Additional methods of examination of the liver and gallbladder

A special place in the diagnosis of diseases of the liver and bile ducts belongs to the biochemical study of blood. This applies primarily to the study of the content of a number of enzymes, among which transaminases - ACT (aspartic transaminase, glutamateoxalatetransaminase, aspartate aminotransferase) and ALT (alanine transaminase, glutamate pyruvatetransaminase, alanine aminotransferase) are isolated , the increase in which indicates the damage (cytolysis) of hepatocytes.

Laboratory methods for diagnosing liver diseases

Blood test. In the general blood test, leukocytosis and an increase in ESR can be detected, which is more common in acute cholecystitis and acute alcoholic hepatitis, leukopenia and thrombocytopenia together with increased ESR (with chronic hepatitis of viral origin ).

Of great clinical importance is the study of y-glutamyltranspeptidase (y-GTP), whose activity increases with cholestasis and acute alcoholic liver damage, and alkaline phosphatase found in cholestasis and tumors; a decrease in serum cholinesterase activity usually indicates severe hepatocyte damage.

The features of disproteinemia, in particular, the presence of hypergammaglobulinemia, are evaluated. By the degree of decrease in albumin content (hypoalbuminemia), cholesterol and prothrombin, the severity of liver failure is judged . High cholesterol in the blood is detected with bile retention ( cholestasis ). In addition to reducing the albumin content, it is important to study the content of other protein fractions, conducted by electrophoresis and immunoelectrophoresis, and the total protein of the blood. With some diseases of the liver, there is an increased level of the latter (hyperproteinemia), which is often combined with hypergammaglobulinemia. It is of diagnostic importance to determine the blood content of certain trace elements, primarily copper and iron. An increase in this indicator can lead to liver damage. A high level of copper is often combined with a low content of ceruloplasmin, which is usually caused genetically and is very characteristic of Wilson-Konovalov's disease.

Immunological methods. A number of immunological methods are used, most of them for the detection of nonspecific changes (definition of immunoglobulins of different classes, complement, circulating immune complexes), but in some cases have some specific significance (high IgA level in serum is often found in alcoholic liver lesions, detection high titers of antinuclear antibodies and antibodies to smooth muscles are characteristic of autoimmune hepatitis, antimitochondrial antibodies - for primary biliary cirrhosis liver).

Recently, methods have been widely used to detect both the infection of hepatitis A, B, C, delta particles with viruses, and the stage of replication of these viruses, especially against hepatitis B viruses (HBV) and hepatitis C (HCV), for example, the HBV replication stage is established by the identification of such markers as HBV-DNA, DNA polymerase, HBe-antigen, HBc-antibodies associated with IgM. These results are important not only to clarify the etiology of liver disease, but also to decide on the appointment of antiviral treatment.

Instrumental diagnostic methods

Endoscopic methods. Among these methods, esophagogastroduodenoscopy is used primarily to detect changes in the veins, esophagus, gastric mucosa (which is characteristic of portal hypertension syndrome), erosive esophagitis (often observed with alcoholic liver damage).

Used X-ray methods (especially for detection of esophageal varices - an important feature of increased pressure in the portal vein system); computed tomography, radionuclide methods and ultrasound (primarily to identify focal, as well as diffuse changes in the parenchyma in cirrhosis and fatty liver disease), which is supplemented by liver angiography.

Special methods of examination of the liver

Methods	Indications
Radioisotope scanning.	Focal lesions (tumors, metastases, cysts, abscesses). Diffuse lesions (cirrhosis in the late stage).
Ultrasound examination.	Focal lesions. Cirrhosis of the liver, steatosis of the liver. Study details of the anatomical structure (diagnosis of cholestasis, portal hypertension, ascites, splenomegaly). Control during liver biopsy, puncture of focal education.
Computer tomography.	Study details of anatomical structure, vascular system, biliary tree (diagnosis of cholelithiasis, abscesses, cysts, tumor metastases, hemangiomas, adenomas). Control during the puncture of the pathological focus.

Laparoscopy and biopsy. Particular importance in the diagnosis of liver and biliary tract diseases is occupied by laparoscopy and targeted liver biopsy (more often a blind percutaneous liver biopsy is used).

Indications for liver biopsy

1. Hepatomegaly of unspecified genesis.
2. Persistent increase in the content of ACT, AJIT, y-GT.
3. Identification of markers of hepatitis viruses.
4. Medicinal lesions of the liver.
5. Alcoholic liver damage.
6. Unexplained hepatomegaly and liver test shifts.
7. Diseases of accumulation.
8. Infectious and systemic diseases.
9. Examination of relatives of patients with hereditary liver diseases.
10. Focal educations.

Cholecystography. Recently, in addition to radiocontrast cholecystography (oral or intravenous), an upward (retrograde) introduction of contrast medium through the mouth of the common bile duct ( endoscopic retrograde cholangiopancreatography - RCPG) is used, which allows to establish the place and cause of bile hypertension, in particular, narrowing (stricture) of biliary ducts.