Jaundice refers to the pathological syndrome of staining of the skin, proteins of the eyes and mucous membranes in different shades of yellow color as a result of an increase in the blood level of a particular pigment – bilirubin, bound or free. Depending on the cause and concentration of certain fractions of bilirubin, jaundice is different in color and manifestations.
Jaundice is not a disease, it is a syndrome, that is, a complex of pathological manifestations associated with impaired liver function and pigment metabolism, and the causes for the development of jaundice may be completely different in each of the cases.
The basis of jaundice is excessive entry of bilirubin into the blood pigment, it is formed from hemoglobin of blood that has been worked out and no longer fulfills its function. The iron ion is cleaved from hemoglobin and reused, and hemoglobin produces bilirubin (still toxic), which is then combined with a special acid (glucuronic acid ), which neutralizes it.
Non-acid bilirubin is called:
- indirectly. It gives a special indirect chemical reaction with reagents,
- unbound ( unconjugated ) or free. It is insoluble in water, quite toxic, binds well to proteins or body fats. Therefore, it is well accumulated tissue.
- When binding bilirubin with glucuronic acid in liver cells, it becomes:
- direct (gives a direct reaction with reagents),
- linked (conjugated).
This bilirubin is non-toxic, soluble in water, it enters the intestine, where it turns into stercobilin (stains stains) and urobilin (absorbed into the blood and excreted by the kidneys, staining urine).
According to the mechanism of the formation of jaundice can be distinguished three large groups:
suprahepatic , these jaundices are not associated with liver problems, caused by the massive breakdown of red blood cells and the release of hemoglobin into the blood,
liver (or they are also called parenchymal), develop due to liver disease, when liver cells do not cope with the processing of bilirubin,
subhepatic or mechanical, when due to various problems the normal flow of bile is disrupted, as a result of which bilirubin cannot be removed.
Manifestations of jaundice occur with an increase in blood levels of bilirubin above 20-30 µmol / l. At the same time, according to the classification, all the reasons are divided into three groups.
1. Causes of suprahepatic or hemolytic jaundice :
- all types of hemolytic anemia,
- poisoning by hemolytic poisons,
- toxic effects on blood cells – red blood cells, leading to their destruction.
2. Causes leading to the development of hepatic or parenchymal jaundice :
- viral liver damage (hepatitis A, B , C, delta and E),
- medicinal hepatitis,
- hepatitis due to poisoning and toxemia,
- alcoholic hepatitis and liver cirrhosis,
- chronic hepatitis, autoimmune lesions,
- tumors and liver cancer.
3. Causes of obstructive or obstructive jaundice :
- blockage of the bile duct stones with cholelithiasis,
- tumors or cysts of the pancreas that violate the flow of bile,
- adhesions in the biliary tract,
- obstruction of bile ducts by parasites,
- other causes of violations of the outflow of bile (thickening, inflammation of the ducts, etc.).
With each type of jaundice, its own mechanism of damage is formed, resulting in a kind of manifestations.
With jaundice due to hemolysis
there is an increased destruction of red blood cells with the release into the blood of a large amount of hemoglobin, which must be transferred to bilirubin and removed from the body.
At the same time, too much work is placed on the liver, while the enzyme for transferring bilirubin from a dangerous form to a non-dangerous one is not enough. Therefore, an excess amount of bilirubin enters the bloodstream and is spread to the tissues. More than the normal amount of bilirubin goes to the intestine, more strongly staining the feces with stercobilin , and an excess of urobilin stains more urine. Since most bilirubin is insoluble, bilirubin does not enter the urine and is not detected in the analysis.
In the analyzes will be:
- blood – a lot of indirect bilirubin, a little direct,
- urine – a lot of urobilin,
- feces – a lot sterkobilina.
- With jaundice as a result of liver damage
damage occurs to the liver cells, which should normally process bilirubin;
small bile ducts inside the liver are damaged, and the bile is poorly separated from them and cannot be removed;
a lot of bilirubin of all kinds is formed – both direct and indirect;
part of bilirubin enters the blood and urine, but the process of excretion of bilirubin with bile in the intestine is difficult.
As a result, the feces will be less stercobilin , and in the urine – less urobilin. Due to the fact that the bile capillaries are damaged, part of the bile, with its bile acids, enters the bloodstream and spreads through the body, causing itching.
This will be:
in the blood – a lot of direct and indirect bilirubin, bile acids.
There is little urobilin in the urine, but there is bilirubin, it gives it a dark color.
in feces little stercobilin – it is light, but not completely discolored.
With jaundice as a result of violations of the outflow of bile
There is a complete overlap of outflow of bile with bilirubin in the intestine. As a result:
sterile in Calais is not at all, it is discolored,
There is no urobilin in the urine, but there is bilirubin – it will give the urine a very dark color,
bile and direct bilirubin, bile acids appear in the blood due to the stretching of the capillaries and their injuries.
Symptoms of jaundice
When jaundice appears a whole complex of symptoms that allow not only to identify jaundice, but also its appearance.
The most basic symptom is the recolouration of the skin, mucous membranes and sclera of the eyes in yellow color. In this case, the skin tone will be different:
hemolytic types of jaundice skin color lemon-yellow color, while there is also pallor,
with parenchymal or hepatic jaundice, the skin is orange-yellow in color,
with mechanical skin can be yellow-olive color with the transition to darkening to brown.
Also, the last two types may occur:
- itching of the skin, more pronounced with the subhepatic form,
- spider veins due to liver damage and blood clotting disorders.
- discoloration of stool and urine.
- an increase in the size of the liver, with hemolytic – even the spleen,
- soreness in right side,
A preliminary diagnosis can be made with yellowing of the skin, but it is necessary to determine the cause of jaundice. Must hold:
general blood and urine analysis
the level of bilirubin in the blood and urine,
biochemical analysis of blood for the determination of the main enzymes of the liver, protein, cholesterol, etc.
blood for antibodies to viral hepatitis and other infections
In laboratory studies, ultrasound of the liver and biliary tract is used, if necessary, of the spleen, duodenal intubation, liver scan, tomography and MRI,
Depending on the cause, jaundice can be dealt with by infectious disease specialists, general practitioners, hematologists, or surgeons.
Hemolytic jaundice is done by hematologists, they conduct a course of treatment of hemolytic anemia, up to blood transfusion.
In case of infectious jaundice , antiviral therapy is carried out in hospitals of infectious diseases hospitals and a course of supporting liver function.
With mechanical jaundice , operations are performed to remove obstacles to the outflow of bile — removing adhesions and tumors, crushing stones, or removing the gallbladder.