Hepatitis

Liver function tests

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1. The most common cause of chronic diffuse liver disease:
a) hepatotropic viruses +
b) toxic hepatotropic agents
c) alcohol

2. What is the most common hepatotropic viral infection that forms chronic diffuse liver disease:
a) HCV infection
b) HBV infection +
c) HAV infection

3. Which of the forms of chronic diffuse liver diseases is not separately distinguished by experts of the Los Angeles classification of chronic hepatitis:
a) toxic hepatitis
b) viral hepatitis
c) alcoholic hepatitis +

4. Which of the following clinical syndromes are characteristic of non-alcoholic steatohepatitis:
a) hyperlipidemia, mainly due to triglycerides
b) the absence of markers of viral infection
c) both options are correct +

5. The morphological criteria for non-alcoholic steatohepatitis are:
a) the presence of fatty degeneration of hepatocytes in combination with necrosis and lymphohistiocytic infiltration
b) the presence of isolated fatty degeneration of hepatocytes
c) both options are correct +

6. What is a “reference” laboratory marker for alcoholic hepatitis:
a) increase in transaminases
b) desaccharized transferrin +
c) increase of γ-glutamine transpeptidase

7. The fastest terms for the progression of chronic hepatitis B into cirrhosis, liver cancer are associated with:
a) male patients
b) both options are correct +
c) alcohol abuse

8. The most common HBV mutation is associated with:
a) mutation in the rge-coh zone +
b) mutation in the s-zone
c) mutation in the DNA polymerase zone

9. Which of the following morphological features determine the nonspecific histological activity index of hepatitis according to Knodell-Ischak:
a) activation of satellite liver cells
b) lymphohistiocytic parenchyma infiltration
c) both options are correct +

10. Desmeth fibrosis 2 index meets morphological criteria:
a) minimal fibrosis
b) moderate fibrosis +
c) severe fibrosis

11. What are the most typical morphological signs of chronic hepatitis B:
a) the presence of background hyaline and / or protein dystrophy in combination with the presence of opaque glassy hepatocytes and hepatocyte nuclei in the form of an “hourglass” +
b) the presence of background fatty degeneration in combination with the formation of lymphoid follicles, the accumulation of chains of lymphocytes in perisinusoid spaces
c) there is no correct answer

12. What are the most typical morphological signs of chronic hepatitis C:
a) the presence of background hyaline and / or protein dystrophy in combination with the presence of opaque vitreous hepatocytes and hepatocyte nuclei in the form of an “hourglass”
b) the presence of background fatty degeneration in combination with the formation of lymphoid follicles, the accumulation of chains of lymphocytes in perisinusoidal spaces +
c) there is no correct answer

13. Indicate the main HCV replication enzymes:
a) helicase, metalloprotease, RNA-dependent RNA polymerase, serine protease +
b) DNA polymerase, protease
c) helicase, RNA-dependent RNA polymerase

14. Is the statement correct that vaccination against hepatitis B virus reduces the incidence of viral hepatitis C:
a) yes
b) not always
c) no +

15. Which of the following interferons has predominantly immunomodulatory activity:
a) γ-IFN +
b) in-IFN
c) a-IFN

16. This interferon has predominantly antiviral activity:
a) β-IFN
b) α-IFN +
c) γ-IFN

17. Select commercial analogues of γ-IFN:
a) rebif, betaferon
b) roferon-A, intron-A, reaferon, rialdiron, egiferon
c) imukin +

18. Choose commercial analogues of α-IFN:
a) rebif, betaferon
b) roferon-A, intron-A, reaferon, rialdiron, egiferon +
c) imukin

19. Select commercial analogues of β-IFN:
a) roferon-A, intron-A, reaferon
b) imukin, egiferon
c) rebif, betaferon +

20. The pharmacological effect of α-IFN is associated with:
a) activation of satellite cells
b) the specific ability to terminate intracellular and viral DNA and RNA
c) both options are correct +

21. The standard for starting treatment for chronic hepatitis B is currently:
a) monotherapy with nucleoside analogues (zeffix, epivir, lamivudine, adefovir - depivoxil) +
b) combined treatment with nucleoside analogues in combination with α-IFN
c) α-IFN monotherapy

22. What are indications for the etiotropic treatment of chronic viral hepatitis:
a) an increase in the level of bilirubin, positive values ​​of the polymerase chain reaction to the detection of the genetic material of the virus, positive results of the detection of total antiviral antibodies
b) an increase in the level of alanine transaminase, positive values ​​of the polymerase chain reaction to the detection of the genetic material of viruses, positive results of the detection of total antiviral antibodies, a morphological study confirming chronic hepatitis +
c) an increase in the level of bilirubin, an increase in the level of transaminases, negative values ​​of the polymerase chain reaction to the detection of genetic material, positive results of the detection of total antiviral antibodies, a morphological study confirming chronic hepatitis

