Method for early diagnostics of cholelithiasis

FIELD: medicine.

SUBSTANCE: one should perform ultrasound testing cholecystic bile and at detecting hyperechogenic particles and decreased contractile function of cholecystic wall by 25% and more one should diagnose early stage of cholelithiasis.

EFFECT: higher accuracy of early diagnostics.

3 ex, 6 tbl

 

The invention relates to medicine and can be used for early diagnosis of gallstone disease.

There is a method of ultrasound diagnosis of gallstone disease, accepted for similar [1].

A known method for the diagnosis of gallstone disease by endoscopic retrograde cholangiopancreatography [2], adopted for the prototype.

However, the method endoscopic retrograde cholangiopancreatography is not a public method of the study and did not allow an early diagnosis of gallstone disease.

The aim of the invention is to improve the accuracy of early diagnosis of gallstone disease.

The technical result is achieved by conducting a study of the gallbladder bile and identifying hyperechoic particles and reduced contractile function of the gallbladder wall by 25% or more are diagnosed with the early stages of gallstone disease.

The method is as follows.

The patient at admission revealed the presence of signs of chronic poisoning: headaches, fatigue, sleep disturbance, appetite, and sometimes low-grade fever. Sometimes patients concerned about intermittent pain in the right hypochondrium and a feeling of bitterness in the mouth - symptoms of biliary dyspepsia. In some cases, the pain syndrome and the syndrome intoxicat and missing.

Carried ultrasound of the liver and biliary tract. Ultrasound has decreased contractile function of the gallbladder. Calculated according to the formula of the original volume of the gallbladder:

V1=8· S1·2/3× 3,14· d1ml, where

S1- the original size of the image of the gallbladder on the screen;

d1the diameter of the gall bladder.

Calculation of the volume of the gallbladder after taking cholagogue Breakfast produced by the formula

V2=100· S22·d1/S12· d2(%)

The condition of the gallbladder wall can be described on the basis of ultrasound as:

- unchanged: the thickness closest to the sensor wall does not exceed 3 mm, wall goodnite throughout, single layer, internal and external contours of her smooth;

inflammatory changes in the gallbladder wall (chronic cholecystitis): wall thickness greater than 3 mm, the inner or outer contour of her rough, fuzzy, echo is increased or/and heterogeneous, there lamination,

- gallbladder cholesterosis: mesh shape in the thickness of the wall is rendered multiple small (1-3 mm) hyperechoic inclusions, as a rule, not giving acoustic shadow; polypous form of single or multiple the public, rounded-oval hyperechoic lesion adjacent to one of the walls of the gallbladder, with a few rough outlines, fairly homogeneous structure, not shifting, without acoustic shadow; polypose-net shape is a combination of sonographic signs of polypous and mesh form.

Depending on the echographic picture of gallbladder bile was highlighted 3 main forms of state carry bile to the gallbladder (biliary sludge):

1. Suspension hyperechoic particles: spot, single or multiple, shifting hyperechoic education, not giving acoustic shadow detected by the change of the body position of the patient;

2. Honetmoon bile with the presence of single or multiple areas of increased echogenicity with clear or blurred contours, shifting, located generally on the rear wall of the gallbladder without acoustic shadow behind the clot;

3. "Putty-like " bile (SI): honetmoon bile with the availability of plots coming in echogenicity to the liver parenchyma, shifting, with clear contours, not giving an acoustic shadow or in rare cases with the effect of weakening for the clot. In some cases the complete filling of the gallbladder " putty-like " bile, with anechoic mass with areas in the lumen of the gallbladder is not visualized.

Provo is iloci the determination of total bile acids and cholesterol in bile by the difference of the absorption of ultraviolet radiation complexes of salts of bile acids and cholesterol with ferric chloride; based on these data, we calculated the coefficient holati/cholesterol.

In addition, we determined the content of phospholipids, lipids and the saturation index of bile cholesterol (CSI). While selected two groups of patients a and b and group C - patients with mixed indices.

In patients of group a marked increase in the level of cholesterol and phospholipids in the bile and increasing the value of the integral indicator lithogenicity - saturation index of bile cholesterol (CSI) compared to the norm, as well as a decrease in the relative content of bile acids. Similar changes occur on the background of a slowdown monooxide liver enzymes responsible for the metabolism of cholesterol and endogenous production of bile acids. In patients group compared to the normal indicators proportion of bile acids and cholesterol in bile revealed a significant decrease in the content of phospholipids. The decline of phospholipids in bile may be due or failure of their endogenous production, or a violation of the mechanism of the excretion of these lipids in bile canaliculi.

