Kuzminskyi I. Features of pathogenesis of functional disorders of the liver under conditions of massive bleeding with combined trauma and ischemic-reperfusion syndrome of the limb

The object is experimental ischemia-reperfusion of the limbs, closed trauma of the abdominal organs is complicated by hypovolemic shock and their combination; the purpose is to find out the effect of ischemia-reperfusion and its combination with the trauma of the abdominal cavity and hypovolemic shock on functional and morphological disorders of the liver in the early post-traumatic period; methods - graphic, experimental, functional, biochemical, morphological, mathematical-statistical; results - In the dissertation the peculiarities of the development of morphofunctional disorders in the acute period and the period of early manifestations of traumatic illness after ischemic-reperfusion syndrome of extremities and its combination with the blunt trauma of the abdominal cavity complicated by hypovolemic shock have been established. For the first time the animal experiment has shown that ischemia-reperfusion of the extremities in combination with the trauma of the abdominal cavity, complicated by hypovolemic shock, affects the functional state of the liver, which manifests in significant decrease of biliary production and biliary excretion. On the background of a simulated injury the rate of excretion and the content of total bile acids in bile decrease. The concentration of direct bilirubin in bile decreases due to the negative dynamics of conjugation of indirect bilirubin in hepatocytes. Reducing the amount of bile acids and growth in this background of cholesterol concentration leads to a decrease in cholato-cholesterol ratio, which indicates an increased lithogenicity of bile. Regardless of simulated traumas, the development of a cytolytic syndrome. In response to simulated trauma in the liver tissue there is an intensification of lipid peroxidation processes. It is proved that simulated injuries are accompanied by significant violations of the mass coefficient of the liver. It has been proved that ischemic-reperfusion syndrome has a potentiating effect and in the group of animals with a combination of the above-mentioned traumas the morphological changes are maximal after 7 days of post-traumatic period.