Jaundice

. Jaundice is always associated with hyperbilirubinemia and occurs for a number of diseases, but with the defeat of the liver and biliary tract is one of the most important and typical symptoms.
Yellow staining first appears in the serum. If you suspect the possibility of the appearance of jaundice (for example, suspected epidemic hepatitis) should take 10 ml of blood from a vein and leave it in a test tube. After some time over the clotted blood clot can be seen painted in yellow liquid layer. With the development of the pathological process yellow color is celebrated on the sclera, in the field of frenulum of tongue and soft heaven, and then all the skin is yellow, and the intensity of jaundice may be different at the same degree and duration of the delay of bilirubin in the body. The latter is connected with the thickness of subcutaneous fat, the development of muscles. In the artificial light (with the exception of lamps "daylight") jaundice can not detect.
Under uniform icteric staining of the skin may be various shades of jaundice. It can be a lemon-yellow, reddish, greenish (the transition deposited in the skin of bilirubin in biliverdin), grey-green, passing in black. The so-called black jaundice associated with long delays bile, often on the grounds of cancer in the field of the biliary tract. The most simple method to help determine the extent and partly type of jaundice is a laboratory method for the determination of bilirubin in the blood (see Ehrlich desireable). For the differential diagnosis of jaundice requires the use of a number of laboratory, x-ray, radio-indicator and other methods (see Liver, research methods).
There are hemolytic, liver and mechanical jaundice (Fig. 9-11).
Fig. 9. Obstructive jaundice (cancer of the pancreatic head). Fig. 10. Hepatocellular jaundice. Fig. 11. Hemolytic jaundice. Under each picture, respectively specify the color of urine and feces (b).
Hemolytic jaundice (synonym: nadrechenskaya, urobilinemia) is the result of excessive education bilirubin increase in kirovogradschine in the body.
Occurs in hemolytic anemia (see), as well as sepsis, lobar pneumonia, a disease Addison - Biermer, malaria, persistent septic endocarditis, when intoxication poisons causing hemolysis (see Hemolytic poisons).
The coloration of the skin with hemolytic jaundice lemon-yellow hue. Patients more pale than yellow. Numbers of free bilirubin (see) in the blood moderately increased. Jaundice is not accompanied by skin itch. She can wear wavelike character. Bradycardia is usually absent. In cases of severe anemia can listen systolic murmur. The liver usually not palpated, sometimes can be increased. Functional tests not changed. The spleen is usually increased. Can be formed pigment stones, and joins the clinical picture of a bile stone disease (see). Urine study finds high content of urobilin, and bilirubin is missing. In Calais - high content stercobilin. In the study of blood - hypochromic type of anemia, a decrease in the osmotic resistance of erythrocytes and positive Coombs test (see Kumbsa reaction).
Hepatic jaundice (synonym: hepatocellular, hepatocellular observed due to lesions of the liver tissue of an infectious or toxic in nature. If the damage liver cells is reduced functional ability for selection of bilirubin from the blood into the bile ducts.
In the study of serum blood detect high content of bound and free bilirubin. In urine appear bilirubin and bile acids, their number is gradually increasing. The number stercobilin in Cala decreased. In the midst of hepatic jaundice in urine missing the urobilin, and in Calais - stercobilin. Duodenal contents discolored. As the amount of jaundice in the urine appears urobilin, the amount of bilirubin in the blood begins to wane; duodenal contents and feces become normal color. The characteristic feature of this type of jaundice is changing all the functional liver samples. The most sensitive test for diagnosis of hepatic jaundice is bromsulfaleinovy sample.
The most common clinical manifestation of hepatic jaundice is at epidemic jaundice hepatitis (see Hepatitis epidemic).
Mechanical jaundice (synonym: obstructive, stagnant, obturator) occurs as a result of closing of hepatic or common bile duct (stone, tumor, sdavlennoy from outside, such as a tumor of the pancreatic head). Due to the presence of mechanical obstruction in the bile duct, the pressure increase in the overlying biliary tract, impaired excretion of conjugated bilirubin in the bile canals. Gall capillaries dilate, are broken. Liver cells are filled with bile, and it goes to lymph cracks and blood.
When mechanical jaundice jaundice color of skin is growing gradually. If complete obstruction of the biliary tract discolored feces, stercobilin missing, urine color black beer, contains bilirubin in large numbers, urobilin missing. In serum found high content of conjugated bilirubin, cholesterol, bile acids and increases the activity of alkaline phosphatase. Jaundice is accompanied by itching, bradycardia. The liver is enlarged. Sometimes detected positive symptom Courvoisier - Terje (palpated distended gall bladder). Obvious violations functional samples of the liver usually not observed.
When the prolonged mechanical jaundice skin gets gray-green in color, sometimes appear hemorrhagic rash associated with lack of vitamin K and changes of the vascular wall. Decreases the absorption of fat-soluble vitamins (A, D, K), calcium, and impaired digestion of meat and fat in the intestine.

  • Jaundice in pregnant women and children
  • Differential diagnosis of jaundice