathy (29-64%) with secondary changes in the optic nerve, there is bulging contours Autonomous ring on the iris (20-33%) and impaired slezoproduktsiya (50-75%).
6. Ocular symptoms in children with chronic kidney disease than adults do not lead to significant distortions of visual functions (except for CHB is cataract, partial atrophy of the optic nerve, and paresis of the eye muscles in Gaucher disease type III). Purposeful eye examination with the use of electrophysiological and psychophysical methods of research and test by Schirmer pozvolyaeyut identify pre-clinical disorders of visual function and prevent the development of the syndrome of “dry eye.”
All children with chronic liver disease should be evaluated by an ophthalmologist twice a year on the stage of chronic hepatitis B, and 3-4 times in cirrhosis.
Targeted Research expose microvessels bulbar conjunctiva and fundus, and a careful examination of the cornea, iris and lens.
Identified eye symptoms can be used as additional criteria of differential diagnosis of CKD in children.
Established link severity of eye symptoms and the severity of the disease and the general characteristic ophthalmic signs of cirrhosis should be considered for dynamic monitoring, assessing the severity of chronic kidney disease and monitoring treatment.
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