FORMATION OF CHRONIC LIVER PATHOLOGY CAUSED BY SOMATIC DISEASES

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 4 FORMATION OF CHRONIC LIVER PATHOLOGY CAUSED BY SOMATIC DISEASES A.V. Muratkhodjaeva1, N.R. Dzhumankulova2 Tashkent State Medical University1 Khoja Ahmed Yasavi International Kazakh-Turkish University2 https://doi.org/10.5281/zenodo.17385523 Abstract. This study focuses on the formation and clinical characteristics of chronic liver pathology caused by somatic diseases in children. Particular attention is given to chronic nonviral hepatitis, including reactive hepatitis developing after acute intestinal infections such as dysentery and salmonellosis, as well as hepatitis associated with chronic focal infections and, less frequently, toxic and drug-induced forms. A cohort of 200 patients was examined using modern laboratory, ultrasound, and endoscopic methods to establish diagnostic criteria and to evaluate disease activity and severity. The results demonstrated that chronic reactive hepatitis was the most common form, often presenting with abdominal pain, hepatomegaly, dyspeptic symptoms, vascular signs, and biochemical abnormalities. The course of the disease ranged from mild to severe, with typical and atypical patterns being observed. Our findings highlight the importance of precise etiological and pathogenetic classification for improved diagnosis, monitoring, and management of chronic non-viral hepatitis in pediatric populations. Keywords: chronic hepatitis; non-viral liver disease; reactive hepatitis; acute intestinal infection; dysentery; salmonellosis; chronic focal infection; toxic hepatitis; hepatomegaly; pediatric hepatology. Introduction Studies of hepatologists are mainly aimed at studying chronic hepatitis of viral aetiology. According to the data of domestic researchers it is established that the specific weight of chronic hepatitis of viral etiology in the region of Uzbekistan is quite high. Literature data indicating chronic hepatitis of non-viral etiology are few. Taking into account the results of prospective dynamic examination of children with various forms of chronic hepatitis, we described a working classification based on etiological and pathogenetic principles with the addition of clinical characteristics of the process, definition of the phase of the disease and indication of the peculiarities of its course (3,5,7,9). The most frequent forms of chronic non-viral hepatitis were reactive hepatitis formed after acute intestinal infection (dysentery and salmonellosis) and chronic focal infection. Depending on the etiological characteristics of the patient's zone of residence, the proportion of each of these forms varied. When diagnosing chronic reactive hepatitis, we were guided by generally accepted views on this pathology. The features formulated by A.S. Loginov and S.D. Podymov include: secondary morphofunctional changes in the liver, the moderation of their severity in the clinical and laboratory and clinical aspects, benign course and reversibility of the pathological process upon elimination of the causes that caused it. At the same time, we took into account the conclusions of the same authors that chronic reactive hepatitis should be considered as ‘the initial stage of liver damage’, which is a background associated with unfavourable course of viral hepatitis with its possible transformation into chronic hepatitis. (1,2,4,6,8) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 5 Chronic hepatitis due to chronic focal infection was diagnosed in those cases when the patient had signs of intoxication due to chronic decompensated tonsillitis, multiple dental caries, maxillary sinusitis, etc. The other group was made up of patients who had chronic hepatitis due to acute intestinal infection, which usually had a severe course with a prolonged period of recovery and prolonged persistence. The other group consisted of patients in whom the cause of chronic hepatitis formation was an acute intestinal infection, as a rule, which was severe with a prolonged period of recovery and long-lasting intestinal disorders, and in some patients - with a tendency to chronicisation of intestinal changes. This group included those who had recovered from salmonellosis and dysentery. A relatively significant group consisted of patients with an unidentified cause of the disease. Drug-induced hepatitis was observed in a few patients. In connection with the above, the first three named forms of chronic non-viral hepatitis were in the centre of attention. The activity of chronic non-viral hepatitis was determined by the severity of clinical manifestations of the disease in combination with abnormalities in biochemical tests reflecting the functional state of the liver, as well as changes in ultrasound and immunological examination. The inactive phase of the disease was defined when the condition became satisfactory with a favourable reversal of all clinical and laboratory-instrumental parameters. (10,11). Due to the fact that the clinical course of the disease did not always fit into the framework of the generally accepted variant, we distinguished typical and atypical course. Methods Taking into account the large number of diagnostic errors in recognising chronic non-viral hepatitis, we examined 200 patients. The diagnosis of chronic non-viral hepatitis was verified using