Hepatic tests: norm, transcript, causesenhance

Update: December 2018 missing in medical literature
a rigorous definition of the term “hepatic blood samples” as well as a list
analyzes that relate to them. Currently, there is
a large number of laboratory indicators that allow
оценить withоwithтояние the liver. Evaluating them, the doctor will be able to conclude
about the activity of the pathological process, its nature and
предположить причину развития diseases. Most
common and informative of these indicators can be attributed
to liver tests.

Why do I need a liver

Many scientists compare this body with the “chemical plant”
our body. Currently, there are more than 200 doctors
various liver functions that ensure normal functioning
organism. They can be divided into the following groups:

  • Participation in the digestion of food. Hepatic cells produce
    bile, which is necessary for the absorption of fat, destruction
    harmful microorganisms in the food lump and improve motility
    intestine. With a deficiency of bile, the patient may appear liquid
    stools with fat, abdominal pain, increased intestinal risk
    infections;
  • Disposal of toxins (alcohol, drugs, poisons, etc.) and
    drugs. For выполнения этой задачи работает ряд жизненно
    necessary enzymes – cytochromes that allow
    process and excrete foreign substances from the body. Row
    pathologies can lead to cytochrome deficiency, delay
    the above substances and increase the likelihood
    poisoning;
  • Maintain normal blood clotting. Severe defeat
    hepatic tissue leads to impaired creation of 4 out of 13 major
    coagulation factors. As a result, a person has signs
    increased bleeding: the appearance of bruises with minor
    injuries, sweating of blood in the joints, the appearance of reddish
    coloration of urine, black feces and other symptoms;
  • Удержание жидкоwithти в пределах кровеноwithной system. One of
    most important mechanisms to prevent the formation of edema, is
    protein production. His certain concentration draws upon himself
    water and prevents its release in the subcutaneous tissue on the legs, arms
    and in the internal organs;
  • Removal of products of destruction of blood cells. Average,
    red blood cell (red blood cell transporting oxygen)
    lives about 180 days. Their content in the blood exceeds several
    trillions, with daily part of red blood cells dying, and on their
    Shift come new cells. As a result, cell death is formed
    unbound bilirubin (this substance is toxic to humans),
    which is taken up by the liver and binds to the components of bile,
    after which it is displayed in the cavity of the duodenum 12.

In severe lesions of the body, all can be violated.
the above functions, however, in the early stages of the disease,
most often only 1-2 of them suffer. At the same time external signs
diseases are absent or expressed very weakly. To timely
detect emerging changes, you can use the next
laboratory research.

What kind of analysis you need to pass

As mentioned above, there is no universal
screening for liver tests. Performance Indicators
liver, are determined during the various procedures. therefore для оценки
the state of the body, it is necessary to pass three basic analyzes:

  • Deployed biochemical blood test;
  • Coagulogram;
  • Общий анализ мочи (withокращенно — Oam).

The first study reveals the pathological process
guess its cause and test some functions,
such as the creation of substances (protein, albumin) and excretion
bilirubin из organism. The purpose of a coagulogram is necessary for
diagnostics of coagulation disorders and risk determination
increased bleeding.

Urinalysis is used to exclude severe
kidney disease. Since the damage to the renal filter also
significant loss of protein can occur, edema and
другие withимптомы, общие with болезнями печени, Oam обязательно проводят
all patients.

Preparation for the survey

Blood test

The study is recommended in the morning, on an empty stomach.
3 days before the procedure it is necessary to exclude alcohol in any
options. Within 3 hours before blood collection is necessary
quit smoking and intense physical activity
(sports training, running, morning exercises, etc.). By
opportunities, you should avoid stress and nervous
overvoltage.

If you don’t donate blood in the morning, you can
daytime treatments. but при этом, withледует withоблюwithти
The following conditions:

  • The time from the last meal is at least 4 hours;
  • On the eve of the survey it is also recommended to avoid physical and
    emotional overload, not smoking;
  • You should refuse to accept caffeine-containing or taurine.
    drinks: any energy drinks, Coca-Cola, coffee, strong tea. Water
    You can drink without restrictions.

