SU1508154A1 - Method of diagnosis of occult forms of liver diseases - Google Patents

Abstract

This invention relates to medicine, in particular, to hepatology and clinical laboratory diagnostics. The aim of the invention is to improve the accuracy of the method. For this, an equal volume of 10% trichloroacetic acid solution is added to 0.5-1.0 ml of the hepatic bile portion, the mixture is centrifuged, then 1.8 ml of distilled water and 0.2 ml are added to 0.2 ml of the supernatant. Nessler's reagent. Colored solution photocolorimeter with a blue filter. The concentration of ammonia is determined by a calibration graph and, if it is 12 µmol / L or more, a latent form of liver disease is diagnosed. The accuracy of the method is 82.5%. 1 tab.

Description

This invention relates to medicine, in particular to hepatology and clinical laboratory diagnostics.

The purpose of the invention is to improve the accuracy of the method.

The method is carried out as follows.

Bile is obtained by duodenal sounding. An equal volume of 10% trichloroacetic acid solution is added to 0.5-1.0 ml of bile, and the mixture is centrifuged. Subsequently, 1.8 ml of distilled water and 0.2 MP of commercial Nessler reagent are added to 0.2 ml of the supernatant. The optical density of the yellow-stained solution was measured on a photoelectrocolorimeter with a blue light filter in a cuvette with an optical path length of 5. mm versus control.

- (2.0 ml of distilled water + 0.2 ml of Nessler's reagent) Amount of ammonia is calculated according to a previously prepared calibration curve.

The calibration curve is constructed in the usual way: in a row of test tubes, 0.1, 0.2, 0.3, etc. are poured. to 1.0 ml of a standard solution of ammogad chloride with a known concentration of nitrogen, add 0.2 ml of Nessler's reagent each and add distilled

 water up to 2.2 MP. The optical density of the obtained solutions was measured on a PEC with a blue light filter in a cuvette with a 5 mm long path against the control (2.0 ml of distilled water + 0.2 Mfi of Nessler's reagent). The gauge curve is plotted on graph paper, laying along the axis

L

15

20

the abscissas are known concentrations of nitrogen, and, on the y axis, the corresponding optical density of the solution. When changing reagents, it is required to build a new calibration curve,

When the concentration of ammonia in the hepatic bile portion (portions C) is 12 µmol or more, a hidden form of liver disease is diagnosed with a hidden-JQ of someone with active hepatitis.

Example 1. Sick M-VA, 50 l. Upon receipt of a complaint of pain in the right hypochondrium, general weakness, feeling of bitterness in the mouth, History - transferred in 196, Acute viral hepatitis. Objectively: the excretion of sclera is revealed, the liver and spleen are not enlarged. In the biochemical study of blood, there is indirect hyperbilirubieemia (30 µmol / l), an increase in the thymol test (7.6 units,). Taking into account the data of anamnesis, physical examination and functional liver tests, it was possible to assume in patients with chronic hepatitis of viral etiology. However, scintigraphy data indicated no evidence of liver damage. A morphological study of the presence of lipofuscin granules in hepatocytes, which is characteristic of impaired pigment metabolism in indirect hyperbilirubinemia. The content of ammonia in bile, investigated by the proposed method, was also within the normal range and amounted to 7.2 μmol / L in portion C. All of the above allowed us to exclude the patient with chronic hepatitis of viral etiology and set the final diagnosis of a functional indirect hyperbi. lyrubinemia,

P m and m e p 2. Sick K-va ,. 40. l. Upon receipt of a complaint of recurrent pain in the right hypochondrium, severe weakness, reduced appetite. A history of acute viral hepatitis, which was transferred in 1981, is noted. Objectively: reduced nutrition, moderate scleral ictericity, liver and spleen not enlarged. During biochemical blood tests, moderate indirect hyperbilinemia (24.8 mmol / l) is moderate, thymol sample is increased to 10 units. In the study of bile by the method described, the concentration of ammonia was increased and was 12 µmol / L (in portion C), a pronounced increase in ammonia in bile, x for chronic diseases, suggested that chronic hepatitis etiology was assumed. Conducted scout revealed a picture of diffuse liver, and puncture of the liver confirmed the presence of

