JAUNDICE

YELLOW - yellowing of mucous membranes, sclera and skin due to accumulation of excess bilirubin in the blood. Jaundice is one of the characteristic symptoms of liver diseases, as well as lesions of the biliary tract and disorders in the erythrocytopoiesis system. The cause of any type of jaundice is the imbalance between the formation and release of bilirubin.

Distinguish superhepatic (hemolytic), hepatic (parenchymal) and sub-hepatic (obturational) jaundice.

Superhepatic (haemolytic) jaundice is caused by increased disintegration of red blood cells or their immature precursors. The result is excessive formation of bilirubin, which exceeds the ability of the liver to bind it and excretion, and an increase in the blood content of glucuronic acid (free) bilirubin, in the urine of urobilin, in the feces of strobilin. In the urine bilirubin, as a rule, is absent. At the same time, reticulocytosis and anemia are observed. The main causes of superhepatic jaundice are hereditary and acquired hemolytic anemia . In addition, it can develop with B12-deficiency anemia (pernicious anemia), erythropoietic porphyria, sepsis, protracted septic endocarditis, infarctions of various organs (often lung infarcts), radiation sickness, malaria, etc., and poisoning with poisons or substances, Capable of causing hemolysis (arsenic hydrogen, trinitrophenol, phosphorus, sulfanilamide drugs), with transfusions of incompatible blood, etc.

For superhepatic jaundice of different genesis is characterized by a number of common symptoms that distinguish it from other types of jaundice. These include: mild jaundice of the mucous membranes, sclera and skin with a lemon tint, along with more or less pronounced pallor; An increase in the content of indirect (unconjugated) bilirubin in the blood serum (hyperbilirubinemia) outside hemolytic crises, usually up to 34-50 μmol / l (2-3 mg%), and in periods of crises - up to 80 μmol / l (4.7 mg%) and more; Enlarged spleen and sometimes liver; Hyperpigmented feces (dark brown color); An increase in the number of reticulocytes in the blood and an increase in the production of erythrocytes in the bone marrow; Shortened life span of erythrocytes. Functional hepatic tests with hemolytic jaundice vary slightly.

Hepatic (parenchymal) jaundice is caused by a pathological process localized in the hepatic cells (hepatocytes) and (or) in the intrahepatic biliary tract. Hyperbilirubinemia is associated with disruption of various metabolic and bilirubin transport links inside the liver. Depending on the localization of the pathological process, there are three types of hepatic jaundice: hepatic-cell, cholestatic and enzymatic.

Hepatic-cellular jaundice is one of the most common manifestations of acute and chronic liver damage. Its origin can be associated with viral hepatitis, infectious mononucleosis, leptospirosis, toxic liver damage (alcohol intoxication, chemical poisoning, drug intolerance, etc.), chronic active hepatitis, liver cirrhosis, hepatocellular carcinoma. The leading role in the development of hepatocellular jaundice is a violation of the integrity of the membranes of hepatocytes and the entry of bound bilirubin into the blood. The excretion of bilirubin into the intestine with a given form of jaundice is reduced, and in the midst of jaundice is sometimes absent. Excretion of urobilin with urine and strobilin with feces is reduced or absent. Bilirubin is excreted in the urine (bilirubinuria).

Cholestatic jaundice is more common in chronic cholestatic hepatitis, primary biliary cirrhosis and the intake of various drugs, especially aminazine, chlorpropamide, testosterone, sulfonamides. The cause of this type of jaundice is a violation of the metabolism of bile components, as well as a change in the permeability of the bile capillaries. There is an increase in serum levels of direct and indirect bilirubin, a high level of alkaline phosphatase and bile acids. Isolation of urobilinogen in urine and strobobilinogen with feces is reduced or absent.

Enzymopathic jaundice is caused by the deficiency of enzymes responsible for seizure, transport, binding to glucuronic acid and excretion of bilirubin from the hepatocyte. This type of jaundice is observed with prolonged starvation, sometimes after the introduction of rontgencontrast substances, radionuclide preparations and other substances that compete with bilirubin for hepatocyte seizure. With enzimopathic jaundice in the blood, the content of indirect bilirubin increases.

Podnechenichnaya (obturatsionnaya) jaundice develops when there are obstacles to the current of bile from the bile ducts into the duodenum. The reason for this is the obstruction of the hepatic or common bile duct by concrements, parasites, papular and papular gland pancreatic tumor compression, as well as cysts and chronic inflammation of the pancreas, cicatrical narrowing of the common bile duct, etc. An obstruction to bile flow causes an increase in pressure in the overlying bile ducts. The bile pigment passes through the walls of dilated bile capillaries, hepatocytes are filled with bile, and it enters the lymphatic fissures and blood. Obstructive jaundice is characterized by a gradual increase in jaundice of the skin, which acquires a yellow-gray or yellow-green color with a blackish tinge. In rare cases, for example, with the so-called ventral stone of the common bile duct, jaundice then appears, then disappears. With obstructive jaundice, all the components of the bile - bilirubin, cholesterol, bile acids - accumulate in the blood, and the amount of alkaline phosphatase increases. Urine acquires a color of beer with a bright yellow foam. The feces decolorize, have a clayey appearance, white-gray color, contains a large number of fatty acids and soaps, stercobilin is not found. The expressed disturbance of functional hepatic tests is, as a rule, absent in the beginning.

Treatment . The patient with jaundice should be hospitalized as soon as possible in order to clarify the diagnosis and conduct rational treatment. Very important and often paramount importance is the treatment of the underlying disease, including surgical intervention (for example, with obstructive jaundice).