23. What is the standard starting treatment for chronic hepatitis C at present:
a) monotherapy α-IFN
b) monotherapy with ribavirin (rebetol)
c) combined treatment with rebetol in combination with α-IFN +

24. Choose the most common side effects of interferon therapy:
a) obesity, dysmenorrhea, arterial hypertension, diarrhea
b) flu-like syndrome, depressive syndrome, cytopenic syndrome (granulocyte and thrombocytopenia), alopecia +
c) cardiopathy, depressive syndrome, hyperuricemia, hyperglycemia, photosensitivity

25. Which of the following is an unconditional condition for discontinuing treatment with α-interferon:
a) aphthous stomatitis
b) flu-like syndrome
c) severe depression +

26. What is the usually limited use of ribavirin in patients with chronic hepatitis C:
a) thrombocytopenia
b) hemolysis +
c) granulocytopenia

27. A prerequisite for the informed consent of the patient before starting treatment with ribavirin in chronic hepatitis C:
a) double contraception +
b) a sharp restriction of physical activity
c) categorical refusal of alcohol

28. Which of the following is most significant for the diagnosis of primary hemochromatosis:
a) increased urinary iron excretion
b) increased levels of hemoglobin and serum iron
c) saturation of transferrin with iron more than 70% +

29. What is the best combination in the treatment of portal hypertension in patients with cirrhosis of the liver:
a) the appointment of combined saluretic therapy with the mandatory inclusion of veroshpiron, limiting the consumption of salt, β-blockers +
b) limitation of physical activity, reduced consumption of sodium chloride, the appointment of saluretics
c) the appointment of saluretics in combination with β-blockers

30. The method of choice in determining therapeutic tactics in patients with progressive hepatic cell failure of any genesis is:
a) massive corticosteroid therapy in combination with cytostatics
b) temporary replacement therapy (artificial liver) with liver transplantation +
c) massive corticosteroid therapy

Description of the technique

Determining the state of an organ by using test strips is far from a new technique that medical staff use when it is not possible to perform a laboratory blood test. Rapid tests are made by large pharmaceutical manufacturers and companies that supply biochemical equipment for laboratories. With the help of modern strips, from 5 to 10 parameters are evaluated, you can purchase such products in pharmacies. The most famous names include “VMline”, “Uribilin”, “Uriskan”, “Urinopolian-2”, “Multistix”.

Test data are approximate, additional examination is required to establish the nature and severity of the lesion, the causes of the disease.

Express indicator performance

Tests to determine liver function do not guarantee an accurate result. With a significant increase in the level of bilirubin against the background of obstructive jaundice, hepatitis of any etiology and other lesions of the organ, the indicator responds to negative processes, which allows one to suspect the development of pathologies and is the reason for a full examination.

An equally important metabolic product is urobilinogen, which combines the substances synthesized by the intestines and liver during the decay of bilirubin. With an increase in his level, the doctor may suspect such diseases and conditions:

  • viral damage
  • inflammation in the liver
  • hemolytic anemia,
  • cancer,
  • resorption of large hematomas,
  • organ damage by toxins.

Not all diseases can be determined using test strips. If urobilinogen is elevated in a child, in most cases it is a sign of intestinal obstruction, colitis or chronic constipation. It is worth noting that the indicators change only with prolonged and systematic negative impact. In addition, a positive result is possible with a violation of blood circulation in the liver, hepatic vein thrombosis. Hepatologists clarify that a functional rapid test is used to quickly obtain results and is not the main method for studying the condition of the liver.

Conducting research

Kits will include indicators soaked in reagents. They are able to change their color with dysfunction of body systems. Interpret the result in accordance with a special scale. Analyzing the state of the liver with the help of functional tests, adhere to the established rules:

  • For research, a clean container is used.
  • The reagent-treated strip is lowered into the collected biomaterial for just a few seconds.
  • Evaluation of the result is made after a minute.

Overeating and violations of the recommended diet do not lead to a significant change in the level of bilirubin and urobilinogen.

Possibility to replace test strips

Functional tests display certain indicators, but do not allow to fully assess the condition of the liver and the causes of malfunctions in the body. Express strips can only be used to obtain preliminary results that are independent of the food consumed and the acidity of the biomaterial. Treatment is prescribed after a full examination.

When may a liver check be required?

