Called pathological jaundice syndrome staining skin, whites of the eyes and mucous membranes in different shades of yellow as a result of increase in the blood level of a particular pigment - bilirubinBound or free. Depending on the cause and the concentration of various bilirubin fractions, jaundice are different in color and displays.
general information
Jaundice - it is not a disease, a syndrome, that is a complex pathological manifestations related to the violation liver and pigment metabolism, and the reasons for the development of jaundice may be quite different in each of the cases.
The basis of the jaundice is excessive blood flow to the pigment bilirubin, it is formed of the blood hemoglobin, the spent and no longer performs its function. Ion iron from hemoglobin splits and goes to recycling, and from hemoglobin turns bilirubin (still toxic), which is then connected to a special acid (glucuronic), it neutralizing.
Not associated with acid called bilirubin:
- indirect. He gives special indirect chemical reaction with the reagents,
- unbound (unconjugated) or free. It is insoluble in water, quite toxic, well connected with proteins or fats of the body. Therefore, it is excellent accumulate tissue.
Upon binding bilirubin to glucuronic acid in liver cells becomes:
- Direct (gives a direct reaction with the reagents)
- linked (conjugated).
This bilirubin is nontoxic, insoluble in water, it gets into the intestines, where it is converted into stercobilin (cal stain) and urobilin (absorbed into the blood and excreted by the kidneys, urine staining).
Classification
According to the mechanism of formation of jaundice can distinguish three large groups:
- suprarenal, jaundice is not associated with liver problems caused by massive erythrocytolysis and access to the blood hemoglobin,
- liver (or also called parenchymal), developed due to liver disease, when the liver cells can not cope with processing bilirubin
- subhepatic or mechanical, when, due to various problems disrupted the normal flow of bile, causing the bilirubin can not be removed.
Causes of jaundice
Manifestations jaundice occur with an increase in blood levels of bilirubin higher than 20-30 mol / l. At the same time, according to the classification, all the reasons are divided into three groups.
1. The causes of the suprarenal or hemolytic jaundice:
- all kinds of hemolytic anemias,
- poisoning hemolytic poisons,
- toxic effect on red blood cells - red blood cells, leading to their destruction.
2. The reasons leading to the development of hepatic parenchymal or jaundice:
- viral liver disease (hepatitis BUT,AT,FROMDelta and E),
- Medicinal hepatitis,
- hepatitis due to poisoning and toxicosis,
- alcoholic hepatitis and cirrhosis liver,
- chronic hepatitis, Autoimmune lesions,
- Tumor and liver cancer.
3. The reasons leading to obstructive jaundice or mechanical:
- blockage of the bile duct stones in cholelithiasis,
- tumor or pancreatic cysts breaking flow of bile,
- biliary tract adhesions in the area,
- blockage of the bile ducts parasites
- other causes of violations of the outflow of bile (thickening, inflammation of the ducts, etc.).
development mechanisms
Each type of jaundice formed a mechanism of damage, leading eventually to the kind of displays.
Jaundice due to haemolysis
It occurs enhanced destruction of red blood cells in blood with a yield large amounts of hemoglobin that must be transferred to bilirubin and removed from the body.
Thus the liver falls too much work, while the translation of the enzyme for bilirubin of dangerous form in a non-hazardous lacking. Therefore, an excessive amount of bilirubin enters the bloodstream and spreads through the tissues. Greater than normal amounts of bilirubin into the intestine is stronger prokrashivaya stercobilin feces and excess urobilin stronger paints over urine. Since most insoluble bilirubin, the bilirubin in the urine and does not get in the analysis not found.
The analysis will be:
- blood - a lot of indirect bilirubin, a little direct,
- urine - many urobilin,
- cal - many stercobilin.
Jaundice as a result of liver damage
- It is going liver damage cells that should normally be processed bilirubin;
- small damaged bile ducts inside the liver and bile thereon poorly separated and is not displayed;
- It produces a lot of bilirubin all kinds - both direct and indirect;
- part of bilirubin enters the blood and urine, but the process of separation of bilirubin in the bile into the intestine is difficult.
As a result, the stool will be less stercobilin and urine - less urobilin. Due to the fact that bile capillaries are damaged, part of the bile, bile acids with her, enters the bloodstream and spreads throughout the body, causing itching.
This will:
- in the blood - a lot of direct and indirect bilirubin, bile acids.
- urinary urobilin little, but there are bilirubin, he gives it a dark color.
- in feces stercobilin little - it is light, but not quite discolored.
Jaundice as a result of violations of the outflow of bile
there is a complete overlap of the outflow of bile bilirubin into the intestine. As a result:
- stercobilin in the stool is not at all, it is discolored,
- urobilin in the urine, but there are bilirubin - he It gives urine a very dark color,
- in the blood due to the stretching of the capillaries and injury appears bile and direct bilirubin, bile acids.
symptoms of jaundice
Jaundice seen a whole range of symptoms that can not only determine the jaundice, but also its appearance.
The most basic symptom is a repaint of the skin, mucous membranes or eyes yellow. In this case, the skin tone will be different:
- in hemolytic jaundice kinds of skin color lemon yellow hue, while there is also a pale,
- with or parenchymal hepatic jaundice skin is orange-yellow,
- under mechanical skin may be yellow-olive color transition in darkening to a brown.
Also in the last two types can occur:
- itchy skin, more pronounced when subhepatic form,
- spider veins due to liver damage, and coagulation disorders.
- discoloration of urine and stool.
- increase in liver size when hemolytic - also the spleen,
- soreness in his right side,
- fever.
diagnosis of jaundice
The preliminary diagnosis can be set if there is yellowing of the skin, but it is necessary to determine the cause of jaundice. It is necessary to carry out:
- general blood analysis and urine,
- the level of bilirubin in the blood and urine,
- biochemical blood tests to determine the underlying liver enzymes, protein, cholesterol etc.
- blood for antibodies to viral hepatitis and other infections,
- fecal.
In laboratory studies used liver ultrasound and biliary tractIf necessary spleen, duodenal intubation, liver scan, tomography and MRI,
jaundice treatment
Jaundice treatment depending on the cause may be engaged in infectious disease, therapists, hematologists, or surgery.
Hemolytic jaundice engaged hematologists, they spend exchange treatment hemolytic anemia, until the blood transfusion.
When infectious jaundice carried antiviral therapy in a hospital infectious disease hospitals, and a course of supporting liver function therapy.
When obstructive jaundice operations performed to remove obstacles outflow bile - removal of adhesions and tumors, crushing stones or gall bladder removal.