Adjust diet for study only and cancel
any drugs without prior consultation
with doctor is not recommended – it can affect the result and
distort the real picture.

Analysis of urine

To properly pass the urine to the study must adhere to
A number of simple recommendations:

  1. Immediately before sampling the analysis, it is necessary to undermine
    soul This recommendation is relevant for both women and
    men;
  2. Starting portion of urine (the first 3-5 seconds from the beginning
    urination) should be skipped past the jar. Failure to do so
    rules can lead to the detection of an increased amount of protein,
    epithelium or cells;
  3. The jar should be purchased at the pharmacy – it guarantees
    the absence of bacteria, foreign proteins or other
    impurities;
  4. Any dietary restrictions or lifestyle changes for
    obtaining an accurate result is required.

Indicators “baked samples”

Diseases or lesions of the organ with toxic substances
invariably affect the state of its cells and the performance of functions.
The most informative indicators that allow you to evaluate
the state of the liver tissue, the rate of liver samples are listed in
table below.

Sample rates What do they testify to?

Biochemical analysis крови

Bilirubin:

  • Total -5-22 µmol / l;
  • Free (unbound, unconjugated) 3.3-12
    �mol / L;
  • Связанный (коньюгированный) 1,6-6,7 мкмоль/л.
Bilirubin is a product of the breakdown of blood cells, which in
the norm is taken up by the liver from the blood and excreted through the biliary
of the way. The increase in its number indicates a problem in
this system:

  • Byвышение только непрямой фракции – признак
    excessive decomposition of red blood cells (blood cells);
  • Byвышение только прямой фракции
    evidence of bile stasis inside the liver or in the biliary tract
    ways (ducts and gall bladder)
  • Byвышение обоих фракций, чаще вwithего, являетwithя
    признаком поражения the liver.
Transaminase Enzymes:

  • АЛТ  8-41 Е/л;
  • АСТ 7-38 Е/л.
In a healthy person, these enzymes are only inside
cells of internal organs. Transaminase boosting and the presence of others
signs of liver damage are often signs of destruction
hepatic cells.
Alkaline phosphatase (SchV)

  • 29-120 U / L or
  • 0.5-2 мкkat / l.
These enzymes usually indicate the presence of stagnation
bile, both intrahepatic and extrahepatic.
Гамма-глутаминтранwithпептидаза (ГГТП) Менее 60 Е/л.
Общий холеwithтерин 3,1-5,0 ммоль/л

One of the main indicators of fat metabolism in the body.
Выработка различных видов холеwithтерина проиwithходит в the liver. therefore
reducing its quantity below normal is 
an indirect sign of damage to this organ.

The increase in total cholesterol can be at high
the number of diseases, including the presence of stagnation of bile inside
liver ducts or in the gallbladder, the presence of fatty degeneration
the liver.

Общий белок 65-86 г/л

The amount of total protein reflects the ability of the liver to create
complex chemical compounds. Albumins – are one of
a kind of protein with a small mass, but at the same time
a large number of functions, in particular: transport of nutrients
substances, fluid retention in vessels.

It should be remembered that reducing their number may also be
associated with damage to the renal filter, so for
правильной диагноwithтики, необходимо также выполнить Oam.

Albumins

  • 35-56 g / l Or
  • 50-60% of total protein

Coagulogram

Протромбиновый индекwith (ПТИ) 80-100% These figures reflect the ability of blood to clot, with
using a number of special proteins – coagulation factors. Since on
background disease decreases the production of some factors –
clotting time increases, and indicators change
coagulogram.
Fibrinogen

  • 2-4 g / l Or
  • 200-400 mg%
Partial activated thromboplastin time
(АЧТВ) 25-37 withекунд

Общий анализ мочи (Oam)

Protein Decreased protein and edema may not be observed.
only against the background of diseases of the digestive system, but also when
damage to the kidney filter. therefore для иwithключения данной группы
патологий необходимо вwithегда выполнять Oam

After analyzing the above indicators you can do
unambiguous conclusion about the presence or absence of pathology. Also
decoding liver function tests can help determine which functions
body violated and how pronounced these violations. but уточнить
diagnosis and type of disease can only be additional methods
survey.