Examination of the most important organs and systems of the body as a preventive measure is recommended regularly. But there are a number of symptoms that indicate that verification is required as quickly as possible. So, the liver should be examined immediately if you notice the following signs of organ dysfunction:

  1. Unpleasant sensations in the area of ​​the lower pair of ribs on the right - One of the first manifestations of liver problems. Unusual sensations and a feeling of tightness or overcrowding in the liver area can accompany barely noticeable pulling pains, tingling. Usually they make themselves felt when laughing, loud conversation or screaming, sneezing, sharp bends to the side, lifting weights, as well as after eating fatty, smoked, fried or spicy foods. At first, a new feeling may not cause pain or tangible discomfort - in this case they also say: “I found out where the liver is.” This is a reason to beware, because even mild symptoms can indicate the initial stage of serious liver disease.
  2. The liver is enlarged . The change in the dimensions of the main gland is accurately detected during ultrasound, but you can notice the changes yourself. A bulging belly will indicate this without an increase in overall fullness and with virtually no weight gain. A symptom is especially noticeable in people with a thin physique.
  3. Bad taste in the mouth . Patients with chronic liver problems note a constant dry mouth and bitterness on the tongue, sometimes with a characteristic aftertaste, which is defined as “coppery”. At the same time, an astringent feeling is noted in the mouth, taste sensations are reduced. Habitual food can cause rejection, up to nausea and the urge to vomit.
  4. Weight loss due to asthenic syndrome . This symptom is largely a consequence of the previous one. Lack of food, loss of taste, nausea lead to a decrease in diet, which leads to weight loss. In this case, the patient complains of unjustified irritability, as well as weakness, drowsiness, fatigue, because the energy needs of the body are not satisfied, and the toxic effects of impaired nitrogen (protein) metabolism increase significantly - with increased concentration of ammonia in the blood, secondary (hepatic) hyperammonemia occurs .
  5. Jaundice - a common set of symptoms, which is expressed in yellowness of the skin, mucous membranes and eye proteins, as well as in the dark color of urine, in itching and peeling of the skin, in chills, bone and joint pain, and is caused by liver problems.

The last symptom complex indicates serious violations in the liver - a neglected disease.

A liver test for diseases is also carried out during pregnancy (ideally, even at the planning stage), before surgery and a course of treatment involving the use of potent drugs.

That allows you to identify a check (screening) of the liver:

  • the fact of the disease itself, its degree, the level of impaired liver function,
  • the presence and degree of histological (cellular) changes in the structure of the liver tissue, such as fibrosis and cirrhosis of the liver,
  • diagnosis of specific liver diseases - viral and autoimmune hepatitis, fatty hepatosis.

How to check the health of the liver, what tests should be taken for this, and what methods are used in modern laboratory practice?

Biochemical blood test to assess the condition of the liver

Blood biochemistry is a laboratory study, the purpose of which is to evaluate the functioning of organs and systems of the body based on data on the speed, nature and final products of metabolism - information on the metabolism of proteins, fats and carbohydrates, as well as on the body's needs for vitamins and minerals. Pathological conditions of the liver are inevitably reflected in the parameters of the biochemical analysis of blood, showing a discrepancy with the norm - with the so-called reference values.

The amount of information required to make, refute or clarify the diagnosis differs depending on the clinical picture formed by the doctor, taking into account the data of ultrasound, anamnesis and general examination of the patient. A hepatologist or therapist can prescribe a standard biochemical screening of 6 indicators or an extended examination, including the determination of up to 15 blood parameters.

In order for a biochemical blood test to give reliable results, it is necessary to properly prepare for it:

  1. The analysis on biochemistry surrenders strictly on an empty stomach . Since the liver is involved in the digestion process, the nature of the food affects the analysis data, significantly distorting them. To avoid this distortion, the last meal should be no later than 8 hours before blood sampling for analysis. The same goes for any drink except water. In addition, before taking the test, it is recommended to refrain from spicy and fatty foods for up to three days.
  2. Alcohol is prohibited! Even a small dose of alcohol causes a significant load on the liver, changes the properties of blood, in particular its coagulability. Therefore, the minimum period between drinking strong drinks and taking blood for biochemistry is three days.
  3. Negatively affects confidence and smoking. . Doctors strongly recommend smoking a cigarette no later than 12 hours before taking the test, if you are prone to this addiction.
  4. Sport will wait too . Three days before the test, it is recommended to exclude physical activity, especially sports. Psycho-emotional stress, stressful situations should be avoided, and a sleep regimen should be observed.
  5. Medication Canceled . Even vitamins can distort the results of a biochemistry analysis, so any medication is not recommended to be taken at least a week before the crucial moment, since some of them can have a long-term effect on the composition of the blood. But if you can’t refuse to take the medicine for clinical reasons, the doctor should be informed about the drugs taken.

