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This pathology is typical not only for the adult generation, but also for children. Thus, jaundice of newborns is a fairly common neonatal pathology. According to statistical data, it ranks 4th in the structure of morbidity among babies in the first week of life. It occurs in 0.7 percent of newborns. Obstructive jaundice is also an equally rare pathology. It occurs in 40 percent of patients suffering from cholelithiasis. In people with tumor damage to the liver and bile ducts, jaundice occurs in 99 percent of cases. Parenchymal jaundice is characteristic of viral liver damage. However, it does not arise immediately, but only in decompensated stages, when the body is no longer able to fight the disease on its own.

Causes of jaundice

Pathogenesis of jaundice

The resulting bilirubin enters the bloodstream. Bilirubin is insoluble in water and therefore uses the protein albumin for its transport. With the blood flow, bilirubin is delivered to liver cells - hepatocytes. Initially, it is captured by these cells, and then transported to the liver, where it binds to glucuronic acid, after which it is released into the bile capillaries. There are two types of bilirubin - free ( indirect) and related ( straight). Before binding to glucuronic acid, bilirubin is called free. After conjugation ( connections) with acid, bilirubin becomes bound or direct.

Bile secretion occurs according to a gradient ( differences) pressure - the liver secretes bile at a pressure of 300 - 350 millimeters of water column. Next, it accumulates in the gallbladder, which already secretes bile depending on need. Bilirubin enters the intestine and, under the action of enzymes, is converted into mesobilinogen and urobilinogen. Urobilinogen is released from the intestine as stercobilinogen ( 60 – 80 mg per day). The latter colors the stool brown. A small part of urobilinogen is reabsorbed through the intestines and enters the liver through the bloodstream. In a healthy person, the liver completely metabolizes urobilin, so it is not normally detected in urine. Part of the stercobilinogen enters the general bloodstream and is excreted by the kidneys ( about 4 mg per day), giving the urine a straw-yellow color.

Thus, the exchange of bilirubin in the body is quite complex and includes several stages. Violation of one of them can cause jaundice.

The causes of jaundice are:

• obstruction of the bile ducts and gallbladder;
• liver pathologies ( hepatitis, cirrhosis);
• premature destruction of red blood cells.

The causes of blockage of the bile ducts are:

• gallstones or bile duct stones;
• cyst localized in the head of the pancreas;
• bile duct tumors;
• stenoses ( narrowing) biliary tract.

Since bile due to obstruction ( obstructions) does not enter the intestines, the stool of a patient suffering from obstructive jaundice becomes discolored. At the same time, freely circulating bilirubin in the blood gives it a dark brown color.

Liver pathologies ( hepatitis, cirrhosis)
Various liver diseases provoke the development of true or so-called “parenchymal” jaundice. Most often, parenchymal jaundice is based on infectious or toxic damage to liver cells ( hepatocytes).

Pathologies that can provoke parenchymal jaundice include:

• acute hepatitis;
• exacerbation of chronic hepatitis;
• liver cirrhosis, including primary biliary cirrhosis;
• systematic use of alcohol;
• exposure to certain viruses and poisons.

Drugs leading to the development of parenchymal jaundice

Premature destruction of red blood cells
Premature destruction of red blood cells underlies hemolytic or suprahepatic jaundice. In this case, the increase in the concentration of hemoglobin in the blood occurs due to the intensive breakdown of red blood cells and, as a consequence, excessive production of indirect bilirubin ( since red blood cells contain indirect bilirubin). The phenomenon of massive breakdown of red blood cells can be observed in the pathology of the spleen, namely in primary and secondary hypersplenism. Anemia can also be a cause of intense breakdown of red blood cells.

Due to the breakdown of red blood cells, a large amount of indirect bilirubin is formed, which the liver does not have time to metabolize. Thus, part of the bilirubin that is still taken up by hepatocytes binds to glucuronic acid, and part remains unbound. Unconjugated bilirubin, which should not normally be present, colors the mucous membranes and skin a bright lemon color.

Hemolytic jaundice can also be autoimmune in nature. The basis of this disease is the massive destruction of red blood cells by the body's own cells. The causes of autoimmune hemolytic jaundice, like other autoimmune diseases, are unknown. Jaundice can also be caused by various genetic diseases.

Genetic pathologies that are accompanied by jaundice include Gilbert's syndrome. This is a genetic disease in which the process of bilirubin metabolism in hepatocytes is disrupted ( its capture and assimilation). The ratio of men and women with this pathology is 3 to 4, and average age The onset of the disease occurs between 12 and 25 years of age. The content of total bilirubin in the blood ranges from 5.1 to 21.5 micromol per liter. The share of indirect ( free) bilirubin accounts for 4 – 16 micromoles per liter ( 75 – 85 percent of the total), while the concentration of direct ( related) is 1 – 5 micromoles per liter ( 15 – 25 percent of the total).

An increase in the concentration of bilirubin in the blood above 27 - 34 micromoles per liter is called hyperbilirubinemia. Bilirubin binds to the elastic fibers of the skin and conjunctiva and gives the skin and mucous membranes an icteric coloration.
Depending on how high the bilirubin level is, there are several degrees of severity of jaundice.

Severity of jaundice

The severity levels of jaundice are:

• mild form of jaundice with a bilirubin concentration of up to 85 micromoles per liter;
• moderate form of jaundice with bilirubin concentration from 86 to 169 micromol per liter;
• severe form of jaundice with an increase in bilirubin level more than 170 micromol per liter.

Somewhat later, icteric staining of the skin appears. If medical assistance is not provided on time, the skin acquires a greenish tint. This is explained by the gradual oxidation of bilirubin into biliverdin, which has green. Even if the patient is not helped at this stage, the skin and mucous membranes acquire a blackish-bronze color. Thus, the evolution of the skin with jaundice is as follows. First yellow, then greenish, and then bronze.

Types of jaundice

The difference between pseudojaundice and true jaundice is that in the first case only the skin turns yellow, in the second both the skin and mucous membranes.

Types of jaundice include:

• obstructive jaundice (subhepatic);
• hemolytic jaundice (suprahepatic);
• hepatic jaundice (parenchymal).

Obstructive jaundice

The intensity of accumulation depends on the degree of obstruction. If stones or a cyst completely close the lumen of the duct, then further flow of bile into the intestine stops. Bile accumulates in the bile ducts, creating high blood pressure. Finding no further exit, it begins to seep into the bloodstream. As a result, the components of bile, namely bilirubin and bile acids, enter the blood. Bilirubin colors the skin and mucous membranes icteric.

Symptoms of obstructive jaundice are:

• severe itching;
• icteric discoloration of the skin and mucous membranes;
• weight loss.

Jaundice discoloration of the skin and mucous membranes
The intensity of jaundice depends on the concentration of bilirubin in the blood. As a rule, with obstructive jaundice the increase in bilirubin concentration occurs very quickly. Therefore, the coloring of the skin is always very pronounced. A feature of obstructive jaundice is a greenish tint to the skin.

Weight loss, vitamin deficiency
Due to the fact that bile does not enter the intestinal lumen, the absorption of fatty acids and fat-soluble vitamins does not occur. Let us remember that bile plays a vital role in the process of assimilation of consumed food. It breaks down fats into small molecules, facilitating their absorption. Also, thanks to the components of bile, vitamins A, D, E and K are absorbed. Therefore, often with obstruction of the gallbladder ( or for other mechanical reasons) patients quickly begin to lose weight.

A deficiency of all fat-soluble vitamins - A, D, E and K - gradually develops. Vitamin A deficiency leads to the development of a disease such as night blindness. Lack of vitamin D underlies the development of osteoporosis and pain in the spine. For chronic cholestasis ( bile stagnation) osteomalacia develops, which manifests itself in a decrease in bone density. The symptoms of vitamin E deficiency are very diverse. It includes symptoms such as polyneuropathy, retinal degeneration, and cerebellar ataxia. The most dangerous consequence of cholestasis is vitamin K deficiency, which manifests itself as hemorrhagic syndrome.

Obstructive jaundice differs not only in clinical symptoms, but also in laboratory signs. She is also characterized by acholic ( colorless) feces, beer-colored urine, increased levels of all bile components.

Diagnosis of obstructive jaundice
As a rule, diagnosing obstructive jaundice is not difficult. Very often the cause is gallstones or cholangitis ( inflammation in the bile ducts). In this case, Charcot's triad is observed - pain in the right hypochondrium, temperature and jaundice. The pain that the patient complains about is very strong, almost unbearable. The patient is tossing about and cannot sit down. The main diagnostic method is most often ultrasound ( Ultrasound). A characteristic feature Blockage of the bile ducts on ultrasound is dilation of the bile ducts ( biliary hypertension).

In addition to ultrasound, endoscopic cholangiopancreatography is often used. This method diagnostics is carried out using an endoscope ( hollow tube), which is injected into the duodenum. Next, a probe with a video camera attached to the end is pulled out from the endoscope, which reaches the bile ducts. The image from the ducts is transmitted to the monitor screen. Thus, a more complete and clear picture of the condition of the bile ducts is achieved.

