Features of the association of calculous cholecystitis complicated by mechanical jaundice and concomitant diseases

The purpose of the study is to improve the quality of diagnosis and treatment in patients with cholecystocholedocholithiasis and MJ aggravated by concomitant diseases. To achieve it, clinical, laboratory and morphologic studies were performed in 537 patients admitted to the emergency surgical department of the Republican Clinical Hospital of Nalchik. The stages of jaundice development were revealed in these patients: cholestasis, cytolysis and cholangitis. The majority of concomitant diseases was generalized atherosclerosis - 372 (69,3%) cases. CHD was diagnosed in 284 (52.9%) patients, hypertension in 99 (18.4%), obesity in 85 (15.8%), and diabetes mellitus in 39 (7.3%). Other comorbidities were less common. The conducted study allowed us to come to the definition of the syndrome of mutual aggravation in patients with LCDD and MJ as a pathologic influence of comorbidities on the main, surgical disease. CIRS, Kaplan-Feinstein and Charlson comorbidity scales were used to characterize the severity of mutual aggravation at different stages of mechanical jaundice. In cholestasis no increase in the index of these scales was noted. At stages of cytolysis and cholangitis comorbidity indices increased significantly. That is, the determination of the severity of mutual aggravation was directly related to the stages of the main pathologic process. At cholestasis in MF patients due to insignificant changes in comorbidity indices the prognosis of mutual aggravation increase is minimal, at hepatocytolysis - the severity of the influence of comorbidities on the main disease increases. In cholangitis - mutual aggravation becomes maximum.