In addition, women are recommended to do a pregnancy test before taking biochemistry for “liver screening”.

The blood sampling for analysis is carried out by the doctor intravenously, does not require any effort from the patient and does not cause pain.

What values ​​are shown by a biochemical analysis for hepatic blood samples and what the result indicates, see table 1.

Table 1 . Deciphering the biochemical screening of the liver

IndicatorNorm for adultsWhat deviation may indicate
Above normBelow normal (sharp drops)
Bilirubin(general)3.4–20 μmol / L Jaundice:
  • hemolytic (suprahepatic),
  • parenchymal (hepatic)
  • cholestatic (subhepatic).
Functional hyperbilirubinemic syndromes
Bilirubin(direct, or conjugated, bound)Up to 8.6 μmol / l
  • Hepatitis: viral and toxic (drug)
  • Jaundice: mechanical and pregnant
  • Disorders of the biliary tract: cholecystitis and cholangitis
  • Biliary cirrhosis, oncopathology
  • Functional hyperbilirubinemic syndromes
AlAT(Alanine aminotransferase)Up to 41 units / liter (men), up to 31 units / liter (women)
  • Heart failure, myocarditis, or extensive myocardial infarction
  • Extensive injury
  • Hepatitis: toxic (alcoholic, drug) or acute viral
  • Jaundice: cholestatic or mechanical
  • Fatty hepatosis
  • Acute pancreatitis
  • Cirrhosis, primary and metastatic liver cancer
  • Vitamin B6 Deficiency
  • Extensive necrosis, cirrhosis
AsAT(Aspartate aminotransferase)Up to 37 units / liter (men), up to 31 units / liter (women)
  • Cardiac surgery, myocardial infarction, acute rheumatic heart disease, severe angina pectoris
  • Pulmonary Thrombosis
  • Extensive muscle injury
  • Cholestatic syndrome
  • Hepatitis: toxic (alcoholic, drug) or acute viral
  • Acute pancreatitis
  • Primary and metastatic liver cancer
  • Vitamin B6 Deficiency
  • Extensive necrosis, rupture of the liver
GGT(Gamma glutamyl transpeptidase)Up to 49 units / ml (men), up to 32 units / ml (women)
  • Cholestatic syndrome: intrahepatic and extrahepatic
  • Acute and chronic hepatitis: toxic (alcoholic, drug), viral, as a result of exposure to radiation
  • Pancreatitis: acute and chronic
  • Jade: glomerulonephritis and pyelonephritis
  • Oncopathology: pancreas, prostate, hepatoma
Alkaline phosphatase40–150 units / l
  • An excess of thyroid hormones - hyperparathyroidism
  • Calcium and phosphorus deficiency
  • Bone tissue pathologies and fractures
  • Cholestatic syndrome: intrahepatic and extrahepatic
  • Toxic hepatitis: alcoholic and drug
  • Necrosis, cirrhosis, liver cancer
  • Deficiencies of zinc, magnesium, vitamins C and B12
  • Blood anemia
  • Metal poisoning
  • Thyroid hormone deficiency

An extended version of a biochemical study to assess liver function also includes indicators of total protein and protein fractions, cholinesterase, lipase, lactate dehydrogenase-1 (LDH), glucose, urea, prothrombin, cholesterol ... Obtaining biochemical analysis data rarely takes more than one to two working days. It should be remembered that the interpretation of screening results and diagnosis is the exclusive prerogative of the doctor. For example, an excess of the normal value of alkaline phosphatase by 3 times can indicate alcoholic or viral hepatitis, 5 times more about fatty liver disease, and 20 times more about drug hepatitis or biliary cirrhosis.

The hepatologist collects puzzles from the data of blood and urine tests, ultrasound results, a general examination, an anamnesis of the patient into a general clinical picture, which can be called cholestatic, mesenchymal-inflammatory, cytolytic syndrome, portal hypertension syndrome or liver cell failure.

Assays for assessing the degree of liver fibrosis (cirrhosis)

Fibrosis is a liver disease in which special liver cells (hepatocytes) are destroyed, and fibrocytes, cells of the connective tissue, take their place. The cause of fibrosis is often infectious liver disease - hepatitis. Also, fibrosis is often the result of damage to the liver tissue by toxic substances, potent drugs and alcohol.