The diagnosis of obstructive jaundice is supported by increased concentrations of bilirubin, bile acids, and liver enzymes. During a medical examination, a dense and lumpy liver is palpated, and local pain is observed in the area of ​​​​the projection of the gallbladder.

Hemolytic jaundice

Hemolytic jaundice is characterized by intense breakdown of red blood cells and the release of large amounts of bilirubin. Hemolytic jaundice is also called prehepatic jaundice. This means that the cause of this disease does not lie in the liver itself ( as in the hepatic form), nor under it ( as with mechanical), and higher, that is, still in the circulatory system. The main laboratory sign for hemolytic jaundice is an increase in the concentration of indirect bilirubin.
The causes of massive breakdown of red blood cells can be anemia, the ingestion of various poisons and toxins into the body, which lead to the destruction of red blood cells.

Symptoms of hemolytic anemia are:

• bright lemon-colored jaundice;
• splenomegaly;
• changes in the blood.

Splenomegaly
Splenomegaly is a syndrome characterized by an increase in the size of the spleen. The increase in the size of the spleen depends on the intensity of hemolysis ( destruction of red blood cells). Splenomegaly is often accompanied by hepatomegaly ( liver enlargement). Urine and feces with hemolytic jaundice become intensely dark color.

Changes in the blood picture
In the blood with hemolytic jaundice, the concentration of indirect bilirubin sharply increases, while the level of direct ( related) remains within normal limits. Also, a large number of young and immature red blood cells appear in the blood, which replace the destroyed ones. This phenomenon called reticulocytosis ( young forms of red blood cells are called reticulocytes) and is characteristic of all hemolytic jaundices. Another indicator of hemolytic jaundice is an elevated serum iron level. Liver tests and cholesterol were within normal limits.

Hepatic jaundice

Causes of hepatic ( parenchymal) jaundice are:

• infectious and toxic hepatitis;
• viral hepatitis B, C, D;
• biliary cirrhosis of the liver;
• drug intoxication.

Symptoms and signs of hepatic jaundice
The clinical picture of parenchymal jaundice is determined by its causes. If intoxication is the basis of jaundice, then symptoms such as nausea, vomiting, and abdominal pain will be present. Jaundice in this case has a saffron tint, causing the patient's skin to turn red. If the course of jaundice is prolonged and there is no adequate treatment, the skin may acquire a greenish tint. Parenchymal jaundice is also accompanied by skin itching, but it is less pronounced than with obstructive jaundice. The level of all liver enzymes increases in the blood - aminotransferase, aldolase, phosphatase. Urine becomes dark in color ( beer shade). On palpation, the liver is enlarged, dense and painful. Often, hepatic jaundice can be complicated by hemorrhagic syndrome.

Diagnosis is based on patient complaints, laboratory and objective data. Patients with hepatic jaundice complain of pain in the right hypochondrium, moderate itching and dyspepsia ( nausea, vomiting). Laboratory data include increased levels of bilirubin in the blood, liver enzymes, the appearance of urobilin in the urine and stercobilin in the feces. Objective data includes signs identified by the doctor himself during the examination. This is the color of the skin ( saffron color), enlarged and painful liver.

Jaundice in newborns

Physiological jaundice of newborns

Causes
The cause of icteric staining of tissues in newborns is the immaturity of the systems that are responsible for the exchange and removal of bilirubin ( substance resulting from the breakdown of red blood cells). In the human body, bilirubin is processed by the liver and excreted naturally. At the time of intrauterine development, the mother’s body “helps” process fetal bilirubin. After birth, the child’s body cannot cope on its own with “neutralizing” the entire volume of bile pigment. In addition, after birth, the level of bilirubin in the blood increases significantly. This happens because during intrauterine development the fetus needs more red blood cells, and after birth the need for them decreases. Red blood cells begin to break down, forming bilirubin. The increased amount of bilirubin combined with the immaturity of the child’s liver leads to the fact that the pigment begins to accumulate in the newborn’s body. There are a number of factors that increase the likelihood of a newborn developing physiological jaundice.

Circumstances that contribute to the development of physiological jaundice are:

• Not balanced diet expectant mother;
• use of tobacco products and other bad habits of women;
• Presence of diabetes mellitus in a pregnant woman;
• iodine deficiency during gestation;
• use of certain medications;
• general unsatisfactory physical condition of a woman.

Symptoms
The only symptom of physiological jaundice is a yellowish tint to the skin. The child’s behavior corresponds to the norm - he is active, not capricious, and eats well. Sometimes, with severe skin staining, the baby may be too sleepy and sluggish to eat. The hemoglobin level when tested is normal, feces and urine have a natural color.

Treatment
Physiological jaundice does not require medical attention. In some cases, the newborn is given intravenous glucose. Most effective method The treatment for this condition is breastfeeding. Breast milk is especially effective in the first days after birth, as it has a mild laxative effect, as a result of which bile pigment is more quickly excreted along with feces.

The maximum period of physiological jaundice is 3 weeks. During this period, you should monitor whether the yellowness becomes more pronounced. If the shade becomes more intense, you should consult a doctor. It is also necessary to seek medical help if, 21 days after birth, the baby’s skin has not acquired a natural shade.

Consequences
Physiological jaundice does not pose any threat to the further growth and development of the newborn.

Pathological jaundice of newborns

Symptoms
Regardless of the cause that provoked pathological jaundice, there are a number of common symptoms of this condition.

Common signs of pathological jaundice are:

• with a pathological form of jaundice, the coloring of the skin is more intense;
• a icteric tint may be observed on visible mucous membranes ( for example, in the mouth) and eye sclera;
• in addition to yellowness, pinpoint hemorrhages and bruises may be present on the skin;
• A distinctive feature of pathological jaundice is its wave-like course ( skin color may begin to recover and then become jaundiced again);
• the child’s behavior is inhibited and lethargic, he refuses food or eats reluctantly;
• increased muscle tone and monotonous crying may be present;
• often the urine becomes darker, and the feces, on the contrary, become discolored;
• as pathological jaundice progresses, symptoms such as convulsions, slow heart rate, and strong high-pitched crying may develop;
• in severe cases, the newborn may fall into stupor or coma.

Causes
Today, there are more than 50 factors that can result in pathological jaundice.

The most common causes of pathological jaundice are:

• Abnormal structure of red blood cells. It is a congenital disease in which yellowness of the skin is accompanied by an enlargement of the liver and spleen. Subsequently, the child develops anemia.
• Incompatibility of the Rh factor, blood group or other blood parameters of the mother and fetus. It provokes increased breakdown of red blood cells, resulting in the development of pathological jaundice, in which the skin acquires a pronounced yellow tint.
• Cephalohematoma (accumulation of blood under the periosteum of the cranial bones). A hematoma is formed due to injuries that the child may receive while passing through the birth canal or due to improper position in the womb. When the hematoma dissolves, hemoglobin breakdown products enter the bloodstream, as a result of which the skin acquires a characteristic shade.
• Gilbert's syndrome. With this disease, the process of removing bilirubin from the body is disrupted due to the abnormal structure of hepatocytes ( liver cells). Often such pathological jaundice is diagnosed as physiological.
• Crigler-Najjar syndrome. A serious hereditary disease that affects the child’s nervous system. Jaundice appears in the first hours after birth.
• Dubin-Johnson syndrome. A congenital pathology characterized by a disruption in the process of removing bilirubin from the liver. Skin coloring is weak or moderate, the liver may be slightly enlarged.
• Features of the composition of breast milk. In some cases, breast milk contains an increased concentration of fatty acids and other substances that disrupt the process of bilirubin excretion in the newborn. Unlike other forms of pathological jaundice, in this case, skin coloring occurs on the 3rd day and persists for 1 to 2 months. When switching to artificial feeding, the manifestations of jaundice are significantly reduced.
• Hormone deficiency in a newborn. With insufficient thyroid function in a child, the maturation of enzymes that are responsible for the proper metabolism of bilirubin is blocked. The yellow tint to the skin persists for a long time, in some cases up to 20 weeks. Pathological jaundice is accompanied by dry skin, swelling, and lethargy. This pathology is also characterized by an enlarged abdomen and digestive disorders ( constipation or diarrhea), low body temperature, low rough voice.
• Liver lesions of a viral or bacterial nature. Yellowness can appear either immediately after birth or several weeks later. In addition to the main symptoms, signs such as bloating, vomiting, enlargement and hardening of the liver are noted.
• Abnormal structure of the bile ducts. With this pathology, the lumen of the bile ducts narrows or is completely blocked. Because of this, the outflow of bile is disrupted, and bilirubin enters the blood. Initially yellow skin gradually acquires a greenish tint. At the same time, the liver increases significantly in size, and dilated veins appear on the abdomen.

In the absence of timely and correctly prescribed treatment, pathological jaundice can lead to various serious complications. The consequences of this condition can manifest themselves both within a short time and in adulthood.