In patients group And the content of total cholesterol in serum was significantly higher compared to the norm. This increased level of serum cholesterol is due to the increase in the proportion of cholesterol low-density lipoprotein (LDL). We are sick of the groups In total cholesterol and LDL cholesterol did not differ from the norm, while the levels of triglycerides (TG) and cholesterol high density were significantly lower and norms, and indicators of patients in group A. in Addition, there is a trend of decrease in plasma phospholipids. Blood lipid profile of patients group includes the distinguishing characteristics of the patients of groups a and B.

Thus, the formation of biliary sludge in the gallbladder occurs on the background of significant changes in biochemical composition of gallbladder bile, indicating the presence of lithogenic properties. Moreover, in patients with biliary sludge in the form honetmoon bile with the presence of clots and " putty-like " bile in 100% of cases reveal a decrease in the pool of bile acids and increased levels of cholesterol and phospholipids in the bile, and serum marked hypercholesterolemia. In patients with biliary sludge in the form of mist echogenic particles lithogenic properties of bile due to a decline phospholipids; in 45% of patients in this group showed increase in cholesterol and reducing the pool of bile acids in bile and serum - cholesterol.

The study gallbladder bile revealed the presence of hyperechoic particles and decreased contractile function of the gallbladder wall at 25% and more possible to diagnose the early stage of gallstone disease.

The way podtverjdau is by the following examples.

Example 1.

Patient, 26 years old, was admitted with complaints of headaches, fatigue. Sometimes the patient experience pain in the right hypochondrium.

Carried ultrasound of the liver and biliary tract. Ultrasound has decreased contractile function of the gallbladder by 25%. The gallbladder wall is not changed, the thickness closest to the sensor wall is 3 mm, wall goodnite throughout, single layer, internal and external contours of her smooth.

Echographic picture of gallbladder bile is characterized by the following features:

suspension hyperechoic particles: spot, single or multiple, shifting hyperechoic education, not giving acoustic shadow detected by the change of the body position of the patient. This ultrasound picture characteristic of biliary sludge.

Determined the content of total bile acids and cholesterol in bile, the content of phospholipids, lipids and the saturation index of bile cholesterol (CST).

Table 1

Biochemical indicators of gallbladder bile,% of the total concentration of biliary lipids
Patient-LCDCholesterolFLX/XCSI
 60,08,332,27,41,6
Norma69,1± 6,25,3± 2,726,0± 5,310-13<1

From table 1 it is evident that this patient's elevated level of cholesterol and phospholipids in the bile and increased the value of the integral indicator lithogenicity - saturation index of bile cholesterol (CSI) compared to the norm, as well as a marked decrease in the relative content of bile acids. The content of lipids in the blood of the patient are presented in table 2.

Table 2

The content of lipids in the blood plasma of the patient in with biliary sludge, mmol/l
Sick

With-in
General

cholesterol
TGCholesterol HDLCholesterol

LDL
FL
 6,01,41,64,03,3
Norma4,1± 1,11,1± 0,4>1,4<3,53,1± 0,3

As can be seen from table 2, the patients ' total cholesterol in serum above the norm. This increase in serum cholestero is and is due to the increase in the proportion of cholesterol low-density lipoprotein (LDL).

Treatment drug hepabene, with positive dynamics of clinical symptoms and the disappearance of sonographic signs of biliary sludge. Found a significant increase holati/cholesterol and decrease ulicny index saturation of bile with cholesterol to normal.

Subsequent follow-up observation period of 9 months showed no progression of symptoms of biliary sludge and gallstones.

Example 2.

Sick To nd, 33 years old, was admitted with complaints of fatigue, sleep disturbance, appetite. Sometimes pain in the right hypochondrium.

Carried ultrasound of the liver and biliary tract. Ultrasound has decreased contractile function of the gallbladder by 35%.

A gallbladder wall with inflammatory changes (chronic cholecystitis), the wall thickness of 3.3 mm, inner or outer contour of her rough, fuzzy, echo is increased, there is a cleavage.

Echographic picture of gallbladder bile - honetmoon bile with the presence of multiple areas of increased echogenicity with sharp contours, shifting, located on the rear wall of the gallbladder without acoustic shadow behind the clot.

Measured the total amount of bile acids and cholesterol in bile were determined content is of phospholipids, lipids and the saturation index of bile cholesterol (CSI) - table 3.

Table 3

Biochemical indicators of gallbladder bile,% of the total concentration of biliary lipids
Patient K-ILCDHallFLX/XCSI
 77,0of 5.415,31,41,4
Norma69,1± 6,25,3± 2,726,0± 5,310-13<1

From table 3 it follows that the patient compared to the normal indicators proportion of bile acids and cholesterol in bile revealed a significant decrease in the content of phospholipids and an increase of the coefficient CSI - increasing lithogenicity of bile.

