SU1119659A1 - Method of diagnosis of liver and biliferous tract diseases accompanied by cytolis - Google Patents

Abstract

A METHOD FOR DIAGNOSTIC DISEASES OF THE LIVER AND DIETARY TRACKS ACCOMPANIED BY CYTOLYSIS, by examining bile, characterized in that, in order to improve diagnostic accuracy, determine the total amount of nucleic acids in the cystic and hepatic biliary obs, and in order to improve the diagnostic accuracy, determine the total amount of nucleic acids in the gallstones and liver with the biliary and ocular disorders in the gallstones and liver; diagnosed with biliary tract disease, and with an increase in both portions - liver disease.

Description

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The invention relates to medicine, namely to a hepatologist, and can be used to diagnose liver diseases accompanied by cytolysis (liver cirrhosis, cholecystitis, hepatitis). A known method for the diagnosis of diseases of the liver and bile ducts, accompanied by cytolysis by examining bile 1. The aim of the invention is to improve the accuracy of diagnosis. The goal is achieved according to the method for diagnosing diseases of the liver and biliary tract, accompanied by cytolysis by examining bile, the total amount of nucleic acids in the cystic and hepatic portions of bile is determined and, when increased, in comparison with the norm in a bladder portion, the disease of the biliary tract is diagnosed, and with an increase in both portions - liver disease. The method is carried out as follows. Bile in a volume of 0.2 ml is boiled in a water bath with 4.8 ml 0.6 n. perchloric acid (HCL4) for 30 minutes, then cooled to 20 ° C. After cooling, the settled proteins are removed by centrifugation. Supernatant spectrophotometrically in ultraviolet light at wavelengths of 270 nm and 290 nm against 0.6 n. perchloric acid in quartz cuvettes with a thickness of 10 mm. The difference between the readings of the spectrophotometer, divided by the empirical coefficient of 0.19, shows the phosphorus content of nucleic acids in micrograms per millimeter of the reaction mixture. To determine the content of nucleic acids in one liter of bile (SI system), the spectrophotometer readings are entered in the formula (1-B) .5.5000.10.3 0.19.0.2 mg / l, optical density 270 nm; optical density 290 nm; 5 - volume of the reaction mixture in ml (0.2-4.8); 5000 is the coefficient to bring 0.2 ml of bile to 1.0 l; 10.3 is the coefficient for converting phosphorus to nucleic acids; 0.19 is the empirical coefficient for determining phosphorus; 0.2 is the volume of bile used in ml. Produced with coefficients, the formula takes the following form (AB). 6776.3 mg / l. In the absence of pathology on the part of the liver and biliary tract, the total amount of nucleic acids in portion B ranges from 196.5 mg / l to 1280.7 mg / l, in the hepatic portion from 223.5 mg / l to 1287.5 mg / l . With inflammation in the gallbladder, the total amount of nucleic acids in portion B is 908.0 mg / l 2107.4 mg / l and in portion C - 304.9 mg / l - 1456.-3 mg / l. In chronic persistent hepatitis, the total amount of nucleic acids in portion B is 1,112.7 mg / l — 1,849.9 mg / l, and in portion C — 1,097.6 mg / l — 2202.2 mg / l. In chronic active hepatitis, the total amount of nucleic acids in portion B is 1,138.4 mg / l — 2181.9 mg / l, and in portion C-2751.1 mg / l — 6,573.0 mg / l. With liver cirrhosis, the total nucleic acid content in bile b serving B is 474.3 mg / l - 2,676.6 mg / l and in bile C portion - 826.7 mg / l - 3,096.7 mg / l. Example I. Patient A. was examined. Upon inquiry, it was revealed that the subject had no diseases of the digestive organs, no contact with hepatotropic diseases, and did not suffer from hereditary diseases. No complaints from the digestive organs. The activity of enzymes in the serum did not exceed the average values of the norm: fructose-1-phosphataldolase (F1-FC) -0.71 units. Act; histidase (GI) - About mmol / tsp; Glutamate dehydrogenase (GDG) —0.8 mmol / (tsp) and serum phosphatase activity in the serum (AP) was 1.02 mmol / tsp. The conclusion is made: practically healthy. The total amount of nucleic acids in the cystic portion of bile (portion B) was 196.5 mg / l, in the hepatic portion of bile (portion C) - 223.5 mg / l. This is the minimum concentration of the total amount of nucleic acids found in the bile of a healthy person. Example 2. Patient I., was admitted for treatment with complaints of pain in the right hypochondrium, poor appetite, weakness. Objectively: the dog is slightly enlarged, moderately compacted, smooth, painful on palpation. The spleen is not palpable. A scanning of the liver with AHjgg revealed a uniform isotope absorption, an enlarged organ. In laboratory diagnostics (total blood protein 80 g / l (normal), thymol sample 8 units (normally up to 5 units), ESR 8 mm / h (normal), GI - 1.0 mmol / tl (normal). At According to the data of the distribution and objective research, one could suspect chronic hepatitis and differentiate chronic active hepatitis from chronic persists, however, according to the laboratory examination, no pathology of the liver was detected, except for;