Possible consequences of pathological jaundice are:

• Toxic poisoning. With an excess of bilirubin, this substance begins to accumulate in adipose tissue and other structures of the body, which can lead to intoxication.
• Albuminemia. High levels of bilirubin cause the amount of protein albumin in the blood to decrease. This condition is accompanied by severe swelling and diarrhea.
• Bilirubin encephalopathy. Brain damage that develops due to exposure to bilirubin. It is accompanied by convulsions, hearing loss, paralysis and can lead to disruption of the mental and physical development of the child.

Prevention of neonatal jaundice

Factors that increase the risk of having a baby with jaundice are:

• the woman's age is less than 18 or older than 40 years;
• history of abortions and/or miscarriages;
• previous premature birth;
• smoking and other bad habits during pregnancy;
• diabetes mellitus in a pregnant woman;
• intrauterine infections;
• negative Rh blood factor;
• jaundice in previously born children.

Symptoms of jaundice

• change in color of urine and feces;
• change in skin color;
• skin itching;
• changes in the blood picture.

Urine and feces with jaundice

Color of urine and feces various types jaundice

Itching with jaundice

Skin with jaundice

The skin of a patient with jaundice may take on various shades. Thus, with obstructive jaundice, the skin acquires a greenish tint, with hemolytic jaundice - lemon, with hepatic jaundice - saffron. Often, scratch marks may remain on the skin, which are a consequence of painful itching. With long-term jaundice, the skin begins to become covered with pigment spots. Pigmentation of the skin is the result of the deposition of bilirubin in the dermis of the skin.

In addition to the above symptoms, jaundice is accompanied by signs of the underlying disease. For example, if the cause of jaundice is viral hepatitis, then the clinical picture of the disease includes nausea, vomiting, and ascites ( accumulation of fluid in the abdominal cavity). If the cause of jaundice is gallstones, the patient begins to lose weight quickly. Also, stones are accompanied by hepatic colic, which manifests itself in acute and sharp pain in the right side.

Differential diagnosis of jaundice

The complaints of a patient with jaundice are:

• skin itching;
• digestive difficulties;
• a sharp decrease in body weight;
• yellow coloring of the skin;
• pain in the right hypochondrium.

Patient examination
The examination of the patient begins with a more detailed study of his mucous membranes ( soft palate and sclera) and skin. Next, the doctor begins to palpate the abdomen, liver and spleen. The abdomen of a patient with jaundice may be slightly swollen and tender. Next, the liver and spleen are palpated. With hemolytic anemia, the spleen is always enlarged due to the breakdown of red blood cells, and with hepatic jaundice, the liver is enlarged. With obstruction of the gallbladder, local pain may be detected.

Bilirubin and other tests for jaundice

Laboratory indicators for jaundice

Ultrasonography ( Ultrasound) with jaundice

Treatment of jaundice

The principles of treatment of jaundice are as follows:

• The cause is treated, that is, the underlying disease, not the symptom. If the underlying pathology is viral hepatitis, then antiviral drugs are prescribed. In the case of obstructive jaundice, the patient will only benefit from surgical intervention. The operations used for obstructive jaundice are varied and depend on the cause and level of obstruction to the outflow of bile. If the cause of jaundice is toxic medications, they are immediately discontinued.

• A mandatory part of treatment is diet. Limit your intake of fats and triglycerides to 40 grams per day.
• Enzymes are also prescribed without fail. The standard of enzyme therapy is the drug Creon. In parallel with enzymes, fat-soluble vitamins are prescribed - A, D, E, K. The dose of prescribed vitamins depends on the degree of their deficiency in the body.
• For non-obstructive cholestasis ( that is, with stagnation of bile without the presence of stones) ursodeoxycholic acid is prescribed. It is produced under the name ursosan, ursofalk.
• All patients are required to be hospitalized.

Treatment of obstructive jaundice

The first stage includes various minimally invasive ( low-traumatic) methods that are aimed at eliminating bile stagnation ( cholestasis). This stage is carried out in combination with conservative therapy. If within 2 to 3 days minimally invasive methods do not give the desired effect, and jaundice continues to increase, it is necessary to perform direct surgical interventions.

Types of surgical interventions for obstructive jaundice

Treatment of neonatal jaundice

Methods that are used to “neutralize” bilirubin are:

• phototherapy;
• infusion therapy;
• taking medications.

The rules for conducting phototherapy are as follows:

• The light source is placed above the crib or incubator ( special camera) child. The child's eyes and genitals are covered with a special bandage.
• The session time depends on the volume of bilirubin in the blood. At low and medium levels, phototherapy is carried out intermittently. If bilirubin levels are high, the child is kept under the lamp continuously until his condition improves.
• During the session, the child should not remain in one position. Therefore, every hour a health care worker turns the newborn over.
• The child's body temperature is checked every two hours. This will prevent the newborn from overheating.
• The volume of fluid a child consumes during phototherapy should be increased by 20 percent. This is necessary in order to prevent dehydration. It is also recommended to continue breastfeeding during treatment.

Infusion therapy
Infusion therapy is the introduction into the body, most often intravenously, of various medicinal solutions. This treatment is prescribed during phototherapy to restore fluid volume if it is not possible to feed the child naturally. Infusion therapy is also indicated for vomiting and frequent regurgitation, and for other conditions in which the newborn loses a lot of fluid.
In some cases, the administration of a solution of glucose and sodium chloride is prescribed in order to eliminate the effects of intoxication and speed up the process of removing bile pigment. If the level of protein in the blood decreases, the administration of an albumin solution is indicated.

Taking medications
The goal of drug therapy is to accelerate the process of removing bilirubin from the newborn’s body. For this purpose, various adsorbents, drugs that improve liver function, and drugs to stimulate metabolism are used.

Drugs that are used to treat neonatal jaundice are:

• Activated carbon. One of the most affordable sorbents. Long-term use of the drug is not recommended, since activated carbon particles can injure the intestinal mucosa.
• Enterosgel. Sorbent based on organic silicon, which has a pronounced detoxification effect.
• Polysorb. An effective drug with sorbent ( absorbent) action, made on the basis of silicon dioxide.
• Magnesia. Prescribed both internally and in the form of electrophoresis

Jaundice- dysfunction of the secretion of bile pigments, in particular the secretion of bilirubin. This disease occurs when there is excessive secretion of this pigment, which as a result is deposited in the tissues of the body. A characteristic manifestation of this disease is an excessively yellow tint of the skin and mucous membranes of various organs.

The development of jaundice is the first evidence of disruption of the biliary tract and liver. Also, this disease signals the occurrence of painful processes in the body that disrupt the functioning of these organs. In some cases, jaundice indicates the presence of diseases, the course of which is accompanied by massive hemolysis.

Classification

In general, there are three forms of jaundice, which are pathogenetic in nature

• hepatocellular form - provoked by dysfunction of bilirubin secretion in liver cells. In some cases, the cause of this form of jaundice is regurgitation of this pigment;
• hemolytic jaundice, or the suprahepatic form of the disease, is characterized by excessive formation of bilirubin in the body. Quite often it develops due to the influence of extraneous mechanisms.
• Obstructive jaundice, known as the subhepatic form of the disease, is a category of jaundice in which the secretion of bilirubin is impaired in the area of ​​the bile ducts.

Jaundice that occurs when the body is exposed to viral hepatitis resembles the hepatic form, developed due to hepatocyte dysfunction, and jaundice of the mechanical form of the disease with compressed and swollen bile ducts inside the liver.

The course of jaundice in the hemolytic form may be similar in nature to subhepatic jaundice, which develops as a result of pigment stones that cause obstruction of the bile ducts.

The hepatic form of the disease may differ in its course with signs of hemolytic and cholestatic syndromes. However, to prescribe the correct treatment, determining the nature of the development of the disease becomes of great importance.

Causes

There are three main categories of hepatic form of the disease

• hepatocellular jaundice, which develops during the course of acute viral hepatitis, cirrhosis and alcoholic liver damage, due to exposure to toxic substances or certain medications. It manifests itself through icteric, bright swelling of the skin, a sudden or more moderate increase in bilirubin levels. Extrahepatic symptoms of jaundice, for example, spider veins, may occur;
• cholestatic form - occurs when the body is exposed to drugs, viral and chronic hepatitis, age-related benign cholestasis, the primary stage of biliary cirrhosis, cholestatic hepatosis that occurs during pregnancy, and other factors;
• enzymopathic form of jaundice - the development of this form of the disease is based on impaired fermentation processes of elements responsible for the capture, conjugation and excretion of bilirubin. The result of this form of jaundice is benign hyperbilirubinemia, which provokes a hereditary defect in the functioning of the body's enzyme system.

Types and symptoms of jaundice

Physiological jaundice

Physiological jaundice is temporary conjugative jaundice, which occurs in 60-70% of healthy newborns due to the fact that fetal red blood cells contain fetal hemoglobin, which is not needed under new conditions. As a result, red blood cells are destroyed after birth (which releases a large amount of bilirubin). This occurs against the background of a deficiency of the protein that ensures the transfer of bilirubin across the membranes of liver cells. In addition, insufficient maturation of the liver enzymatic systems interferes with the conversion of indirect bilirubin into bound bilirubin. Because of this, the rate of bilirubin excretion from the body of newborns is very low.

