In this condition, the skin and the whites of the eyes acquire a yellowish hue due to an abnormally high content of bilirubin pigment in the blood. Bilirubin is a normal product of the exchange of heme-iron component of hemoglobin erythrocytes. There are three main types of jaundice: hepatic-cell, hemolytic and obstructive. Symptoms of these conditions should be carefully examined to establish the correct diagnosis.
Hemolytic jaundice
Hemolytic jaundice is the result of the destruction of erythrocytes. Urine in these patients is normal color, because with this form of jaundice, an insoluble form of bilirubin accumulates in the blood. The presence of urobilinogen in the feces (the function of the liver is not broken) gives them the usual color.
Obstructive jaundice
Obstructive jaundice develops in the presence of an obstruction for the outflow of bile. In patients, brown staining of urine is observed because of the high concentration of water-soluble form of bilirubin, as well as discoloration of feces. Elevated levels of bilirubin in the blood cause severe itching. A sign of obstruction of extrahepatic bile ducts can be fever with chills. A high level of bilirubin and, accordingly, jaundice can develop as a result of three main processes:
- increased destruction of erythrocytes (hemolysis) with excessive release of insoluble bilirubin into the blood;
- damage to liver cells, which leads to insufficient processing of water-soluble bilirubin;
- obstruction (blockade) on the way of excretion of water-soluble bilirubin in the lumen of the intestine. In this case, even a normal amount of pigment can not be excreted with feces and urine.
Hemolytic jaundice
Increased destruction of erythrocytes occurs:
• in newborn children with excess red blood cells;
• in patients with malaria; in patients with sickle cell anemia;
• with hereditary spherocytosis (the presence of an abnormal form in the bloodstream of erythrocytes).
Hepatic-cellular jaundice
Hepatic-cell jaundice develops in viral infections, particularly in hepatitis A, B, C, D and E. Jaundice is also accompanied by cirrhosis and the use of certain medications. The life span of erythrocytes is about 120 days, after which they are destroyed in the spleen. In this case, insoluble bilirubin is released, which is not excreted by the kidneys. With the bloodstream, it is sent to the liver, where it turns into a water-soluble form. From the liver, most of the soluble bilirubin passes through the bile ducts into the gallbladder, and from there to the intestine. In the gut lumen, soluble bilirubin undergoes further processing with the participation of bacteria to form a substance that imparts a characteristic color to the feces. Urobilinogen - a form of processed bilirubin - is partially absorbed into the bloodstream and excreted by the kidneys and liver.
It is extremely important to determine the cause of jaundice.
• The presence of episodes of pain and intermittent jaundice is likely to indicate gallstones.
• Constantly increasing jaundice combined with weight loss can be a sign of pancreatic cancer. 1 Alcohol abuse or long-term use of drugs in history presupposes liver damage.
Diagnostic tests
• Blood test to determine the type and severity of jaundice. With obstructive jaundice, the level of the hepatic enzyme of alkaline phosphatase increases sharply. The defeat of the liver cells is accompanied by an increase in the concentration of transaminases. With anemia, a blood test will detect a decrease in the number of red blood cells and the presence of sickle cells or spherocytes. Ultrasound and other imaging techniques will remember to clarify the type of obstruction. To diagnose chronic hepatitis, liver biopsy may be required. Tactics of treatment depends on the type and cause of jaundice, I Hepatitis A does not require special antiviral treatment. Patients are advised to follow a diet and avoid drinking alcohol. Chronic hepatitis can not be treated with antiviral drugs. Obstructive jaundice may require surgical operation depending on the cause of obstruction and its localization. The prognosis in most cases of jaundice is favorable. Suspicion of chronic hepatitis occurs if:
- symptoms are not resolved;
- the liver is enlarged;
- at a biopsy sites of death of liver cells are found out;
- liver tests are increased within 6-12 months.
Chronic hepatitis and especially cirrhosis are a serious problem and can lead to complications such as:
- liver failure;
- bleeding from the esophagus.
The development of jaundice - a symptom of many liver diseases - can be prevented. For the prevention of infectious hepatitis with a fecal-oral transmission mechanism (A and E) when traveling to endemic areas, the following rules should be adhered to:
- Use only boiled or bottled water, even for cleaning your teeth;
- When using tablets for sterilizing water, carefully follow the instructions;
- Avoid eating food stored or cooked in unsanitary conditions;
- Do not use ice to cool drinks and do not eat thermally unprocessed food;
- wash hands before eating and after using the toilet.
Prevention of hepatitis, transmitted through the blood and sexually (B, C, D), provides:
- avoidance of casual sex;
- condom use.