Signs of pathology in liver samples

Pathological changes in the analysis can fundamentally
divided into three options. The first – withвидетельwithтвует о повреждении и
разрушении hepatic cells. The second option allows you to detect
violation of the main functions of the body, such as synthesis
vital substances processing toxins and medicinal
вещеwithтв, захват и выведение из организма bilirubin. Last
possible changes may indicate stagnation of bile
inside the liver ducts, or in the gallbladder.

It should be remembered that liver function tests are non-specific.
indicators that may vary with various diseases.
therefore их необходимо оценивать в комплекwithе with другими данными:
by complaints human, the state of the digestive system, stool painting and
urine.

The following are possible pathological changes in
results and principles of their decoding.

Signs of cell disruption

First of all, the increased
liver enzymes, which are normal, are present in
blood in a fairly limited amount. Also, due to
damage to tissues suffer other functions in the first place –
capture and removal of bilirubin.

Due to the destruction of cells, bound bilirubin is released into the bloodstream –
its conjugated (bound fraction) rises. Due to
impaired capture of unbound bilirubin, due to a decrease in
the number of functioning cells – increases indirect
(unconjugated, unbound) fraction.

Thus, signs of tissue damage and damage
Cell structures is:

  • Increased ALT levels;
  • Increased AST concentration;
  • Growth rates of total bilirubin, its bound and unbound
    fractions.

At the same time, the person is not bothered by the symptoms of the disease.
Only with high activity pathology, appears yellowing
sclera of the eyes and skin, in the absence of a strong tan. Can be celebrated
more intense staining of feces in dark brown and
dark urine (to light brown or even “beer” color).
Pain, swelling and discomfort in the abdomen, as a rule, no.

Violation of the functions of the body

When the pathological process leads to the inability of the liver
adequately perform their tasks, a person has a whole
complex of various symptoms and changes in laboratory tests.
The most significant in the diagnosis are the following signs:

Indicator Clinical symptom

Biochemical analysis

Increase in total and unbound or unconjugated
bilirubin
  • Dark urine;
  • More intense staining;
  • The appearance of a yellow tinge sclera of the eyes and skin.
The decrease in blood concentration of total protein and albumin
  • The appearance of soft edema in any parts of the body. Edemas may be
    very massive, fluid in addition to subcutaneous tissue is often
    accumulates in the abdomen, chest cavity and pericardial
    bag;
  • The appearance on the skin of vascular “stars” – small
    hemorrhages resembling burst capillaries. Originate from
    Violations of sex hormones.

Coagulogram

Reduction of PTI, fibrinogen, APTT levels

Increased bleeding, including from the gums, from the mucous
nose, on the skin and in the internal organs (including the intestines and stomach).
Signs of bleeding from the digestive tract can be:

  • Feces are black with a foul odor, provided there is no
    reception before this activated carbon, preparations of bismuth and other
    coloring matter;
  • Vomiting with blood or the color of “coffee grounds”;
  • When bleeding from the lower intestine into the stool can be
    evenly mixed with dark scarlet blood;
  • With the release of blood from hemorrhoidal cells feces remains
    unchanged, but on top of it or on toilet paper
    a blood mark remains.

Oam

Urine protein concentration less than 0.3 g / day or less than 0.14 g / l

Отwithутwithтвие белка в Oam и выwithокие печеночные пробы позволит
confirm that there are problems with the liver or nutrition, at low
protein concentration in the blood. However, the presence of a small
concentration of protein compounds in the urine does not always exclude
hepatic pathology and requires the study of other indicators of the table
hepatic tests.

Bile stasis

The cause of intrahepatic congestion, most often, becomes
proliferation of connective tissue instead of normal hepatic
tissue. Connective tissue fibers fill the volume of the affected
parts of the body, but they can not perform any of its functions.
Additionally, they squeeze the existing bile ducts and break
of these, the outflow, which leads to “sweating” of the components of bile through
walls of bile vessels in the blood.

The signs of this pathological condition are a number
elevated hepatic tests:

  • Increased total cholesterol;
  • Increasing the concentration of GGTP, schV;
  • Significant increase in total and related concentration
    bilirubin.