Physiological jaundice of newborns manifests itself in the form of yellow staining of the mucous membranes and skin on the 3-4th day after birth. In this case, there is no enlargement of the liver and spleen, there are no signs of anemia and hemolysis (increased breakdown of red blood cells).

With the improvement of the functioning of the bilirubin excretion system and the disappearance of excess blood cells from the bloodstream, jaundice disappears (usually this process takes 7-14 days), without causing any harm to the newborn’s body. For severe jaundice, doctors previously used intravenous infusions of a solution of glucose, phenobarbital, and ascorbic acid. This is now being abandoned due to the low effectiveness of the technique.

In premature babies, physiological jaundice is more common, it is more pronounced and lasts longer - about 3-4 weeks. The level of direct bilirubin in the blood becomes maximum on days 5-6 of life. If the jaundice is intense, the doctor may recommend medications and phototherapy (UV irradiation of the skin with a special lamp). Under the influence of a lamp, bilirubin undergoes structural isomerization, turning into lumirubin - they are excreted more easily, passing into urine and bile.

Hemolytic jaundice

Hemolytic jaundice can be caused by the following diseases: hemoglobinopathy, hereditary anemia, hyperbilirubinemia. Hemolytic jaundice is also caused by the following diseases, which manifest themselves as yellowing of the eye sclera and skin:

• lobar pneumonia;
• subacute endocarditis (septic);
• malaria;
• Addison-Beermer disease;
• malignant tumors;
• pulmonary infarction;
• liver damage.

The causes of hemolytic jaundice include the toxic state of the patient’s body due to poisoning with hydrogen sulfide, phosphorus, arsenic, and sulfonamide.

Jaundice in children in most cases manifests itself in a hemolytic form. The development of this form of jaundice is influenced by malaria, exposure to toxic substances, lymphosarcoma, hemoglobinopathy, hereditary microspherocytic anemia, pulmonary infarction and other diseases.

Symptoms of jaundice in this form are as follows: pale and icteric shades of the skin and sclera, a slight increase in liver volume, and an enlarged spleen.

Diagnosis of this form of jaundice also shows the presence of hyperbilirubinemia, in which the indirect fraction predominates. Also, the symptomatic picture of this form of the disease includes an increased level of stercobilin in feces, metamorphosis of red blood cells, or reduced resistance of these blood cells.

Subhepatic jaundice

The subhepatic form of jaundice in its development is based on obstructions in the outflow of bile from the bile ducts to the area of ​​the duodenum.

In most cases this form jaundice is diagnosed in the case of the development of cholelithiasis and neoplasms that have arisen in the area of ​​the hepatopancreatodual zone.

Obstructive jaundice

Obstructive jaundice is a pathological syndrome that consists of a violation of the outflow of bile through the bile ducts into the duodenum due to certain mechanical obstacles. Frequently used synonyms: subhepatic jaundice, acholic jaundice, extrahepatic cholestasis.

Mechanical obstruction of the bile ducts is a complication for a large number of diseases affecting both the pancreas and the system of bile ducts and sphincters that regulate the natural flow of bile. The problem is accompanied by characteristic general symptoms: icteric coloration of the skin, eye sclera and mucous membranes, discoloration of feces and darkening of urine, abdominal pain, itching.

Progressive jaundice of this type can lead to liver and kidney failure, purulent cholangitis, biliary cirrhosis, sepsis, and cholangitis liver abscess. If qualified assistance is not available, death cannot be ruled out.

Most often, obstructive jaundice has causes related to cholelithiasis (in 20% of cases), malignant tumors (67%). In patients under 30 years of age, cholelithiasis predominates; after 30 and before 40 years, the two causes occur evenly (almost 50/50%), after 40 years, tumor causes are more common. Obstructive jaundice is more often diagnosed in women (up to 82%). However, tumor blockage of the bile ducts is more often diagnosed in men (54%).

The symptomatic picture of obstructive jaundice is as follows: paroxysmal pain in the area of ​​the right side of the hypochondrium, sometimes painful sensations occur in the upper abdomen, vomiting, diarrhea, nausea, decreased appetite, weight loss, itchy skin, feverish sensations.

In the case of obstruction processes, at a level below the point where the cystic duct enters the common bile duct, an increase in the volume of the gallbladder may be observed, which is called Courvoisier's symptom. In this form of the disease, the stool has no color, and the urine is dark in color.

With the development of the subhepatic form of the disease, hyperbilirubinemia is most often observed. high level, the cause of which is direct bilirubin. The disease also manifests itself through high levels of alkaline phosphatase activity. In the case of a prolonged obstruction process, aminotransferase activity occurs at an unusually high level. With the development of complete obstruction of the bile outflow tract, discoloration of the duodenal contents appears.

Conjugation jaundice

Conjugation jaundice of newborns is a condition caused by the immaturity or ambiguity of any component of the bilirubin metabolic system. Normally, it occurs from the second to the tenth day of life (the name is physiological jaundice of newborns), but sometimes it is a symptom of a congenital disease. Also called conjugation jaundice is a type of postpartum jaundice that occurs on the second day of life (more often in premature babies) and lasts about 14-30 days. Differential diagnosis of such a disease is difficult to carry out, therefore inpatient monitoring of the child’s mother is recommended.

It is important to distinguish conjugation jaundice from hemolytic and obstructive jaundice, since treatment methods and prognosis are completely different. Regardless of the type, jaundice is a yellow discoloration of the eye sclera and skin (due to the toxic pigment bilirubin). Bilirubin is formed in the body from the breakdown of red blood cells and hemoglobin.

Conjugation jaundice is a group of diseases in which the level of bilirubin in the blood becomes elevated due to a disruption in the process of its transition from indirect to bound form. This occurs due to congenital disorders of liver enzyme functions.

Parenchymal jaundice

Parenchymal jaundice is a dangerous disease that requires immediate treatment. This type of jaundice is characterized by the content of the toxic pigment bilirubin in the blood, which is completely eliminated from the body during normal functioning of the liver. However, with liver failure or incomplete conduction of the bile ducts, there is an accumulation of bilirubin in the blood, which causes the skin, mucous membranes and sclera of the eyes to turn yellow.

Parenchymal or hepatic jaundice is quite easily diagnosed. In addition to the obvious sign - yellowing of the skin, sclera and mucous membranes - the disease is accompanied by severe pain in the right side (in the area where the liver is located).

Typical symptoms of parenchymal jaundice:

• apathetic state;
• chills;
• headache (migraine);
• fever;
• loss of appetite;
• fast weight loss;
• nausea;
• muscle pain.

Parenchymal jaundice manifests itself in several types: hepatocellular, enzymopathic, cholestatic. Hepatocellular jaundice develops with viral hepatitis in acute form, with liver cirrhosis, under the influence of drugs with toxic side effects. The last factor is very common, since not all people are responsible for the quality of the medications they take and self-medicate.

Kernicterus

Kernicterus (bilirubin encephalopathy) is a severe brain injury from unconjugated bilirubin that occurs with hyperbilirubinemia of any origin. The pathological condition is typical only for newborns.

Bilirubin encephalopathy in premature infants can develop in two phases. The first is asphyxial. With it, the child sucks poorly, his posture is relaxed, the reaction even to weak stimuli is sharp, breathing is rare, and stops for long periods. The newborn turns blue, and when auscultated, wheezing is detected in the lungs. Short-term convulsions begin, the longissimus muscle of the head and neck tenses. The face is mask-like, the eyes are wide open, frightened.

The first phase quickly passes into the next phase - spastic. It is characterized by a severe picture of damage to the nuclei of the brain: the newborn has a piercing cry, all extensor muscles are tense, breathing is disrupted. Bilirubin encephalopathy is a very serious disease, so you need to know more about it in order to detect it in time.

Kernicterus of newborns has acute symptoms that grow rapidly. In most cases, they are observed in the first 48 hours of a child’s life after birth. Bilirubin encephalopathy has serious consequences.

Characteristic symptoms of kernicterus:

• apnea (stopping breathing) for a short or long period. Respiratory distress continues for quite a long time;
• involuntary movements (twitching) of the limbs, sometimes leading to convulsions. In the first year of life, a child may make uncoordinated involuntary movements, which can cause seizures to recur. Around 3 years of age, involuntary muscle contractions become constant;
• hypertonicity or hypotonia of muscles in the limbs. You can recognize the symptom by the inability to unclench the child’s fist or stretch his legs;
• sudden involuntary throwing of the head back;
• mental and emotional disorders leading to 3 years of life to mental retardation;
• increased body temperature;
• kernicterus is characterized by damage to the auditory and visual apparatus, which over time leads to deafness and blindness (if pathology is not detected at the very beginning),
• staining of the skin, eye sclera and mucous membranes in a bright yellow color, discoloration of feces, staining of urine;
• an increase in the size of the liver and spleen (detected by palpation);
• drowsiness, which is replaced by screaming and intense crying. Lethargy or restlessness;
• strong bulging of the fontanel.

