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Microscopic examination of bile
Last reviewed: 23.04.2024
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Normal bile does not contain cellular elements; sometimes there is an insignificant amount of crystals of cholesterol and calcium bilirubinate.
Slime in the form of small patches indicates catarrhal inflammation of the bile ducts, duodenitis.
Erythrocytes have no diagnostic value, since they often appear as a result of trauma during probing.
Leukocytes. Diagnostic value of leukocytes found in small flakes of mucus in combination with the epithelium of gallstones or gall bladder. The presence of leukocytes only in portion A is observed in duodenitis and in inflammatory events in large bile ducts. The detection of leukocytes mainly in portion B, with a smaller content in portions A and C, indicates the localization of the inflammatory process in the gallbladder. Prevalence of leukocytes in portion C is noted with cholangitis. A significant number of leukocytes in all bile fractions are observed in attenuated elderly patients with septic cholangitis and liver abscesses. Eosinophilic leukocytes are found in allergic cholecystitis, cholangitis and helminthic invasions.
Epithelium. The high prismatic ciliated epithelium is characteristic of cholecystitis, small prismatic cells of the hepatic passages, or high prismatic epithelium of the common bile duct - for the cholangitis. Large cylindrical cells with cuticle and villi indicate a pathology in the duodenum.
Cells of malignant neoplasms can be detected in the contents of the duodenum in neoplasms.
Cholesterol crystals. Their number increases with the change in the colloidal stability of bile (cholelithiasis). They tend to accumulate along with the rest of the crystalline elements of bile, microliths, calcium salts (bilirubin calcium), crystals of fatty and bile acids.
Normally, all the crystalline elements are absent, their presence indicates a violation of the normal colloidal properties of bile, that is, the pathological process of cholelithiasis.
Sterility. Normal bile is sterile. When parasitic diseases in the bile, vegetative forms of lamblia, eggs of helminths (with opisthorchiasis, fascioliasis, clonorchiasis, dicrocoliosis, stronto-giloidosis, trichostrongyloidosis) are found in bile. Detection in the bile of the intestinal erythema and liver fluke causes significant difficulties, therefore, if suspicion of strongyloidiasis and fascioliasis are shown multiple studies.
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