Pronounced stagnation of bile is invariably accompanied by intense
зудом, из-за отложения withвязанной фракции bilirubin в коже. but
it should be remembered that the disturbance of the outflow may also be associated with
diseases of the gallbladder and biliary tract.

Additional examination

Low or elevated hepatic rates do not accurately
determine the cause of the disease. For this purpose, an appointment is necessary.
additional diagnostic procedures. These include a number
analyzes and instrumental techniques, which will allow to exclude
the presence of hepatitis, hereditary metabolic disorders (disease
Wilson-Konovalov), cirrhosis, vascular lesions of the organ and
oncological diseases.

Most often, to determine the cause of pathology is recommended
the following studies:

Purpose of appointment Principle of

Analysis of blood hepatitis (B, C, D)

Exclusion of viral infections affecting organ tissue.

Taking a small amount is enough to perform the analyzes.
venous blood. At the same time, the time of day and connection with food not
important for obtaining a reliable result.

Determination of ceruloplasmin concentration

Exclusion of congenital disorders of copper metabolism in the body (diseases
Wilson-Konovalov), which leads to rapidly progressive
cirrhosis.

Determination of antimitochondrial antibodies

It is recommended in the absence of a clear cause of violation
the liver. Allows you to exclude the presence of a number of autoimmune diseases
(including primary biliary cirrhosis) in which the body
begins to destroy healthy human cells.

Abdominal ultrasound

Included in the standard of examination. Ultrasound is necessary to determine
the structure and size of the liver, the presence of free fluid in the abdominal
cavity, measuring the size of the spleen.

This research is absolutely safe for
human, however, requires some training. 3 days before the ultrasound
a person should refuse foods rich in fiber (raw
vegetables and fruits, whole grains, fresh bread).

The survey is performed on an empty stomach (before it – 8 hours of hunger),
water is allowed to drink.

Fibroscan

Allows you to determine the state of the tissues of the body, the presence of lesions
proliferation of connective tissue, the development of cirrhosis.

Fibroscan (или элаwithтография) выполняетwithя по тем же принципам,
as ultrasound, however, does not require any
preparation from the patient. The average time is 20 minutes.

Biopsy

This study is necessary to establish the final
diagnosis, with suspected cirrhosis or cancer
diseases.

Biopsy – это операция, которая требует полноценной подготовки
from a person, including a comprehensive survey of his condition,
determination of blood group and Rh factor, coagulation state
system.

After performing anesthesia, the puncture needle is taken
a small portion of the tissue of an organ for examination under a microscope.
Typically, needle insertion is controlled by ultrasound.
by the apparatus.

The result is prepared within 1-2 weeks.

The final list of studies required for a specific
the patient is determined by the attending physician. It can be supplemented by various
research options such as the Reberg test (for
assessment of kidney condition and exclusion of hepatorenal syndrome),
scintigraphy, computed tomography and magnetic resonance imaging.

FAQ

Вопроwith: Где можно withдать печеночные пробы?

There are two fundamentally different options. The first –
free, as part of free services provided
compulsory health insurance (CHI). For this you need
turn to the district therapist who after complex
examinations for suspected organ disease
hepato-biliary system, will guide you for further examination.

The second option is to pass tests that are included in liver function tests, in
private laboratories. Unfortunately, it should be noted that
The option is much easier and faster. but перед этим рекомендуетwithя
consult a doctor who will determine the list
indicators needed specifically for you.

Вопроwith: Кто может правильно раwithшифровать
survey results?

Any doctor, including your GP knows the rules
tests and is not eligible to provide medical care. For
getting a consultation is enough to sign up for it on a scheduled
reception

Вопроwith: Может ли негативно повлиять на withоwithтояние
health taking tests?

Currently, any laboratory carefully observes everything.
norms of blood sampling, uses only disposable
instrumentation, medical personnel undergoes periodic
comprehensive examination. Accordingly, the probability of infection
patient is minimal. Harm from a decrease in blood volume in the body,
due to the intake of a small amount for research, be not
can.

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