Neonatal jaundice

After birth, the child’s body is not yet sufficiently adapted and formed; many organs do not function to the full extent of their capabilities. This also applies to the liver, which filters the blood entering the body. In neonatal jaundice, the pathogenesis is as follows:

• enriched blood produces breakdown of red blood cells;
• during the breakdown process, bilirubin is formed - a toxic element that is excreted from the body after breakdown in the liver;
• excess hemoglobin is not excreted due to unformed liver, lack of necessary enzymes, too high concentration of bilirubin in the blood or a number of other factors (for example, blockage of the bile ducts);
• long-term preservation of a high concentration of bilirubin leads to toxic damage to a number of systems and organs (in particular, the brain).

Common reasons for the accumulation of large amounts of bilirubin in a child’s blood: prematurity, immaturity of liver cells, hyperproduction of bilirubin, low ability blood serum to bind bilirubin. Prolonged neonatal jaundice requires differentiated diagnostics to identify the causes of high bilirubin concentrations and methods for their elimination.

Obstructive jaundice

Obstructive jaundice is the deposition of yellow bilirubin pigment in the mucous membranes and skin, associated with difficult secretion of the pigment into the gallbladder and the flow of bile into the duodenum. Obstructive jaundice in most cases is associated with intrahepatic blockage of the bile ducts.

Intrahepatic obstruction and extrahepatic obstructive jaundice can be caused by hepatitis, drug effects, and primary biliary cirrhosis. With intrahepatic obstructive jaundice, liver cell damage occurs and the patency of the bile canals is impaired.

Risk factors for the occurrence of intrahepatic obstructive jaundice:

• narcotic substances or chemical toxins;
• estrogens or pregnancy;
• Dubin-Johnson syndrome;
• viral or chemical hepatitis;
• primary biliary cirrhosis;
• tumors (infiltrative).

Extrahepatic obstructive jaundice may be caused by extrahepatic obstruction of the bile duct. Factors: tumor compression, the presence of a congenital common bile duct cyst, extrahepatic biliary atresia, gallstones, postoperative inflammation, stenosis.

Specific symptoms of obstructive jaundice are quite pronounced character. First of all, this is pigmentation of the mucous membrane and skin: first of individual parts of the body, and then of the entire body. With this type of jaundice, the skin tone is quite rich lemon. Severe pain (sometimes of a spasmodic nature) in the area of ​​the right hypochondrium and below may also be observed. They are caused by the gallbladder's attempts to normalize the flow of bile, which is not normally excreted from the organ.

As already mentioned, the product of defecation is discolored, with particles of undigested food, and high in fat. At the same time, the urine takes on a dark, rich color. The patient complains of headaches, dizziness, nausea and vomiting, and lack of appetite. If these symptoms are observed, obstructive jaundice is highly likely to be suspected. These signs should never be ignored, since in most cases treatment is carried out in the form of surgery.

Jaundice in newborns

The most common type of jaundice in newborns is diagnosed 3-4 days after birth in approximately 60-70% of children. The condition is not dangerous and goes away on its own over time. The reason for such jaundice is the immaturity of the child’s body systems, which are not able to process large amounts of bilirubin. In this case, other signs of jaundice in newborns are rarely observed - drowsiness, lazy sucking and vomiting are possible only with a very large amount of bilirubin in the blood.

How severe physiological jaundice is should be determined by a pediatrician. The fact is that the intensity of external yellowness is not an indicator. An analysis is needed to determine the level of direct bilirubin in the blood. Its maximum concentration is observed on the 3rd day of life. Usually, the child’s body slowly copes with bilirubin by binding it with albumin (it prevents toxic effects).

If there is a lot of bilirubin, albumin is not able to completely neutralize its toxicity, which is why bilirubin penetrates into the nervous system. This dangerous condition, since toxic effects on the brain cannot be ruled out. This condition is called “kernicterus” or “bilirubin encephalopathy.” Such postpartum jaundice in newborns is recognized by symptoms: drowsiness, convulsions, weakened grasping reflex. Late manifestations are paralysis, deafness, and mental retardation.

Previously, when the level of free bilirubin increased, intravenous infusions of glucose solution, ascorbic acid, choleretic agents, and phenobarbital were used. However, modern specialists are increasingly abandoning such therapy: a number of studies around the world have confirmed its ineffectiveness. However, some domestic specialists still use these funds.

General characteristics of physiological jaundice:

• appears 2-3 days after birth;
• growth occurs on day 3-4;
• extinction is observed on days 7-10, complete disappearance - on days 14-21;
• yellowness with an orange tint;
• the general condition of the newborn is not impaired;
• the liver and spleen are not enlarged;
• the color of feces and urine is not changed.

Pathological jaundice in newborns

Pathological jaundice in newborns in most cases manifests itself in the first 24 hours after birth. Often, there is an enlargement of the liver and spleen, discoloration of feces, darkening of urine, and sometimes spontaneous appearance of bruises on the body and pinpoint hemorrhages. A blood test reveals increased hemolysis (breakdown of red blood cells) and anemia.

If there is incompatibility between mother and child regarding Rh factor or blood groups, increased hemolysis is observed. Severe jaundice often occurs if the mother has the first blood group, and the child has the second or third. Each subsequent pregnancy may increase the risk of such complications. This is why it is extremely dangerous for women with a negative Rh factor to have abortions.

Types of jaundice in newborns:

• conjugation - occurs due to liver enzyme deficiency;
• hemolytic - associated with blood problems - for example, with changes in the structure of red blood cells or hemoglobin;
• hepatic - occurs with various liver diseases;
• obstructive (mechanical) - occurs when the natural outflow of bile is disrupted.

Conjugation jaundice develops when, for some reason, liver enzymes do not actively bind and process bilirubin into cells. Constitutional liver dysfunction (called “Gilbert-Meulengracht syndrome”) - hereditary disease, very similar to physiological jaundice in newborns. Happens quite often. A failure in the level of bilirubin in this case is associated with a violation of its processing due to hereditary inferiority of the liver enzyme system. A newborn in this condition needs to be treated and observed for a long time by a gastroenterologist.

Hemolytic jaundice develops with a deficiency of enzymatic systems of red blood cells, with disturbances in the structure of hemoglobin. The destruction of red blood cells is associated with a number of genetically determined disorders - for example, microspherocytosis (Minkowski-Choffard anemia), disorders of the structural part of hemoglobin (for example, sickle cell anemia), changes in the structure and shape of the red blood cell, etc. To treat conditions that are accompanied by the destruction of red blood cells, exchange blood transfusions are often resorted to - this makes it possible to remove antibodies and bilirubin that provoke hemolysis.

Parenchymal (hepatic) jaundice in newborns develops when liver tissue is damaged by bacteria, viruses, and toxins. With hepatitis B and C, sepsis, cytomegalovirus infection, bilirubin accumulates in the blood, the skin and mucous membranes become yellow with a greenish tint, and the liver and spleen become enlarged. The feces become whitish and the urine darkens.

Treatment of such jaundice in newborns is carried out comprehensively, necessarily ensuring an impact on the cause of the disease. Naturally, first of all it is necessary to neutralize the infectious process. However, now it is not possible to select effective treatment methods for all types of infections. This is another factor why you need to responsibly prepare for pregnancy (especially if the expectant mother has infectious diseases).

Mechanical (obstructive) jaundice in newborns occurs when the outflow of bile is disrupted. The main reason is a decrease in the patency of the bile ducts due to underdevelopment (atresia), malformations, neoplasms (including neoplasms of other organs). In some cases, the structure of bile changes - it becomes viscous and thick, thereby accumulating in the bile ducts. Due to their overcrowding, bile enters the blood and provokes the symptoms of jaundice. In most cases, it is impossible to treat such jaundice without surgery.

Jaundice in adults

Jaundice in adults is a fairly common disease, especially common in countries with poor sanitary conditions for the population and a hot climate. In Eastern Europe, the incidence rate of viral jaundice is 25 people per 100 thousand population per year.

If we talk about the most common association (as already mentioned, people often associate jaundice only with hepatitis A) - this is a viral pathological process accompanied by impaired liver function and general intoxication of the body.

Generally speaking, jaundice symptoms in adults are as follows:

• yellowness of the skin;
• an increase in the size of the spleen and liver;
• an increase in the number of red blood cells in the blood;
• the appearance of a venous network in the abdominal area.

One of the manifestations of jaundice in adults is severe itching of the skin, change in the color of urine and feces. High levels of bilirubin in the body cause the stool to become grayish and the urine to become significantly darker. The patient has a loss of appetite, severe pain in the area of ​​the right hypochondrium, which has a pulling or spasmodic nature.

How does jaundice manifest in adults?

