Method for early predicting cholelithiasis

FIELD: medicine, surgery.

SUBSTANCE: one should carry out virological testing patient's blood serum and hepatic bioptates. At detecting TTVDNA and HGVRNA it is necessary to perform ultrasound survey, and at availability of biliary sludge one should conclude upon early stage of cholelithiasis.

EFFECT: higher accuracy of diagnostics.

3 ex

 

The invention relates to medicine and can be used for early diagnosis of cholelithiasis associated with TTVDNA and HGVRNA - virusesa.

There is a method for early diagnosis of cholelithiasis by cholecystocholangiography adopted for similar [1].

A known method for the diagnosis of cholelithiasis by ultrasound [2], adopted for the prototype.

However, the accuracy of early diagnosis of cholelithiasis associated c TTVDNA and HGVRNA, according to the method prototype is relatively limited.

The aim of the present invention is to improve the accuracy of early diagnosis of cholelithiasis associated with TTVDNA and HGVRNA - virusesa.

The technical result is achieved by that conduct virological study of blood serum and liver biopsy specimens and detection TTVDNA and HGVRNA perform an ultrasound of the biliary tract and the presence of biliary sludge judge early cholelithiasis.

The method is as follows.

At admission the patient complains of bloating, irregular stools, heartburn, feeling of bitterness in the mouth, belching air; sometimes the patient occurs aching pain, feeling of heaviness in the epigastric region, the right and left podrebarac, worse after exercise and after the deposits, accompanied dyspeptic disorders.

Determine the content of immunoglobulins in the serum: IgM, IgG and IgA; and the level of bilirubin, alkaline phosphatase, gamma-glutamyltranspeptidase, alanine and aspartic transferring enzyme.

Spend fractional duodenal intubation and in the portion "B" determine the total concentration of bile acids and cholesterol. Calculate holeto-cholesterol index and the index of saturation of bile with cholesterol (CSI).

Conduct a biopsy using a needle Magiii. The syringe filled with sterile solution, a needle after anesthesia of the skin injected into the upper quadrant without going through it completely. Part of the solution clean the needle from fragments of skin. Then pull the plunger of the syringe, creating a constant aspiration. When the breath of the patient on the exhale the needle, located perpendicular to the surface of the skin, fast movement is introduced into the liver and output. The needle tip is placed on sterile filter paper. The remaining solution push the biopsy material from the needle.

Carry out the determination by the method of enzyme immunoassay - HBsAg, anti-HBS, HBeAg, HBeAb, HBcAb IgM, HBcAb IgG, HCVAb IgM and HCVAb IgG. HGV RNA, TTV DNA in serum and liver biopsy specimens. Detect the presence V(+) and HGV(+) in serum and liver biopsy specimens.

Perform ultrasound examination of the liver and biliary tract. According to the U.S. is barouni signs of diffuse liver disease, thickening of the gallbladder wall and the presence of suspended solids and biliary sludge in the gall bladder.

Morphological examination of the liver biopsy specimens of patients infected with TTVDNA and HGVRNA, showed the presence of moderately expressed focal portal, periobalance and lobularia hepatitis with deposits of lipofuscin. Inside cloves marked necrosis of liver cells; adjacent hepatocytes are wrinkled, acidophilic cytoplasm, hyperchromic or pyknotic the core. Observed changes of the epithelium of the bile ducts. The epithelium of the bile duct dystrophic modified Observed flattening, swelling of individual epithelial cells, the boundaries are fuzzy, there is desquamation of the epithelium.

Thus, damage of liver cells and bile ducts due to TTV and HGV - virusesa, with subsequent development of cholelithiasis is as follows. TTVDNA, damaging the liver cell, helps produce bile lower holeto-cholesterol index, the index of saturation of bile with cholesterol and bilirubin. There are prerequisites for the formation of pigment stones. HGVRNA damage along with liver cells mainly epithelial cells of the gallbladder and bile ducts by desquamation of the epithelium. Desquamated epithelial cells may be the foci of crystallization of bile with you who akim pigment, cholesterol and bile acids. Ultrasound confirms these changes in the form of biliary sludge, which is an early ultrasound sign of cholelithiasis. The presence of biliary sludge judge early cholelithiasis.

Way of the following examples.

Example 1.

Patient M., aged 44, when receiving complains of heartburn, a feeling of bitterness in the mouth, nousou pain, feeling of heaviness in the epigastrium, worse after exercise.

In the study of blood serum Ac AT - 41,2 u/l, al AT - 44,6 u/l; alkaline phosphatase -182 u/l, gamma-glutamyltranspeptidase - 54,9 u/l, bilirubin - 42,0 μm/L. the Content of immunoglobulins in the serum was: IgM - 165 mg% (normal 105), IgG -1910 mg% (normal 1080), IgA-365 mg% (normal 155).

Spend fractional duodenal intubation. In portion "B" total concentration of bile acids stood at 64.5 μm/l and cholesterol - 5,6 μm/L. Holeto-cholesterol index - 8,5 (norm 10-13) and saturation index of bile cholesterol (CSI) - 1,85 (normal less than 1.0).

Conduct a biopsy using a needle, Mangini diameters of 1.4 mm Syringe filled with sterile solution volume of 3 ml, the needle after anesthesia of the skin injected into the upper quadrant without going through it completely. Part of the solution (2 ml) clean needle from fragments of skin. Then pull the plunger of the syringe, creating the village is Ioannou aspiration Is a slow step in the procedure. When the breath of the patient on the exhale the needle, located perpendicular to the surface of the skin, fast movement is introduced into the liver and output. This is a quick step in the procedure. The needle tip is placed on sterile filter paper. The remaining solution push the biopsy material from the needle.

