Chemical research bile

To estimate the concentration function of the gallbladder and bile colloidal stability conduct biochemical research.

The most important in the diagnostic value of the components of bile are bile acid, cholesterol, bilirubin, phospholipids, proteins, fatty acids, mucoid substance and hexosamines.

Bile acids

Bile acids are specific to bile. They are formed in the liver and is a product of cholesterol metabolism. Cholic and chenodeoxycholic acid called primary biliary, or free. They are joined in the bile with amino acids - glycine and taurine, forming glycocholic, taurocholic, glycochenodeoxycholic and taurohenodezoksiholevuyu acid.

Normally, in the bile contents of the duodenum free bile acids not found. To 90 % absorbed bile acids together with nutrients (lipidami, fat-soluble substances, calcium salts, phosphorus et al.) in the distal small intestine. The remaining bile acids under the influence of gut microflora in turn secondary bile acids (deoxycholic and lithocholic), that part from the portal vein, and partly excreted in the feces. The absorbed in the intestine, primary and secondary bile acids by the portal vein to the liver and secreted into bile again. The blood content of bile acids minor. Determination of bile acids in the bile to evaluate the functional state of the liver, gallbladder and biliary tract.

Because, that bile, obtained by duodenal intubation, It may be in varying degrees of duodenal divorced, pancreatic and gastric juice, the definition recommended hour production rate of bile acids, t. it is. the amount of bile acids, admitted to the intestine at a time. This gives an idea of ​​the secretory function of the liver, excretory function of the gallbladder and bile ducts, as well as the degree of security bile digestion. The secretion of bile acids is directly proportional to the amount of bile secreted and its components, so for debit-hour bile acids can be judged on the number of released bile.

To determine the flow rate of bile acid-hour at duodenal intubation for 10 min collected bile portion A, then introduced cholagogue, whereupon bile portions B until no (about 30 m); in the time remaining (20 m) collect bile portions C. Thus, while collecting all the portions of the bile 60 m. Next, measure the volume of the received portions of the duodenal contents and define each of them the amount of bile acids.

In determining the content of bile acids 1 ml portions of mixed (mixture of equal parts of each volume) for debit-hour amount of bile acids in milligrams multiplied by the amount of total bile, vыdelivsheysya for 1 no. In the case of determining the amount of bile acids in each serving separate calculation will be. Outside amount of bile acids in milligrams given sample is multiplied by the volume in milliliters corresponding portions - get the amount of bile acids in the dose in milligrams. Further, the amount of bile acids (milligrams) in all portions are summed to give a yield-hour amount of bile acids in bile, allocated for 1 h sensing.

Often bile acid content was determined by Reinhold-Wilson. A more accurate and is perfect chromatography technique bile acids, but because of the complexity of its introduction into clinical practice is difficult. Determine the bile acid can also be by other techniques. So, determination of bile acids and methods Ganitkevicha Popova-Vippati based on their spectral characteristics, however, these methods do not allow to identify types of bile acids.

Cholesterol in the bile

The level of cholesterol in the bile is determined to assess its colloidal stability (by holatoholesterinovomu factor) state and cholesterol metabolism (This data complements the indicator level of cholesterol in blood). The bile is cholesterol free, which in physiological conditions, is a part of the lipid complex.

The basis of determining the level of cholesterol in the bile is the reaction Lieberman-Burchardt, at which the solution of cholesterol in chloroform in the presence of acetic anhydride becomes red, and then blue-green.

Normally, cholesterol (mmol / l) bile include:

• in a portion A -0,39-0,53;
• in a portion of B -1,18-1,54;
• in a portion of C - 0,52-0,68.

The concentration of cholesterol in the bile portions B and C in chronic cholecystitis without stones, especially in cholelithiasis, often enhanced.

An important indicator is holatoholesterinovy ​​factor (ratio of the concentration of bile acids to the cholesterol concentration in the portions B), normally it ranges from 16 to 28. Reducing it indicates a violation of the colloidal stability of bile. The index less 11 evidence of acquisition of bile lithogenic (kamneobrazuyuschih) properties.

Bilirubin in bile

The content of total bilirubin was determined in fresh bile methods van den Berg, Nendrasheka, Kleggorna and Count.

Normally, bilirubin (mmol / l) bile is:

• in a portion A - 227;
• in a portion B - 657;
• in a portion of C - 339.