If we consider the threat of infection with viral hepatitis A, the risk group may include relatives or those who have close constant contact with a person infected with the virus, people who have unprotected sexual contact with an infected person, and people traveling to a country where the prevalence of this virus is very high. People who use drugs (especially intravenous drugs) are also at risk.

How is jaundice transmitted from person to person?

Jaundice, as already noted, is characterized by the appearance of yellow pigmentation on the skin, eye sclera and mucous membranes. To determine the risk of the degree of contagiousness of jaundice, all symptomatic types and modes of transmission should be considered in more detail.

You should start with the physiological jaundice mentioned above. It is provoked by improper functioning of the liver, a malfunction in the functionality of the bile ducts, leading to large amounts of bilirubin entering the blood. Accordingly, it leads to a characteristic change in skin color. Such jaundice passes without complications and, due to its origin, cannot be contagious.

To eliminate its negative impact on the patient’s body, it is recommended to observe special diet(refusal to eat fatty, spicy, spicy foods). Sunbathing and taking medications prescribed by a doctor with a hematopoietic and choleretic effect are also recommended. Those around the patient do not need to use special methods protection - there is no risk for them.

Jaundice and hepatitis

Infectious or viral jaundice - contagious or not? If the yellowing of the skin is caused by a virus or infection, jaundice is associated with quite serious illness- hepatitis. Hepatitis is divided into several types. Having understood them, you can determine the degree of danger of infection with jaundice.

Hepatitis A

They are classified as contagious diseases, and the risk of infection is quite high. Hepatitis A is transmitted by the fecal-oral route, mainly through contaminated food and water. This type of hepatitis can also be provoked by an intestinal infection during the multiplication of the virus in liver cells with its further entry into the tissues of the patient’s body. The incubation period of the hepatitis A virus is from 15 to 45 days.

During this time, the disease can have an ambiguous course: the exacerbation phase can be replaced by attenuation. Complications with this type of hepatitis are liver and nervous system diseases. It is impossible for people who have recovered to become infected with hepatitis A again. Is jaundice contagious in adults in such cases? Yes, it's contagious. Places where large numbers of people live without adequate living conditions are considered especially dangerous.

Hepatitis B

In most cases, it is transmitted parenterally - through contaminated needles during blood transfusions or injections with a shared syringe (relevant among drug addicts). The development of hepatitis B is slow, the disease lasts a long time, and can become chronic, which in turn increases the risk of developing cirrhosis of the liver. The incubation period is very long - up to six months. Is jaundice caused by hepatitis B transmitted to other people? Of course - with the blood of an infected person, as well as through sexual contact.

Hepatitis C

It is transmitted only parenterally and is characterized by a course characteristic of hepatitis B. It is rarely found in a severe form - more often it becomes a chronic condition, which can become a factor in the development of liver cirrhosis. The incubation period ranges from several days to 26 weeks. Is jaundice transmitted by airborne droplets with this form of hepatitis? No - only through the bloodstream, as well as unprotected sexual contact with an infected person.

Viral hepatitis also occurs in other variants - hepatitis delta, etc. All of these forms are also contagious and are transmitted by the fecal-oral route.

Is jaundice contagious in newborns?

Considering the prevalence of jaundice in children after childbirth, the relevant question is: is jaundice transmitted in newborns? No, infantile jaundice is absolutely not contagious, since in most cases it is not caused by a pathogen (as with hepatitis), but by increased breakdown of red blood cells and low liver functionality, which does not have time to process bilirubin released in large quantities.

Treatment

Patients who have suffered or are suffering toxic liver damage first of all need emergency care. Measures of this assistance provide for the immediate cessation of the processes of penetration of toxic substances into the patient’s body. Antidote therapy can be used for these purposes. Also, emergency measures involve actions aimed at neutralizing and removing the toxin from the patient’s body.

Patients with mechanical form diseases, no more than 1 ml of atropine sulfate solution with a concentration of 0.1%, or 1 ml of a papaverine solution with a concentration of 2% is administered to eliminate pain, which is pronounced.

Treatment of jaundice also involves hospitalization of the patient, especially if the disease is caused by viral hepatitis. Measures to cure the disease are applied within the infectious, surgical or therapeutic hospital, depending on the form of the developing disease.

Medicines for jaundice

Treatment with Ursosan

Ursosan is a medicine created on the basis of ursodeoxycholic acid, which is one of the natural and least cytotoxic components of bile acids. The drug is an effective hepatoprotector (improves liver functionality).

The acid in the drug binds toxic substances from the blood, converting them into safe micelles. It can strengthen the cells of the liver, gastrointestinal tract, bile ducts, protect them from toxic bilirubin by being included in cell membranes. In addition, it will promote the development of liver cells and the natural secretion of bile acids to reduce the content of pathological bilirubin. The drug helps reduce the level of cholesterol particles in the blood.

Ursosan contains magnesium stearate, corn starch, titanium dioxide and other excipients. Pay attention to the complete composition in order to exclude possible allergic reactions when taking it.

Ursosan for jaundice must be prescribed by the attending physician, based on diagnostic data (in particular, the level of bilirubin in the blood). Self-prescription of dosage based on instructions is prohibited!

Ursofalk for jaundice

The drug Ursofalk for newborns is produced in the form of suspensions of 250 ml. For older children, the manufacturer has provided the drug in capsule form. The kit always includes a 5 ml spoon (this is the daily dose for a newborn). If the doctor prescribes Ursofalk for jaundice in newborns, the dosage may be different - for example, 10 ml per 1 kg of weight. Taking the drug is recommended in the evening, before bedtime.

• severe liver disease;
• dysfunction of the pancreas;
• kidney dysfunction;
• inflammation of the biliary tract.

The drug may cause side effects: in particular, insomnia, allergic reactions, anxiety for no reason. Regurgitation and vomiting occur very rarely, and sometimes bowel movements become more frequent. Incorrect dosage can lead to liver dysfunction (this can only be determined after testing).

Diagnosis and treatment of jaundice in adults

The first signs of jaundice in adults are a signal that you need to see a doctor without delay. Modern medicine is capable of completely restoring the human body in almost all types of jaundice initial stage. To make a diagnosis, the patient is referred for the following types of studies:

• blood test (general and biochemical);
• analysis for the level of bilirubin in the blood;
• liver studies;
• liver biopsy - if previous diagnostic methods did not give an unambiguous result.

How is jaundice treated in adults? The approach and technique depends on the form of jaundice and its stage. For the most effective therapy, it is important to accurately determine the cause of jaundice. It is almost always possible to use conservative treatment (except for obstructive jaundice) or surgical intervention (from eliminating the cause of obstruction to liver transplantation).

The complex of measures for conservative therapy includes taking antihistamines, steroids and other drugs, following a diet, and plasmapheresis. The goal of treatment, for example, for viral hepatitis is to get rid of the virus, prevent the transition to the chronic phase and the development of liver cirrhosis, and eliminate the risk of infecting loved ones.

Nutrition for adult jaundice should be based on the consumption of proteins, B vitamins, iron: poultry, fish, eggs, dairy products. The diet should include grain bread and dried apricots. Detailed information treatment and diet should be provided by the attending physician, based on diagnostic data. You cannot prolong the disease and self-medicate - this can lead to the development of serious consequences, from which only a liver transplant can save you - a very expensive operation.

Treatment of jaundice in young children

Considering that many “adult” treatment methods cannot be applied to infants, phototherapy for neonatal jaundice is one of the most effective ways to combat excess bilirubin. The second name of the technique is phototherapy.

Phototherapy is a physiotherapy procedure that is based on the therapeutic effects of ultraviolet rays that imitate sunlight with a wavelength of 400 to 550 nm. A light wave with such characteristics promotes the conversion of bilirubin into an isomer, which the child’s body can easily excrete along with feces. This will reduce the level of bilirubin in the blood and protect the newborn’s body from the toxic effects of the pigment.

How is phototherapy performed for jaundice?

A completely undressed child should be placed in a box (incubator), his eyes should be covered with a special blindfold or glasses (to protect from ultraviolet radiation), and the genitals should be covered with light-proof fabric (applies to boys). As a bandage, you can use thick gauze in several layers.

The lamp for the treatment of jaundice in newborns is installed at a distance of about 50 cm from the child’s body. It is most effective to use a combination of 4 ultraviolet lamps and 2 fluorescent lamps. Naturally, only a photo lamp for the treatment of jaundice in newborns has a therapeutic effect. During the procedure, breaks of a maximum of 2-4 aces in a row are allowed. However, if the increase in bilirubin levels is pronounced, phototherapy should be continuous.

The average duration of the course is 96 hours. After every hour of irradiation, it is recommended to change the position of the newborn’s body: lay him on his back, on his stomach, on his side. Body temperature measurements are taken every 2 hours to avoid overheating.

In this case, we are not talking about stopping breastfeeding - on the contrary, it must be continued, since mother’s milk helps to quickly remove bilirubin from the blood. Therefore, it is necessary to put the newborn to the breast quite often, taking breaks from the physical procedure. If for certain reasons the baby cannot be fed from the breast, the mother needs to pump and feed the baby from a spoon or bottle. Phototherapy suggests that the daily amount of fluid needed by a newborn should be 10-20% greater than the physiological need.

