Functional diagnostics of liver

Violations of the liver revealed only with the help of complex samples, reflecting how the different functions of the liver, and the defeat of the structural elements.
The study pigmentary exchange. Blood bilirubin. Determination of the level of serum bilirubin krope (see Bilirubinemia) gives the possibility to determine the presence of jaundice. There are a significant number of laboratory studies of the content of bilirubin in blood serum, but they are all based on different principles, so it's possible to compare only the values obtained with the same method. The greatest distribution for practical purposes is the quantitative determination of bilirubin in van den Berg (see Bilirubin).
In hepatic and mechanical jaundice increases especially the content of bilirubin direct reaction (associated), while hemolytic - content of bilirubin with indirect reaction (free).
Other methods of determination of bilirubin (Pokalchuk, Fouche, icteric index Meulengracht, the sample of Bergmann - Albatta) are approximate methods are not widespread.
For differential diagnosis of jaundice investigate the quantitative proportions of the various factions of bilirubin. With this purpose the method is used to separate definitions fractions of bilirubin in Andrasik and Cleghorne, based on the fact that in the presence of solution of caffeine bilirubin (free and bound) diazotized databasechangelog acid. Normally the content of indirect bilirubin in this method ranges from 0.4 to 1 mg%; associated bilirubin is missing. Another method (Varela Fuentes) based on the property of indirect bilirubin dissolved in chloroform. Normally the content of indirect bilirubin - 0.5 mg%, direct bilirubin is missing.
Quantitative determination show that in hepatic and mechanical jaundice sharper just broken bilirubinometry function of liver cells, as evidenced by the high number of direct bilirubin in the blood. With the development of the disease can disrupt the transformation in the liver indirect bilirubin direct, which leads to an increase in the indirect bilirubin fraction in the blood. Hemolytic jaundice moderate increase of bilirubin due to the indirect faction.
The definition ester-soluble bilirubin is not sufficiently reliable method to diagnose tumors choledocho-pancreatic area.
Bilirubin in urine. Bilirubin appears in the urine when hyperbilirubinemia with direct qualitative reaction, i.e. in hepatic and mechanical jaundice (see B or rubineru). He is not filtered in the glomeruli, and gets into the urine by highlighting the channel, when bilirubinemia exceed 2 mg%. There are various qualitative urine samples for the presence of bilirubin: sample Rosina with Lugol solution; sample Gmelin (see Gmelin test) with a mixture of nitric and nitrous acids; reaction with methylene blue; methods with use pills that contain desecrate.
Determination of bilirubin in duodenal juice. The lack of bilirubin in duodenal juice occurs if complete blockage of the bile ducts, and increased content - hemolytic jaundice, anemia patients, splenomegalia cirrhosis and other diseases associated with the phenomena of hemolysis. Use the following sample: reaction with detraction, the reaction with alcohol and sulfuric acid.
The content stercobilin in Calais. Cholesky chair suggests that bilirubin misses the intestine because of the blockage of the bile duct or violation excretory ability of liver cells. Qualitative methods of determination of bile pigments in Calais are: sample Schmidt with a solution of mercuric chloride and sample Schlesinger with 10% alcoholic solution of zinc acetate. Quantitative determination stercobilin in Calais method Adler is set to confirm the increased hemolysis in the absence of jaundice.
The content of urobilin in the urine. The increased content of urobilin in the urine (see Urobilinemia) is found not only in diseases of the liver, but also at the diseases proceeding with high hemolysis, fever and reinforced putrefactive processes in the intestine. When complete mechanical jaundice the urobilin in the urine is not defined.