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First of all, yellowing of the sclera and skin, darkening of urine and lightening of feces attract attention. Patients feel weakness, decreased performance, moderate discomfort and heaviness in the right hypochondrium, nausea, lack of appetite, loosening of the stool, sometimes urticaria rashes on the body are possible (red, itchy rash in the form of small blisters - urticaria). Perhaps an increase in the size of the liver, less often - the spleen, an increase in the lymph nodes surrounding the portal triad. The severity of viral hepatitis.
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Extremely severe Disturbance of consciousness, hemorrhagic syndrome, temperature of 38 ° C and above, ascites, decrease in the size of the liver, hepatic dullness percussion (when tapping) is not determined Severe Yellowness of the skin and sclera is pronounced, muscle weakness, drowsiness, aversion to food, nausea, repeated vomiting, decrease in the size of the liver Moderate Severe icterus of the skin and sclera, weakness, lethargy, lack of appetite, nausea, vomiting, enlargement of sulfasalazine pills Mild Slight icterus of the skin and sclera, slight weakness and loss of appetite, enlargement of the liver.
pathogenesis of viral hepatitis. Detailed pathogenesis of each type of viral hepatitis should be considered in separate articles. It is enough to understand the options for the normal functioning of the liver and the general mechanisms of its pathology. The formation and exchange of bilirubin is normal.
Bilirubin is a product of the transformation of hemoglobin (Hb), a kind of "waste" that must be removed from the body. It is formed mainly from Hb, which is released from red blood cells (lifetime 120 days). The destruction of hemoglobin and the formation of bilirubin occurs in the cells of the phagocytic mononuclear system:
A brief scheme for the formation of bilirubin looks like this: Erythrocytes (in the spleen) - Hemoglobin (in the spleen) - Verdoglobin (a product of azulfidine oxidation of the non-protein part of hemoglobin, which is formed in the cells of the macrophage system) - Biliverdin (an intermediate product of the breakdown of hemoglobin).
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The first phase: the formation of free (indirect) bilirubin in the spleen and hepatocytes (liver tissue cells). The second phase: its entry into the blood and transfer by albumins (simple water-soluble proteins) to hepatocytes. Third phase: binding of free bilirubin to glucuronic acid in hepatocytes (formation of azulfidine or direct bilirubin). The fourth phase: the release of direct bilirubin by hepatocytes in the composition of bile into the bile capillary. Fifth phase: entry of bilirubin-diglucoronide (direct bilirubin) into the duodenum in the form of bile.