The increased concentration of bilirubin in the batches A and B points to stagnation and concentration of bile, and reduced constitutes a violation of the concentration function of the gallbladder. Changing the content of bilirubin in the portion C indicates a violation of liver function bilirubinvydelitelnoy. A comparison of the level of bilirubin in the portion C and the serum is a complementary way of differentiation of different types of jaundice.

Lipid complex in the bile

In terms of the lipid complex can be seen on the colloidal stability of the bile and exocrine function of the liver.

The complex includes a lipid: cholesterol, Fatty acids and bile, bilirubin, phospholipids and a small amount of protein bile.

Using lipid complex with bile into the intestine derived insoluble substance. Lipid Complex firmly holds insolubles, preventing the loss of the sediment, t. it is. it provides colloidal stability of bile. Determine lipid complex by electrophoresis on paper.

Normally, the content of the lipid complex in the bile (g / l):

• A -2,19 per serving;
• in a portion of B -7,69;
• in portions C -4,69.

The concentration of the lipid complex is often reduced patients acalculous (in portions B and C) and calculous chronic cholecystitis, and in individuals, suffering from disorders of the gallbladder and postcholecystectomic syndrome. Decreasing the amount of bile lipid complex promotes precipitation of insolubles.

The reduced concentration of the lipid complex in the portions B and C indicates a violation of secretion of bile and colloidal stability.

In the case of the destruction of the lipid complex in the gallbladder inflammation when its level is reduced only in the portions B.

Elevated concentrations of lipid complex when acalculous cholecystitis and cholelithiasis is rare, it is usually accompanied by hypotension gallbladder.

Proteins and psevdomutsin in bile

Proteins and psevdomutsin (mucoid substance) play an important role in maintaining the colloidal stability of the bile. Determining the level of bile proteins is of great importance for the diagnosis of cholecystitis.

Determine the amount of protein bile desirable Lowry method, which is characterized by high sensitivity.

The normal concentration of protein (g / l) is:

• in a portion of B - 3,6-4,6;
• in a portion of C - 3,4-4,0.

More significant is the total protein content in the bile (mg):

• in a portion of B -136,
• in a portion C -63.

With an active inflammatory process the protein content in the bile rises, and atrophy of the mucous membrane of the gall bladder is reduced in a portion of B. In chronic cholecystitis, bile protein level may be different.

Psevdomucin allocated mainly epithelial cells and glands of the mucous membrane of the gallbladder and biliary tract. Determining the level of psevdomutsina has important diagnostic value in acute cholecystitis.

Content mukoproteidov (mukoidov), precipitated by phosphotungstic acid, t. it is. gistomukoida, is determined by approaches Vejmera-Machine.

Normally, the content gistomukoida (g / l) is:

• in a portion of B -0,04-0,07:
• in a portion of C - 0,03- 0,06.

In acute cholecystitis increased number gistomukoida (on average 12 time), in chronic - changes differently.

Hexosamines in bile

Content hexosamines examined for diagnosis of stagnation and inflammation of the bile ducts.

Determine for hexosamines Elson-Morgan method modification Rimington. When this substrate is hydrolyzed acid, hexosamines acetylated acetylacetone, treated with alkali to give a cyclic oxazole or pyrrole, that binds to β-dimethylaminobenzaldehyde, thereby producing a colored substrate, color intensity is measured colorimetrically.

The normal concentration of bile hexosamines (g / l) is:

• in a portion of B -0,22-0,27;
• in portions C -0,14-0,19.

When stagnation and inflammation in the bile ducts in bile hexosamines level rises. Elevated hexosamines bile portions C may be observed in patients with the syndrome postcholecystectomic 75 % cases. Changes in the level hexosamines is a different character in chronic lesions of the gallbladder.

Lysozyme in bile

Lysozyme - an important factor humoral immunological reactivity, which is found in many body fluids and tissues, including bile.

Determination of enzymatic activity of lysozyme is based on its ability to dissolve the bacterial cells. Evaluated on the change in the degree of light transmission suspension under the influence of bile.

Patients holetsistoangioholangitom lysozyme concentration decreases in all three portions of bile (A, B, C), but the most significant decrease was observed in a portion of B, t. it is. in the gallbladder bile.

Reduced levels of lysozyme in the bile portions C indicates involvement of inflammation of the bile ducts.

Reduced levels of lysozyme in the bile, As in other liquids, evidence of the oppression of non-specific immunity and local protective function. After treatment significantly reduced level of lysozyme in most patients is preserved.

Determination of lysozyme in the bile can serve as an objective indicator of involvement in the pathological process of the biliary tract.