Jaundice
Jaundice - syndromes of various origin, characterized by icteric staining of the skin and mucous membranes.
Jaundice (true) is a symptom complex characterized by icteric staining of the skin and mucous membranes, caused by the accumulation of bilirubin in the tissues and blood. Depending on the causes of hyperbilirubinemia, jaundice is distinguished for hemolytic (superhepatic), parenchymal (hepatic) and mechanical (subhepatic) jaundice.
Jaemolithic jaundice see Diseases of the blood system.
Jaundice is false (pseudo-yellow) - icteric staining of the skin (but not of the mucous membranes!) Due to the accumulation of carotenes in it with prolonged and abundant use of carrots, oranges, pumpkins, and acrychin, picric acid and some other preparations.
Jaundice mechanical see Surgical diseases.
Jaundice parenchymatous (hepatic) is a true jaundice that occurs with various lesions of the liver parenchyma. It is observed in severe forms of viral hepatitis, ikterogemorrhagic leptospirosis, poisoning with hepatotoxic poisons, sepsis, chronic aggressive hepatitis, etc. Due to the defeat of hepatocytes, their function to trap free (indirect) bilirubin from the blood, bind it with gliuronic acid to form a nontoxic water-soluble bilirubin -glucuronide (direct) and release of the latter into the bile capillaries. As a result, the serum level of bilirubin increases (up to 50-200 mmol / l, rarely more). However, not only the content of free but also bound bilirubin (bilirubin-glucuronide) rises in the blood - due to its inverse diffusion from the bile capillaries into the blood capillaries in dystrophy and necrobiosis of the hepatic cells. There is icteric staining of the skin, mucous membranes.
Parenchymal jaundice is characterized by skin color - saffron-yellow, reddish ("red jaundice"). At first the icteric color is manifested on sclera and soft palate, then the skin is dyed. Parenchymal jaundice is accompanied by pruritus of the skin, but less pronounced than mechanical, since the affected liver produces less bile acids (the accumulation of which in the blood and tissues causes this symptom). With a long course of parenchymal jaundice, the skin can acquire, like a mechanical one, a greenish tint (due to the conversion of bilirubin deposited in the skin into biliverdin having a green color). Usually the content of aldolase, aminotransferase, especially alanine aminotransferase is increased, other liver tests are changed. Urine acquires a dark color (the color of beer) due to the appearance in it of the associated bilirubin and urobilin. The feces become discolored by reducing the content of stercobilin in it. The ratio of the amount of excreted stercobilin to feces and urobilin bodies with urine (which is an important laboratory sign of differentiation of jaundice), which is in the norm of 10: 1 to 20: 1, decreases significantly with hepatic cell jaundice, reaching 1: 1 in severe lesions.
The course depends on the nature of the liver damage and the duration of the damage to the beginning; In severe cases, liver failure may occur.
Differential diagnosis is performed with hemolytic, mechanical and false jaundice; It is based on anamnesis, clinical features of parenchymal jaundice and laboratory data.
Treatment. The main disease is treated.
- Diseases of the digestive system
- Alimentary dystrophy (hunger disease, protein-free edema, etc.)
- Amyloidosis
- Arteriomeenteric obstruction
- Achalasia Cardia
- Achilles of the stomach functional
- Bauthinite
- Gastritis
- Gastrocardinal syndrome
- Hemochromatosis
- Hepatitis
- Hepatoses
- Hepatolenticular degeneration
- Hepatolienal syndrome
- Hyperbilirubinemia functional
- Hyperlipemia essential
- Hypersecretion of gastric function
- Dysbacteriosis intestinal
- Digenesis of the digestive tract
- Dyspepsia
- Duodenitis
- Constipation
- Candidiasis
- Carcinoid
- Intestinal lipodystrophy
- Colitis
- Insufficient Absorption Syndrome
- Insufficiency of digestive syndrome
- Pancreatitis chronic
- Hepatic Insufficiency Syndrome
- Food allergy
- Diarrhea (diarrhea)
- Portal hypertension syndrome
- Post-hepatitis syndrome
- Sprue tropical
- Tuberculosis of the digestive system
- Cholecystitis chronic
- Cirrhosis of the liver
- Esophagitis
- Enteritis
- Intestinal enteropathies
- Peptic Oesophageal ulcer
- Ulcer of small intestine simple
- Stomach ulcer and duodenal ulcer
- Ulcers symptomatic
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