thymol test (+ 3 units). Bile was obtained from a patient by duodenal sounding, and proteins bound to nucleic acids (pyronin-dyeing, fractions) were determined by a known method in the hepatic bile portion. In the C portion, 10 pyronin-dying fractions were detected, indicating their presence of active hepatitis (normally 1-2, with inactive hepatitis 3-7 and with active hepatitis 8-20 pyronin-redding fractions), but the absence of an increase in the activity of enzymes in serum excluded chronic active hepatitis. In the patient in the cystic and hepatic portions of bile, the total amount of nucleic acids was determined by the proposed method. In portion B, 1504.1 mg / l, in portion C, 1,680.4 mg / l, indicating chronic persistent hepatitis. In order to clarify the diagnosis, the patient underwent a liver biopsy puncture, the result of which confirmed the presence of chronic persistent hepatitis. He was diagnosed with chronic persistent hegtatitis in the acute stage.

Example 3. The patient K. was surveyed. Sick for two years. The disease is associated with postponed viral hepatitis, for which it was treated in an infectious diseases hospital for three months. After discharge, she was hospitalized three times. On admission: the stomach is slightly retracted, soft, palpation is painful in the right hypochondrium. The liver protrudes 7–8 cm from under the costal arch. Based on the clinic and objective data, hepatitis can be diagnosed without differentiating into forms {persistent or active). In a laboratory study of ESR 25 mm / h, thymol sample 6 units, aminotransferase ALT - 0.165 mmol / tl., ACT .- 0.188 mol / tl: according to laboratory data - chronic persistent hepatitis, but radioisotope scanning of the liver with you an increase in the liver, a decrease and an uneven accumulation of the isotope in the lower part of the HF lobe, which is characteristic of cirrhosis of the liver.

The patient was prescribed duodenal intubation, and in the hepatic bile portion, proteins associated with nucleino- were identified. vym acid.m by a known method. Fourteen pyroNi-dye fractions indicating active hepatitis have been identified. In the cystic and hepatic portions of bile, the total amount of nucleic acids was determined. In portion B - 1694.0 mg / l; in portion with - 5082.2 mg / l. Such a total amount of nucleic acids in bile is characteristic of chronic active hepatitis. The diagnosis was confirmed by puncture biopsy.

Example 4. Patient V., ill for 5 years. Upon admission to the hospital, he complained of constant pain in the right hypochondrium, feeling of fullness in the epigastric region, nausea, feeling of bitterness and dry mouth, poor appetite, edema in the legs, increased body temperature, partial nasal bleeding, finding oneself, general weakness . From past diseases viral hepatitis. Objectively: skin and visible mucous membranes with hepatic signs, edema of the legs. Abdomen is enlarged due to ascites. Hepato-and splenomagali. Clinical evidence of cirrhosis of the liver. The activity of all enzymes in the serum

5 increased: F-1-F-A - 2.2 units. act., GI 1.5 mmol / t., GDH - 3.5 mmol / t., however, it is unequivocally regarded that the patient has chronic active hepatitis or cirrhosis of the liver due to a change in the activity of enzymes in the blood serum.