Every day (if there is a risk of developing encephalopathy - every 6 hours), take the newborn’s blood for a biochemical analysis in order to monitor the effectiveness of treatment.

Indications for phototherapy

A phototherapeutic irradiator for the treatment of neonatal jaundice is recommended for:

• the risk of developing hyperbilirubinemia detected during pregnancy;
• morphofunctional immaturity of the newborn;
• the presence of extensive hemorrhages and hematomas;
• complex of resuscitation measures;
• physiological jaundice;
• hemolytic disease in case of incompatibility with the mother’s blood group;
• an increase in bilirubin above 5 µmol/l per hour (for full-term newborns) or 4 µmol/l per hour (for premature infants).

Indications for phototherapy in the first 7 days of life, depending on the level of bilirubin and weight: less than 1.5 kg of weight, 85-140 µmol/l bilirubin, 2 kg and 140-200 µmol/l, 2.5 kg and 190-240 µmol /l, more than 2.5 kg and 255-295 µmol/l.

Phototherapy is stopped if there is a decrease in the level of total bilirubin in the blood, and the level of free bilirubin does not increase. The therapeutic procedure in this case is considered complete and successful.

It is important to list contraindications to phototherapy: high levels of conjugated bilirubin, impaired liver function, obstructive jaundice. You also need to know that a lamp for jaundice in newborns can provoke a number of adverse reactions that do not affect the general condition of the newborn. These are, in particular: dry and flaky skin, frequent bowel movements, drowsiness, allergic rash, bronze coloring of the skin.

Glucose for jaundice in infants

According to modern medical statistics, physiological jaundice is diagnosed in 60% of newborn babies. main reason- excess concentration of a pigment called bilirubin in the child’s blood. Jaundice in most cases manifests itself on the 2-3rd day of life in the form of characteristic staining of the skin and mucous membranes, and disappears by itself on the 7-10th day.

Is it necessary to use and how to give glucose to a newborn with jaundice in such situations? This question is quite controversial. Transient jaundice, not accompanied by health problems, does not require treatment. However, if signs of intoxication are noticeable (lethargy, weight loss), specific therapy is critical. Along with the drug, domestic pediatricians prescribe 5% glucose for newborns.

If we take into account the opinion of doctors from the American Academy of Pediatrics, they claim that 5 percent glucose for newborns with jaundice is not able to reduce the content of bilirubin in the blood. US pediatricians say that best prevention and one of the ways to treat jaundice (in combination with others) is to frequently put the newborn to the breast. Colostrum and first milk can activate the processes of removing bilirubin from the body. At the same time, adding glucose, according to American pediatricians, can provoke stool retention, thereby only aggravating the problem.

Ultimately, you should trust your doctor - he can prescribe glucose intake based on diagnostic data and the general health of the newborn.

Conventional wisdom calls for jaundice to be considered a disease, however, this is not entirely true. Jaundice (jaundice) is a set of symptoms indicating a disease.

Treatment of jaundice is mandatory, including at home; a set of measures is provided for this. But first you need to establish the reasons for its appearance.

in adults it occurs when bilirubin accumulates in the blood and tissues. Bilirubin is the main component of bile, which is formed as a result of the natural destruction of red blood cells that have served their purpose. The latter help move oxygen and carbon dioxide throughout the body.

Bilirubin itself is a toxic substance, and the liver is responsible for processing poisons in the body. When the liver's processing of bilirubin is impaired, jaundice occurs. It is called true and in this case treatment is prescribed.

But false jaundice also happens - for example, it occurs when eating bright yellow or orange foods in excessive quantities. Carotenes (pigments) accumulate in the body, which give the skin a jaundiced color. Treatment of jaundice in adults should be timely, including treatment of concomitant diseases.

Principles of treatment of jaundice

Features and principles of treatment of jaundice in adults are that therapy carried out at home depends on several factors, primarily on the type of jaundice:

• - occurs in adults due to the development of any pathologies (among them - a decrease in hemoglobin in the blood, lymphocytic leukemia, tropical malaria, etc.);
• - associated with liver damage and often develops against the background of and;
• - occurs due to a violation of the passage of bile against the background of the formation of stones or tumors.

The doctor makes a decision on how to treat jaundice in adults depending on the intensity and duration of the disease. The results of blood tests (for the presence of hepatitis, including), urine and feces are important for treating adults at home.

An ultrasound of the internal organs is prescribed, and in difficult cases, additional studies - endoscopy, computed tomography, and sometimes a liver biopsy for the correct treatment of jaundice in adults.

Therapy carried out at home should be aimed at preserving the liver, preventing cirrhosis, and also protecting others from infection with viral hepatitis. Common treatments for jaundice:

• diet therapy;
• taking medications to boost immunity, relieve itching, and in some cases painkillers;
• taking vitamins and hepatoprotectors;
• plasmapheresis - blood purification and filtration;
• phototherapy - exposure of pigment to ultraviolet light.

Nutrition

Comprehensive treatment of jaundice at home in adults prescribed by a gastroenterologist includes, first of all, diet.

The diet should be high-calorie, balanced, consisting of dishes that will not harm the liver. Food should only be eaten fresh and warm. The patient's diet must contain sufficient amounts of protein, vitamin D (found in meat and animal products) and iron.

You need to eat at home often in small portions, at least 5 times a day. A diet is prescribed for the treatment of jaundice in adults, which consists of three stages.

The first stage (about two days) involves the consumption of glucose solution, fruits, sweet compotes and tea. Due to the intake of glucose, processes in the liver cells are normalized. Solid food is not recommended during this period; liquids help remove toxins from the body.

The second stage (about a week) involves the inclusion of vegetable broths and cereals, as well as a small amount of solid food, in the diet.

The third stage (until recovery) allows you to eat dietary foods allowed for liver diseases.

What can be done during the treatment of jaundice in adults:

• dry bread, crackers, biscuits;
• vegetable and cereal soups, stewed vegetables and cereals;
• lean meat, poultry and fish only boiled or baked, steamed cutlets;
• low-fat milk, kefir and cottage cheese, casseroles and puddings made from them, hard cheeses;
• sweet compotes, jelly, marmalade, jam, caramel.

When treating jaundice at home in adults, consumption of fresh berries - raspberries and strawberries, herbs - dill and parsley is encouraged.

What is not allowed during the treatment of jaundice in adults:

• canned food, smoked food, pickles and marinades, fried foods;
• fatty meat, poultry and fish, broths made from them;
• spices, chocolate, herbs, coffee, alcohol (under especially strict prohibition);
• legumes, radishes and radishes, mushrooms;
• fresh bread, cream cakes, pastries.

Medication support

When answering the question of how to treat jaundice at home in adults, we must not forget about medications in addition to diet.

1. Etiotropic (eliminating the cause) therapy - a medicine for jaundice in viral hepatitis (lamivudine) and (antiviral drugs based on sofosbuvir, daclatasvir; ribavirin, interferon), for an inflammatory process in the gallbladder - antibacterial drugs.
2. Improving digestion - taking enzyme preparations (Creon, Pancreatin, etc.).
3. Vitamins A, K and D.
4. Boosting immunity.
5. Increasing the concentration of active acids, reducing the synthesis of cholesterol in the liver - (ursodeoxycholic acid - UDCA).
6. Relieving skin itching (antihistamines).
7. Strengthening the exchange (Essentiale, Heptral, etc.).
8. Antispasmodics in case of obstructive jaundice (No-spa, Dibazol, etc.).

Treatment for the disease in adults includes IVs and medication injections. These manipulations belong to classical drug therapy.

Phototherapy

Drug support for treating adults at home will be effective in conjunction with phototherapy sessions for jaundice. During such sessions, under the influence of ultraviolet rays, the pigment is destroyed and the patient feels better.

Phototherapy uses ultraviolet lamps to treat adults. Bright sun rays can also have a positive effect.

The procedure is used for treatment. However, phototherapy is also deservedly popular in the treatment of jaundice in adults.

The lamp for the treatment of jaundice in adults has an optimal radiation spectrum; as a result of its exposure, bilirubin acquires a water-soluble form and becomes non-toxic.

Unconventional methods of treatment

Folk, non-traditional methods for treating adults at home can alleviate the patient’s condition during the attenuation of the disease or during the course of chronic jaundice. However, you need to know how to treat jaundice at home using unconventional methods.

Juice therapy

Usually beet juice is used with the addition of a few drops of lemon. Squeeze the juice from bright burgundy fruits, without veins, and let the drink sit in the refrigerator for about 3 hours. Every morning take about 100 g of juice. Pumpkin juice is useful; it is recommended to take up to 200 g per day.

Healing herbs

A good way to cleanse the liver of toxins is to collect herbs - mint, yarrow and chamomile. Mint is a medicinal, essential oil plant, and is a choleretic and analgesic. The phylloquinones contained in yarrow actively dissolve fats. Pharmaceutical chamomile relieves internal swelling, spasms and inflammation.