Table 4

The content of lipids in the blood plasma of patients with BS, mmol/l
Patient K-ITotal cholesterolTGCholesterol HDLCholesterol LDLFL
 4,50,51,03,32,8
Norma4,1± 1,11,1± 0,4 >1,4<3,53,1± 0,3

As can be seen from table 4, the patient total cholesterol and LDL cholesterol did not differ from the norm, while the levels of triglycerides (TG) and cholesterol high density were significantly lower than normal.

Thus, the formation of biliary sludge in the gallbladder occurs on the background of significant changes in biochemical composition of gallbladder bile, indicating the presence of lithogenic properties. Moreover, the patient with biliary sludge in the form honetmoon bile with the presence of clots in the bile reveal a significant decrease in the content of phospholipids and an increase of the coefficient CSI, reflecting increasing lithogenicity of bile on the background of the decline in contractile function of the gallbladder. It is possible to diagnose the early stage of gallstone disease.

A course of treatment the patient drug hepabene. There is positive dynamics of clinical symptoms and a positive sonographic dynamics in ultrasound of the gallbladder. Normalization of the lipid spectrum of blood serum.

The patient was discharged in a state of clinical and laboratory remission.

Example 3.

Patient X -, 56 years old, complains upon receipt for signs of chronic poisoning: headaches, fatigue, sleep disturbance, APET is the the fever. Periodically, the pain in the right hypochondrium and a feeling of bitterness in the mouth - symptoms of biliary dyspepsia.

Carried ultrasound of the liver and biliary tract. Ultrasound has decreased contractile function of the gallbladder by 52%. Ultrasonography of the gallbladder says:

in the thickness of the gallbladder wall multiple small (1-3 mm) hyperechoic inclusions, not giving acoustic shadow; and multiple, rounded-oval hyperechoic lesion adjacent to the rear wall of the gallbladder, with a few rough outlines, fairly homogeneous structure, not shifting, without acoustic shadow (polypose-net shape cholesterosis).

Echographic picture of gallbladder bile: honetmoon bile with the availability of plots coming in echogenicity to the liver parenchyma, shifting, with clear contours, not giving an acoustic shadow - " putty-like " bile.

Determined the content of total bile acids and bile cholesterol and phospholipids, lipids and the saturation index of bile cholesterol (CSI) - table 5.

Table 5

Biochemical indicators of gallbladder bile,% of the total concentration of biliary lipids
Patient X-LCDHall.FLX/XCSI
 54,28,818,36,21,9
Norma69,1± 6,25,3± 2,726,0± 5,310-13<1

As seen from table 5 that the patient has increased cholesterol and a decrease in the level of phospholipids in bile, increase the value of the integral indicator lithogenicity - saturation index of bile cholesterol (CSI) compared to the norm, as well as a decrease in the relative content of bile acids.

Table 6

The content of lipids in the blood plasma of the patient X-VA, mmol/l
Patient X-Total cholesterolTGCholesterol HDLCholesterol LDLFL
 7,21,01,24,42,8
Norma4,1± 1,11,1± 0,4>1,4<3,53,1± 0,3

As can be seen from table 6, the patient, the content of total cholesterol in serum was significantly higher than the s with the norm. This increases the proportion of cholesterol low-density lipoprotein (LDL) cholesterol while lowering levels of triglycerides and phospholipids.

The formation of biliary sludge in the gallbladder occurs on the background of significant changes in biochemical composition of gallbladder bile, indicating the presence of lithogenic properties. Moreover, in the patient with biliary sludge in the form of a " putty-like " bile revealed reduction of the pool of bile acids and increased levels of cholesterol and a decrease in the level of phospholipids in bile and serum marked hypercholesterolemia.

The study gallbladder bile revealed the presence of hyperechoic particles and decreased contractile function of the gallbladder wall at 52%, which allowed us to detect the early stages of gallstone disease.

Patients received treatment according to standard methods. After the treatment there has been a disappearance of clinical symptoms and positive dynamics of the echographic picture of the gallbladder.

Follow-up observation for 16 months did not reveal the formation of gallbladder stones.

The diagnosis and subsequent treatment according to the claimed method 69 patients. 59 patients diagnosed gallstone disease at an early stage.

The method of early diagnosis of gallstone disease by at travelog research characterized in that conduct research gallbladder bile and identifying hyperechoic particles and reduce the contractile function of the gallbladder wall by 25% or more are diagnosed with the early stages of gallstone disease.



 

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