Carry out the determination by the method of enzyme immunoassay - HBsAg, anti-HBS, HBeAg, HBeAb HBcAb IgM, HBcAb IgG, HCVAb IgM and HCVAb IgG. HGV RNA, TTV DNA in serum and liver biopsy specimens. Detect the presence of TTV(+) and HGV(+) in serum and liver biopsy specimens.

Morphological examination of the liver biopsy specimens of a patient infected TTVDNA and HGVRNA, showed the presence of moderately expressed focal portal and lobular hepatitis with deposits of lipofuscin. Inside cloves marked necrosis of liver cells; adjacent hepatocytes have withered cytoplasm, pyknotic the core. Observed changes of the epithelium of the bile ducts: desquamation of the epithelium, as well as the swelling of individual epithelial cells.

Perform ultrasound examination of the liver and biliary tract. According to the ultrasound signs of diffuse liver disease and the presence of biliary sludge in the gall bladder.

Desquamated epithelial cells may be the foci of crystallization of bile with a high content of pigments, cholesterol and bile acids. Ultrasound p is dtarget these changes in the form of biliary sludge, which is an early ultrasound sign of cholelithiasis. The presence of biliary sludge judge early cholelithiasis.

Treatment with antiviral drugs and drugs improving the ratio of bile acids, cholesterol and bilirubin. Subsequent follow-up observation for 12 months showed no progression of cholelithiasis.

Example 2.

Patient C-WA, 35 years old, was admitted with complaints of flatulence, unstable stool and heartburn; occasionally a feeling of heaviness in the epigastric region, the right and left podrebarac.

When s serum Ac AT - 46,7 u/l, al AT - 48,9 u/l; alkaline phosphatase - 175 u/l, gamma-glutamyltranspeptidase - 51,7 u/l, bilirubin - 46,8 μm/L. the Content of immunoglobulins in the serum was IgM - 183 mg%, IgG - 1750 mg%, IgA - 298 mg%.

Spend fractional duodenal intubation. In portion "B" total concentration of bile acids was 87.8 m/l and cholesterol was 7.3 μm/L. Holeto-cholesterol index - 8.1 and a saturation index of bile cholesterol (CSI) - 2,05.

Perform liver biopsy with subsequent determination of HBsAg, anti-HBS, HBeAg, HBeAb, HBcAb IgM, HbcAb IgG, HCVAb IgM and HCVAb IgG. HGV RNA, TTV DNA. Detect the presence of TTV(+) and HGV(+) in liver biopsy specimens, and then the serum.

Morphologically showed the presence of periobalance and lobular, hepati is and with deposits of lipofuscin. Inside cloves marked necrosis of liver cells; adjacent hepatocytes are acidophilic cytoplasm, hyperchromic nuclei. The epithelium of the bile duct dystrophic changed. There has been a swelling of individual epithelial cells and desquamation of the epithelium.

Perform ultrasound examination of the liver and biliary tract: signs of diffuse lesions pecena, thickening of the gallbladder wall and the presence of suspended solids and biliary sludge in the gallbladder. The presence of biliary sludge is an early ultrasound sign of cholelithiasis.

The patient refused treatment. Follow-up observation in the course of the year showed the formation of pigment stones of the gall bladder. A year and a half spent cholecystectomy.

Example 3.

Patient, 56 years of age, complains when applying for nousou pain, feeling of heaviness in the epigastric region, the right and left podrebarac, worse after exercise and experiences, accompanied dyspeptic disorders.

When s serum Ac AT - 49,7 u/l, al AT - 53,5 u/l; alkaline phosphatase - 192 u/l, gamma-glutamyltranspeptidase - 63,6 u/l, bilirubin - 48,1 μm/L. the Content of immunoglobulins in the serum was: IgM - 184 mg%, IgG - 2150 mg%, IgA - 347 mg%.

Perform a liver biopsy and biopsy define the content of HBsAg, anti-HBS, HBeAg, HBeAb HBcAb IgM HBcAb IgG, HCVAb IgM and HCVAb IgG. HGV RNA, TTV DNA. Detect the presence of TTV(+) and GV(t) in the serum and liver biopsy specimens.

Perform ultrasound examination of the liver and biliary tract. According to the ultrasound signs of diffuse liver disease, thickening of the gallbladder wall and the presence of suspended solids and biliary sludge in the gall bladder.

Morphological examination of the liver biopsy specimens of patients infected with TTVDNA a HGVRNA, showed the presence of moderately expressed focal portal periobalance and lobular hepatitis with deposits of lipofuscin. Inside cloves marked necrosis of liver cells; adjacent hepatocytes are wrinkled, acidophilic cytoplasm, pyknotic the core. Observed changes of the epithelium of the bile ducts. The epithelium of the bile duct dystrophic changed. There is flattening, swelling of individual epithelial cells, there is desquamation of the epithelium.

Ultrasound examination confirmed these changes and as biliary sludge, which is an early ultrasound sign of cholelithiasis.

The patient treatment with anti-virus and reduce lithogenetic bile products.

The patient is put into a state of clinical remission. At discharge recommendations on diet and herbal medicine. Follow-up observation within 1.5 years showed the reduction lithogenicity of the bile and the absence of biliary sludge.

According to the claimed method was carried out diagnostics 34 men and 29 women. 59 patients diagnosed TTVDNA and HGVRNA-associated cholelithiasis at an early stage of biliary sludge).

Sources of information

1. Diseases of the digestive system in children. N/p Mazurina A. M., 1984, - 630 C.

2. Ibid.

Method for early diagnosis of cholelithiasis by ultrasound, wherein the pre-spend virological study of blood serum and liver biopsy specimens and detection TTVDNA and HGVRNA and the presence of biliary sludge judge early cholelithiasis.



 

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