Determining the type of jaundice has undoubted importance for rational treatment of the patient (differential diagnosis of jaundice are shown in table).
| Indicators | Type of jaundice | ||
|---|---|---|---|
| hemolytic (nadrechenskaya) | liver (gepatozellliarny) | mechanical (obstructive) | |
| History | Similar diseases with relatives, jaundice for the first time in childhood, strengthening of jaundice after staying in the cold | Contact with toxic substances, alcohol abuse; contact with sick with jaundice, infectious diseases (mononucleosis) | Bouts of abdominal pain (with or without jaundice); re-hives; operations on bile ducts, dramatic weight loss |
| Color of skin | Pale-yellow lemon shade | Orange, yellow | Yellow-grey, greenish |
| The intensity of jaundice | Small | Moderate | From moderate to sharp |
| Skin itch | No | Unstable | Sustainable |
| The severity of the liver | No | Often in the early stages of the disease | Rarely, excluding the acute cholecystitis and echinococcosis |
| Pain in the liver | No | Rarely | Often in the presence of stones or tumors |
| The size of the liver | May be increased | Increased, normal, reduced | Increased * |
| The size of the spleen | Increased | Increased | Generally not enlarged |
| Urine color | Normal, maybe the dark (in the presence of urobilin) | Dark (the presence of the conjugated bilirubin) | Dark (the presence of the conjugated bilirubin) |
| The content of urobilin in urine | Sharply increased | You may not be short period, further excessively or moderately increased | No if complete blockage |
| Color Kala | Normal or dark (enhanced content stercobilin) | Pale (reduced stercobilin, increased amount of fat) | Pale (no stercobilin, increased amount of fat) |
| The functional liver samples | The increase in the concentration of free bilirubin in the blood. Sedimentary reaction is negative. The activity of alkaline phosphatase not changed | The increase in the concentration of bound and free bilirubin. Alkaline phosphatase activity is sometimes raised. Increased activity transaminaz. Sediment samples positive | The high content of conjugated bilirubin in the blood. The increased activity of alkaline phosphatase. The elevated levels of cholesterol in the blood. Sediment samples negative |
| Special tests allowing to detect the type of jaundice | Coombs Test. Determination of resistance of erythrocytes | Liver biopsy. Laparoscopy. Radioisotope study with Bengal rose or colloidal gold. Bromsulfaleinovy sample | The definition of occult blood in the stool. X-ray examination of the gastrointestinal tract and biliary tract. Liver biopsy. Percutaneous intrahepatic cholangiography. Laparoscopy. Scans of the liver |