Bile was obtained from a patient by duodenal sounding, and in the hepatic bile portion, proteins bound to nucleic acids were detected by a known method. 12 pyronin-dye fractions testifying to active hepatitis were revealed, however, the clinical course and the results of radioisotope diagnostics indicated cirrhosis of the liver. In the hepatic and cystic portions of bile, the total amount of nucleic acids was determined, which amounted to 1097.3 mg / l in portion B and 1813.1 mg / l in portion C, which is characteristic of cirrhosis of the liver. The diagnosis was confirmed by puncture biopsy.

Example 5. Patient P. was examined. On admission to the hospital, he complained of pain in the right hypochondrium of paroxysmal nature, nausea, vomiting with bile, bitter taste in the mouth, and belching with air.

0 The clinical picture of the disease showed chronic cholecystitis, however, some ESR increase up to 19 mm / h and thymol test up to 12 units. inclined the doctor to think about hepatitis. The patient underwent duodenal intubation and. In the hepatic bile portion, the pyronin-containing fractions were determined by a known method. In the hepatic bile portion, 2 fractions were revealed, which indicated the absence of hepatitis. In the cystic and hepatic portions

0 bile determined the total amount of nucleic acids, the predominant increase in which in the cystic bile portion indicated inflammation in the gallbladder: in batch B - 1626.3 mg / l, in batch C - 1084.2 mg / l. Radiocontrast examination of the gallbladder in the bottom area revealed rounded shadows with a diameter of 3-5 mm, which confirmed the diagnosis of chronic calculous cholecystitis.

Example 6. Patient S., was admitted for treatment with a diagnosis of duodenal ulcer. On admission, he presented gutters for a feeling of heaviness and pain in the epigastric region 30–60 minutes after eating and “hungry pain. Repeatedly treated for duodenal ulcer disease in inter-collective farm hospitals, however, radiological confirmation of the presence of ulcers was never received, and the diagnosis was made on the basis of complaints from the patient. Laboratory data without features. In a patient, bile was obtained by duodenal intubation and the total number of nucleic acid cells was determined. In portion B, 1,558.5 mg / l and in portion C, 1,084.2 mg / l. The advantageous increase in the total amount of nucleic acids in the cystic portion of bile indicated the presence of cholecystitis. A radiopaque study revealed a slowdown in the evacuation of contrast from the gallbladder and a picture of pericholecystitis. During repeated duodenal intubation, vegetative forms of lambia were found in a patient in the bile.

Example 7. The patient was admitted to the hospital with a diagnosis of exacerbation of chronic cholecystitis, about which she had been repeatedly treated. Based on patient complaints and laboratory data, a clinical diagnosis was made: chronic stoneless cholecystitis.

On the same day, the patient was performed duodenal intubation. In the liver

portions of bile by the known method were determined pyronin-Krasia fractions (8 fractions), indicating active hepatitis. In the cystic and hepatic portions of bile, the total amount of nucleic acids was determined: in portion B - 1829.6 mg / l and in portion C - 4797.6 mg / l. On the basis of a pronounced increase in the total amount of nucleic acids in portion C, a diagnosis of active hepatitis should have been made, but there was no clinical evidence of active hepatitis. In 10 days the patient had a sharp rise in temperature to 38.7 ° C, sharp weakness and malaise appeared.

5 The skin and visible mucous membranes acquired an icteric color, the color of the urine became dark yellow. Increased serum aminotransferase and pigment concentrations indicated viral hepatitis: ALT - 3-2 mmol / tl, ACT-1.2 mmol

 (t., bilirubin total 75.8 mmol / l, direct 48.23 mmol / l, indirect 28.08 µmol / l) the patient was transferred to the infectious diseases hospital with a diagnosis of viral hepatitis A.

The proposed diagnostic method made it possible to detect active hepatitis in 10 days. before the appearance of the clinical picture of the disease.

The invention allows to increase the diagnostic accuracy up to (from 74 ° / o by a known method). In addition, the proposed method is quite simple and does not require a long time (it takes 1-1.5 hours to implement).

Claims (1)

METHOD FOR DIAGNOSTIC OF DISEASES OF THE LIVER AND BILITARY WAYS ACCOMPANIED BY CYTOLYSIS by examining bile, characterized in that, in order to increase the accuracy of diagnosis, the total number of nucleic acids in the cystic and hepatic portions in bile and its portions is increased in comparison with the diagnosis of bile ducts, and with an increase in both portions - liver disease.