There are four stages of fibrosis, which in the international METAVIR system are indicated by indices from F1 to F4, where F1 is the easiest stage, and F4 is already cirrhosis. Index F0 means that the liver is without signs of fibrotic changes.

The disease is diagnosed by ultrasound examination of the hypochondrium. However, such a study of the liver is not exhaustive: sometimes fibrosis gives an ultrasound picture similar to cancer or hepatosis.

To clarify the picture of the disease, biopsy was previously widely used - taking samples of liver fiber for analysis. But modern laboratory diagnostic methods, in particular FibroTest, FibroMax, and SteatoScreen, developed by the French company BioPredictive and received state registration in Russia, made it possible to avoid this traumatic method back in 2007.

Actual methods for determining the state of the liver structure consist in the deep mathematical processing of various indicators (absolute values ​​and relationships between each other) of the patient’s blood, including α2-metaglobulin, apolipoprotein, bilirubin, glucose, AST, ALT, triglycerides and others.

In addition, the patient’s height and weight, gender and age are taken into account. The result of FibroTest is a numerical value from 0 to 1 in increments of 0.01.

Blood sampling and preparation for FibroTest is the same as in biochemical analyzes. In this sense, FibroTest is an advanced biochemistry.

Another approach to detecting fibrotic changes is elastography . It was established that structural disorders of the liver tissue (fibrosis, cirrhosis, oncology) cause an increase in the organ elasticity index. Using an ultrasound device (FibroScan), an accurate measurement of the elasticity of the liver in pascals is carried out, after which the general value is displayed, which is used for diagnosis. This method is also an effective liver cancer test. The interpretation of the indicators of both methods is shown in the table.

table 2 . Comparative interpretation of the results of the FibroTest study and elastography

METAVIRFibroTestElastography (cf. kPa)
F00,00–0,274,38
F10,28–0,475,84
F20,48–0,587,45
F30,59–0,748,7
F40,75–127,6

A further sharp increase in liver elasticity (75 kPa) indicates the presence of hepatocellular carcinoma (HCC, liver cancer).

Laboratory diagnosis of viral and autoimmune liver diseases

If the liver disease has an infectious (viral) or autoimmune nature, this is manifested by the presence of antibodies in the blood.

At some point, the immune system begins to take its own cells as pathogenic agents and begins to fight them. The causes and nature of the phenomenon have not yet been fully studied.

But before diagnosing autoimmune hepatitis, the infectious nature of the disease should certainly be ruled out. To confirm or exclude the presence of this factor immediately, tests for antibodies of the IgG and IgM classes against viral hepatitis A, B, C, D, G, E are assigned, as well as qualitative and quantitative determination of RNA and DNA viruses by PCR - polymerase chain reaction.

Markers of autoimmune hepatitis (AIG) are such specific antibodies:

  1. AMA-M2 . The main marker of autoimmune hepatitis type 1, primary biliary cirrhosis. The main indicator of the presence of this disease.
  2. LKM-1 . Autoimmune hepatitis type 2 marker. LKM-1 is not enough to make a diagnosis of blood, since this antibody can occur in hepatitis C.
  3. LC-1 . Also a type 2 hepatitis marker. The presence in the blood of both LC-1 and LKM-1 at the same time allows us to make an exact conclusion that the disease is of an autoimmune nature, the viral origin is excluded.
  4. SLA / LP . Autoimmune hepatitis type 3 marker. It is sufficient for diagnosis, as it does not occur in other diseases.

What is the feature of each type of autoimmune hepatitis?

  1. Type 1 . It can occur at any age, but the peak incidence occurs in adolescence and pre-retirement age. If untreated, it causes complications in the form of cirrhosis in more than 40% of patients. The main method of therapy is the use of immunosuppressants (drugs that suppress the immune system).
  2. Type 2 . A rarer type of AIH, but more dangerous: most often affects children under 14 years of age, resistant to immunotherapy. Discontinuation of drugs often causes relapse of the disease. Often combined with other diseases - insulin-dependent diabetes, ulcerative colitis.
  3. Type 3 . It is observed in patients with hepatitis of the first type (every tenth carrier of AIH of type 1 is simultaneously susceptible to type 3), so there is still no consensus on whether this form of the disease is a separate type.

Studies on viral or autoimmune damage to the liver, as a rule, are carried out according to the results of biochemical screening - assessment of liver function, if the latter revealed serious deviations from normal values.

So, neglect the symptoms indicating possible problems with the liver, in no case should. Modern medicine provides all the possibilities for quick and accurate diagnosis of functional disorders of this organ. You should be attentive to your health and consult a doctor at the first sign of illness, or rather, for preventive purposes.

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