Affiliation:
1. Federal State Budgetary Educational Institution of Higher Education “Izhevsk State Medical Academy” of the Ministry of Health of the Russian Federation
Abstract
The purpose of the work is to diagnose the early stage of cholelithiasis through a comprehensive study of bile in patients with NAFLD. Materials and methods. We examined 210 patients with NAFLD at the steatosis stage. The diagnosis was confirmed based on general clinical indicators, ultrasound and liver elastography data, and assessment of blood enzyme levels. All patients underwent ultrasound examination of the gallbladder, study of the microscopic and physicochemical properties of bile (specific gravity, acidity, surface tension, viscosity, lithogenicity indices, cholesterol content, bile acids, phospholipids) obtained as a result of multifractional duodenal intubation, and crystallography. Results: Ultrasound examination revealed biliary sludge in 72% of patients. Microscopic examination of bile revealed crystals of cholesterol and calcium bilirubinate in 75.4% of patients. Biochemical analysis of bile revealed significant changes, expressed in increased cholesterol, decreased bile acids, phospholipids, cholate-cholesterol and phospholipid-cholesterol ratios. A study of the physical properties revealed thickening of bile and an increase in its viscosity. Crystallography revealed elements with high optical activity, which became the basis for the formation of gallstones. Conclusions: In patients in the steatosis stage of NAFLD, a decrease in lithogenicity indices, an increase in acidity and thickening of bile are determined, indicating the tendency of bile to stone formation. Signs of biliary sludge (putty-like bile, microlithiasis), characteristic of stage I cholelithiasis, are detected by ultrasound of the gallbladder in 72% of patients in the steatosis stage of NAFLD. Bile crystallography made it possible to identify crystal optical markers indicating changes in the microstructure of gallbladder bile in patients in the steatosis stage of NAFLD. When conducting an examination of patients with NAFLD in the steatosis stage, to diagnose the early stage of cholelithiasis, it is recommended to conduct multifractional duodenal intubation with subsequent study of the physicochemical properties and structural changes of bile.
Publisher
LLC Global Media Technology
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