Hepatobiliary function in children with insulin-dependent diabetes mellitus

Abstract

The hepatobiliary system plays the crucial role in the development of metabolic disorders in diabetics. Involvement of the hepatobiliary system may develop at the early stages of diabetes mellitus. The present study was aimed at elucidation of the specific features of bile excretion and production in children with type I diabetes making use of present-day diagnostic methods. Fifty-two patients with type 1 diabetes aged 6 to 15 and 20 healthy controls were examined. Besides common clinical studies, fractionated duodenal probing followed by biochemical analysis of the bile, ultrasonic examination of the hepatobiliary system, and dynamic hepatobiliscintigraphy were carried out. Typical changes in liver parenchyma developing after fatty hepatosis type were found to play the main role in the structure of hepatobiliary involvement occurring in insulin-dependent diabetes. Disorders of bile excretion are caused by dyskinetic disorders of extrahepatic bile duct and choleresis changes. Bile excretion arrhythmia manifests most frequently as hypertensive dyskinesia. In patients with a longstanding disease bile excretion changes are mainly due to increased tone of the sphincter of Oddi and decelerated contractility of the gallbladder. Biochemical composition of the bile was characterized by decreased concentration of bile acids, phospholipids, and bilirubin, by a lower cholate-cholesterol coefficient, and increased levels of cholesterol and total lipids.