modern laboratory, endoscopic and ultrasound methods of investigation to identify the symptoms of the disease most characteristic of this or that form. From these, a choice was made of highly informative indicators characteristic of this group of diseases, which occurred in various combinations in the observed patients. Results Pain syndrome was most often (34%) manifested by vague pains in the upper abdominal cavity and almost always combined with a feeling of constant heaviness (98%) and aching pain in the right subcostal area (93%). Dependence of pain on food intake was observed in more than half of patients (66%) and in chronic reactive (79%) hepatitis. Itching of the skin (55%) and a sensation of bitterness in the mouth (38%) were frequent complaints. The first of these signs occurred in half of the patients with chronic reactive hepatitis (58%), in particular in all patients with inflammatory diseases of the biliary system the second symptom was determined in 44% of cases). Table 2 Objective clinical indicators of examination of patients with different forms of chronic nonviral hepatitis Symptoms Chronic non-viral hepatitis reactive toxic from a chronic focal infection Р=24 after dysentery or salmonellosis. Р=40 Total 200 Skin colour: - pale grey 69(96) - 58(90) 8(12) 24(100) - 25(62) - 176(88) 8(4) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 6 - dingy with a jaundiced tinge Signs of hypopolyvitaminosis 67(93) 64(100) 20(83) 34(85) 185(92) Petechiae and ecchymoses 34(47) 12(18) - 2(5) 48(24) Vascular asterisks 24(33) 49(77) 2(8) 10(25) 75(37) Nosebleeds 8(11) 62(97) 1(4) 5(12) 76(38) ‘Palmar’ erythema 72(100) 64(100) 8(33) 10(25) 154(77) Painful palpation in the epigastric region: - in the right subcostal region - left subcostal 72(100) 4(5) 64(100) 31(48) 24(100) 24(100) 40(100) 40(100) 200(100) 99(49) Hepatomegaly: slight 20(28) 29(45) 20(83) 15(37) 84(43) Thickening of the liver 16(22) 60(92) 2(8) 12(30) 90(45) Splenomegaly - 8(12) - 1(2) 9(4) Note: In brackets - % of the number of patients in each group. values were rounded when determining percentages. Objective signs characterising chronic non-viral hepatitis include hepatomegaly of various degrees of severity (Table 2), the nature of splenomegaly, the presence of extrahepatic symptoms (vascular asterisks, palmar erythema, ecchymoses and petechiae), as well as signs of gastric and intestinal dyspepsia. Differential diagnosis of the severity of the course of individual forms of chronic non-viral hepatitis was carried out using discrete quantitative assessment - quantisation of the most frequently used qualitative signs (A. Allazhil et al., V. Dolgopolova). The intensity of individual symptoms and syndromes was assessed using a four-point system: 0, 1, 2, 3. Taking into account the scheme of their discrete quantitative assessment developed by us (Table 3), we came to the conclusion that the most pronounced signs of the disease are noted in children with toxic form of chronic non-viral hepatitis, but in our case were pronounced in patients with chronic reactive hepatitis, and then chronic hepatitis in the presence of chronic focal infection and after dysentery or salmonellosis. Discussion In 200 children with different forms of the disease, 8 per cent had a mild course, 65 per cent had a moderate course and 27 per cent had a severe course. The criteria determining the severity of the course of the disease are the pain syndrome, the degree of severity of hepatomegaly and the nature of changes in the consistency of the liver, accompanied by damage to other organs of the digestive system and biochemical and biochemical abnormalities. Other organs of the digestive system and abnormalities in biochemical and functional liver tests. Table 3 Scheme of discrete quantitative assessment Analysed feature score SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 7 1. Hepatomegaly: - absent - slight - pronounced - demonstratively pronounced 0 1 2 3 2. Thickening of the liver - absent - slight - pronounced - demonstratively pronounced 0 1 2 3 3. Pain syndrome (in the right subcostal region); - absent - mild - pronounced - sharply expressed 0 1 2 3 4. Extrahepatic ‘vascular signs’ - absent - sporadic - present in combination - multiple 0 1 2 3 5. Signs of gastric dyspepsia: - absent - mild - moderately pronounced - pronounced 0 1 2 3 6. Signs of intestinal dyspepsia: - absent - mild - moderately pronounced - pronounced 0 1 2 3 7. Conjugated lesions of other digestive organs (stomach, biliary system, intestines, pancreas): - absent Simultaneously involved in the pathological process: 2 organs 3 organs total involvement of the digestive organs 0 1 2 3 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 8 8. Liver functional abnormalities according to biochemical samples: - absent - changes in 1-2 samples - changes in 3-4 samples - of all samples studied 0 1 2 3 9. Signs of liver damage on ultrasound: - absent - subtle - pronounced - demonstrably expressed 0 1 2 3 10. Signs of changes in the biliary tract and gallbladder: - absent -scarcely expressed - pronounced - demonstrably expressed 0 1 2 3 REFERENCES 1. Podymova S. D., Vinnitskaya E. V. Liver hepatocerebral dystrophy // Experimental and Clinical Gastroenterology | issue 163 | No. 3 2019 2. Lurie Yu.E., Metelin A.V., Kuznetsova A.E. 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