Thus, it was obtained in the application of the diagnostic data base

chronic patient

checks, which flowed hidden, were scintigraphic,

PRI me R 3, Sickly Received a complaint about a character in the right oozing after eating, burping in the mouth. Similar pains

25 3 years old. Objectively: the lizel is not enlarged, fell at the point of the bile. Biochemical study functional pefc

30 nen, Cholecystography you kinesia gallbladder. tigraphy - signs of pore not revealed, The patient was well diagnosed with cholecystitis with dyskinesia of the pa- vyr. When conducting a probe for a microscopic examination of bile, the definition is contained in the bile. The ammonia content of C is 26.5 µmol / L, which is greater than that of a healthy liver. In this connection,

The assumption about the presence of a latent form of chronic In the future, the patient was tested by a biopsy, and a morphological study revealed an arctic portal and forehead patitis with minimal activity. Thus, it was possible to diagnose the current chronicly when clinical, biochemical scintigraphic data changed and could not serve the criteria,

35

40

who is active hepatitis ,,

Traction of ammonia in the bile, characteristic of chronic liver diseases, suggested that the patient has chronically active hepatitis of viral etiology. A scintigraphic scan revealed a picture of diffuse liver disease, and puncture biopsy of the liver confirmed the presence of chronic

Thus, the data obtained on the basis of the application of the proposed diagnostic

chronically ill pef

hidden checks are confirmed by scintigraphic and morphological research methods.

0

about

PRI me R 3, Ill G ,, 58 l. She complained of dull pain in the right hypochondrium, aggravated after eating, belching, bitter taste in the mouth. Such pain notes for 3 years. Objectively: the liver and spleen are not enlarged, palpation is painful at the point of the gallbladder. Biochemical blood tests showed no functional changes in the liver, Cholecystography revealed gallbladder hyperkinesia. When scintigraphy showed no evidence of liver damage, the patient was suspected to have been diagnosed with chronic cholecystitis with biliary dyskinesia, and in the course of duodenal sounding, microscopic examination of bile was carried out in parallel with bile ammonia. The content of ammonia in a portion of C - 26.5 μmol / l, which is much higher than in healthy and characteristic of chronic liver diseases. In this connection,

e the assumption that the patient has a latent form of chronic hepatitis. The patient was subsequently underwent hepatobiopsy, and a morphological study revealed a picture of chronic portal and lobular hepatitis with minimal activity. Thus, the pre-diagnosed method of diagnosing ammonia in the bile made it possible to detect the patient's current chronic hepatitis, when clinical, biochemical and scintigraphic data were not changed and could not serve as diagnostic criteria.

five

0

Comparison of the method with known biochemical indicators is presented in the table.

The data presented indicate the possibility of early and more accurate diagnosis of latent forms of liver disease when using the pre-treated diagnostic method. Moreover, the proposed diagnostic method can be used as a screen for the detection of latent forms of the pathology of the liver. The accuracy of the method is 82.5%.

Claims (1)

Invention Formula A method for the diagnosis of latent forms of liver diseases by means of a biochemical study of a cancer, which is carried out by the fact that, in order to improve the accuracy of the method, the concentration of ammonia in the hepatic bile fluid is determined by adding to 1/10 hour of 10-fold diluted deproteinized bile. Neslér's reagent followed by colorimetry and with a content of 12 µmol / L and more, a latent form of liver disease is diagnosed. Bilirubin total., µmol / l Albumins, rel.% Gamma globulins rel.% Timolova test units ApAT, mol / l Ammonia in bile (portions C), µmol / l 9,712,6 Compiled by S. Fedorov Editor M. Kelemesh Tehred I. Veres Order 5535/47 Circulation 789 VNIIPI State Committee for Inventions and Discoveries at the State Committee on Science and Technology of the USSR 113035, Moscow, Zh-35, Raushsk nab. 4/5 0.05 0.05 0.05 0.05 0.05 LO, 001 Proofreader L. Beskid Subscription