Excretory function of liver

The definition excretory functions of liver is administered by intravenous injection of colors that stand out then bile or urine. Liver function assessed by the speed of extinction paint from the blood or time of occurrence and its concentration in bile.
As the substances used to evaluate excretory functions of the liver, use bilirubin, bromsulphalein, azorubine-S, rose Bengal.
Load the bilirubin allows to estimate functional liver's ability to change the level bilirubinuria. OK 4 hours after intravenous injection of 50 mg bilirubin concentration in blood does not exceed 15% compared with the maximum concentration defined in 5 minutes after the introduction of the solution. The sample has not found wide application, since it can not be used in the presence of jaundice.
The test with the introduction of bromsulphalein * (BSP) is one of the most physiological and specific to the liver. The sample is proposed Kosental and White (1925), based on the ability of liver cells to capture BSP and highlight it with gall. Extrahepatic cells are practically not involved in the elimination of paint. Speed of the purification of the blood from paint - clearance - depends only on the state of the hepatic parenchyma and blood flow in the liver. Some effect on the rate of the sample can have severe hypoproteinemia, because the liver captures BSP, only in the connection with plasma albumin; lack of albumin is slowing elimination of paint.

BSP soluble in water, the concentration in the biological liquids is determined by the intensity of red-purple dye solution. Intravenous solution BSP, as a rule, does not give adverse reactions described, only a few cases of anaphylactoid reactions, and thrombophlebitis.
The number of input BSP in the formulation of the sample varies at different authors from 2 to 5 mg weight of the patient. The maximum concentration of BSP in the plasma created in 3 minutes after the introduction of the solution. In the subsequent portions of blood the colour intensity decreases rapidly. If we take the maximum concentration of paint on 3-th minute after the introduction of the solution for 100%in healthy individuals concentration BSP respectively will be after 15 minutes -30%, 30 minutes-10%, 45 minutes by 0.2%. The test results can be expressed in the form of clearance BSP, i.e. calculation of the volume of plasma free from BSP, per unit of time. Normal clearance is 5-7 ml/min per 1 kg of body weight of the test.

In addition to the determination of the concentration of BSP in the blood can be defined and its excretion in the bile. OK BSP appears in the duodenal contents 15 minutes after intravenous administration, and for the first 2 hours are allocated to 80% of the paint.
Damage of the liver parenchyma is slowing of plasma purification from BSP. Most expressed the delay in infectious hepatitis - up to 50% 45 th minute, somewhat less cirrhosis of the liver - up to 30% (Davis, 1946; Popper, Schaffner, 1961). When mechanical jaundice delay BSP depends on the degree of damage of the liver parenchyma. For the diagnosis of obstructive jaundice valuable information, present the results of chromatographic determination BSP and its metabolites. Metabolites BSP are formed in the liver parenchyma; when its defeat in the blood is delayed a large amount of the drug metabolites are also only 6-8% (Carbone, Grodsky, 1959). When mechanical jaundice process of transformation BSP is violated much less so about 50% of the detainee in the blood BSP make its metabolites.
The sample is a reliable test for determination of the functional state of the liver parenchyma, however, that the stagnation of liver and cirrhosis with severe portal hypertension slow in removing the BSP from the blood can be caused by the violation of his transport to the liver.
Test with atropinom-S is less specificity in comparison with bromsulfaleinovy. The drug is administered intravenously, the test results are assessed but the time of occurrence and intensity of the red colouring of the bile or urine. In healthy individuals discoloration of the bile is no later than 20 minutes after administration. The urine output 10-12% of paints for the first 1 to 3 hours. If the damage of the liver parenchyma paint secreted into the bile later and to a lesser extent, in the urine may reach 100%.
Test with Bengal rose (potassium salt metriod-tetrachloro-fluorescein) takes on new significance in connection with the receipt of the preparation, marked with radioactive J131 **. This allowed to reduce the dose of paint to a few micrograms. This eliminates toxic effect of the drug. Scintillation counter, you can record the speed and intensity of accumulation of the drug in the liver uptake in the intestine, and to determine the clearance of blood. The drug is administered intravenously in the amount of 10 to 15 g. In healthy individuals half clearance is 10 to 15 minutes; the time half-excretion from the liver is 1-2 hours; time of the appearance in the gut - 10-15 minutes (K. S. Martirosov, B. N. Tkachev, 1963). When parenchymal liver is slowing down and reducing accumulation of Bengal rose in the liver, as well as slowing the cleansing blood and inflow of paint in the intestine (the So-Century Mosneaga, 1963). This shows the impaired ability of polygonal cells to capture the last. The greatest value is the sample for estimation of permeability of bilious ways: by placing the counter over the area of the intestine, it is possible to detect a sharp deceleration or complete cessation of receipt of the indicator in the intestine during mechanical blockage of the bile ducts.

* Methodology cm: I. T. Abasov, Klin, honey., № 9, 1962.
** See: M. N. Fateyeva. Essays radioactive diagnostics, M, 1960