Sauerkraut brine

Horseradish root

The plant itself and its root are extremely rich in vitamins B and C. It contains a lot of potassium, calcium, and contains essential oils. The crushed root is poured with a liter of well-boiled water. Insist for a day, during the day you need to drink a glass of tincture, dividing its contents into 4 parts.

Lice

Treatment with lice for jaundice has been known for a long time. The lice are rolled into bread crumbs and eaten; recovery, according to reviews, occurs quickly. Evidence-based medicine does not consider this treatment method effective. Moreover, lice are carriers of various infectious diseases: eating them can be unsafe.

Prevention of jaundice

Preventive measures against are simple and accessible to everyone at home. They help avoid the use of conservative therapy for jaundice.

1. Maintaining personal hygiene and leading a meaningful, healthy lifestyle. An image that does not allow the use of suspicious, harmful substances, or close contacts with unfamiliar people.
2. Foods eaten daily require attention. Vegetables and fruits should be washed well. For drinking, use only boiled water; tap water is prohibited.
3. Modern disinfectants work well in large crowds. They are used to wipe hands, work surfaces, and office supplies.
4. Vaccination - famous modern way fight against hepatitis causing various... Vaccination against jaundice (from,) guarantees no risk of getting hepatitis for 5–10 years.
5. Be careful when visiting tattoo and piercing parlors. Listen to feedback regarding the work of these establishments and observe the manipulations and hygiene of employees.
6. Be careful during sexual intercourse and use protective equipment with people whose past is little known.

Useful video

For more information about jaundice, watch the following video:

Conclusion

1. Jaundice is not considered a disease in in every sense words. Jaundice is a syndrome or a set of any disease that causes it.
2. To understand how to treat jaundice in adults, you need to determine the reasons that caused it. To do this, you need to undergo a comprehensive examination at a medical institution. When the results are received, treatment of jaundice begins.
3. The main component of treatment is diet, which requires taking medications, phototherapy and, if desired, traditional methods of getting rid of jaundice. All these measures, applied at home, together will lead to complete recovery (except for chronic hepatitis B).
4. Preventing the disease in adults is much more important: for this purpose, special preventive measures have been developed that are available to everyone.

Jaundice in an adult is manifested by a specific icteric appearance of the skin and mucous membranes. Often the outer layer of the eye (sclera) is also involved in the process. This symptom can be a companion to various diseases.

The main cause and types of jaundice in adults

The change from normal skin color to jaundice is a consequence of a violation of pigment metabolism, in particular bilirubin, a substance formed during the breakdown of red blood cells. accumulates in the blood, poisons the body and colors the skin in characteristic color tones.

Doctors use pathogenetic (according to the mechanism of occurrence) and clinical classification of jaundice.

This stands out:

• prehepatic(suprahepatic) jaundice – hemolytic, resulting from blood diseases);
• hepatic(parenchymal) – develops as a result of liver disease;
• subhepatic(mechanical) – in which there are obstacles to the removal of bilirubin from the liver.

Each type of jaundice is characterized by the most typical shades of color on the skin:

• yellow with the addition of reddish - appears with hepatic variants of jaundice;
• yellow with lemon tones - characteristic of blood diseases against the background of hemolysis (breakdown of blood cells);
• dark green – characterizes the presence of mechanical obstacles to the outflow of bile.

What conditions and diseases cause jaundice in adults

To correctly understand the mechanism of development of jaundice, it is necessary to establish the causal relationship of the main forms of this condition.

Suprahepatic Jaundice is the result of the process of decomposition and breakdown of red blood cells. It leads to an increase in the content of bilirubin in the blood, the “utilization” of which the liver is not able to fully cope with.

note: Bilirubin consists of two main types. First - free(indirect, insoluble, unconjugated) toxic complex that is associated with blood proteins and circulates freely in the bloodstream. Second - unfree(direct, soluble, conjugated), formed by binding in the liver cells of the first type with glucuronic acid. It is not poisonous and is released into the intestines as part of bile.

In the suprahepatic variant of jaundice, the increase in total bilirubin is caused by an increase in free bilirubin, since liver cells cannot cope with its binding. This toxic substance leads to poisoning of the body.

The main type of diseases that cause suprahepatic jaundice is hemolytic anemia (when blood cells are destroyed): familial hemolytic jaundice, thalassemia, sickle cell anemia, etc.

Some autoimmune processes lead to hemolysis.

Hepatic jaundice is caused by damage (alteration) of liver cells (hepatocytes) and intrahepatic bile capillaries. The process of destruction of hepatocytes is accompanied by an increase in the content of total bilirubin in the blood, against the background of an increase in free bilirubin.

The development of hepatic jaundice is caused by:

• infectious (acute and chronic forms);
• of various etiologies;
• in the liver against the background of chronic alcohol poisoning, other toxic and medicinal lesions;
• (hepatocellular) liver;
• autoimmune diseases that damage liver tissue.

Subhepatic jaundice develops when there is a violation of the outflow of bile from the intra- and extrahepatic bile ducts. This disorder provokes a mechanical obstruction in the path of bile secretion (blockage, obstruction).

Obstructive jaundice gives characteristic changes in... The level of bilirubin increases mainly due to the direct fraction. The indirect form may be within normal limits, or slightly increased. Bilirubin is also detected in urine.

Diagnosis of diseases leading to jaundice

When determining the cause of jaundice, patients undergo an examination, which begins with an examination and interview with a doctor.

Additionally assigned:

Symptoms of jaundice in adults

The picture of the disease depends on the underlying disease and complications leading to the development of jaundice. But at the same time, a number of similar symptoms characteristic of jaundice can be identified. These include:

• an increase in body temperature that is not relieved by antipyretics;
• frequent, loose stools;
• dark urine, discoloration of feces due to infectious hepatitis;
• itchy skin sensation;
• general weakness due to intoxication, which is accompanied by and;
• (constant, or paroxysmal) in the right hypochondrium, weight loss;
• decreased appetite, bitterness in the mouth;

note: The clinical picture can be supplemented by specific symptoms characteristic of specific diseases that caused the patient’s jaundice.

Directions for treating diseases with jaundice in adults

The choice of treatment plan depends on the underlying disease that caused the jaundice and the severity of the patient’s condition. In this case, the need for inpatient treatment (in a therapeutic or surgical department) or the possibility of outpatient therapy is determined.

Patients undergo:

• Detoxification treatment– prescribed for acute forms of pathology accompanied by severe intoxication. The duration and volume of infusion therapy is decided individually, based on the patient’s condition and laboratory diagnostics (especially in infectious hepatitis, acute and chronic alcohol poisoning, drug-induced liver damage, drug complications).
• Treatment– indicated in cases of infectious bacterial causative factors leading to jaundice. It is necessary to carry out a previous determination of the sensitivity of microbial flora to antimicrobial drugs. Compliance with treatment regimens, high doses and concomitant antifungal therapy is very important.
• For diseases that lead to jaundice against the background of damage to hepatocytes, a positive effect is given hepatoprotectors, protecting and restoring liver tissue.
• Anemia in most cases requires hematotherapy(natural blood and its preparations, as well as plasma transfusions and blood substitutes).
• The oncologist chooses the treatment tactics for the neoplastic process (surgical treatment, chemotherapy, radiotherapy).
• Surgery– indicated in the presence of a large number of large stones in the gall bladder and ducts. Plastic surgeries are performed for anomalies of the biliary tract and after complications due to a previous intervention. Sometimes a liver transplant is used.
• Immunotherapy.
• In severe cases - therapy hormonal drugs.

Traditional medicine and jaundice in adults

Treatment with traditional medicine during the acute icteric period is ineffective; it should be used in the attenuation phase of the disease and in chronically ongoing processes between exacerbations.

Complications of diseases that cause jaundice in patients

The manifestation of jaundice can essentially also be attributed to complications of diseases. And the consequences that may occur against the background of existing jaundice may be different.

Most often, pathologies occurring with jaundice often lead to:

• anemia;
• chronicization of the main process;
• development of benign and malignant processes;
• acute and chronic liver failure;
• shock, against the background of pain;
• hepatic encephalopathy;
• death in severe cases.

Diet for jaundice and prevention of its occurrence

In hospitals, patients suffering from diseases with icteric manifestations receive dietary food No. 5 according to Pevzner.

The diet includes:

During illness you should avoid:

• all types of conservation;
• fatty foods (meat and dairy, fish);
• fried foods, which are strictly contraindicated for jaundice;
• chocolate, cocoa, coffee, pastries, seasonings, spices;
• any types of alcohol.

Forecast and prevention of jaundice in adults

The outcome of the disease accompanied by jaundice depends on the cause, form and severity of the process. With properly organized treatment, in most cases it is possible to cure the patient or significantly improve his condition.

For preventive purposes, in order to avoid the development of jaundice, it is necessary to promptly seek advice from a specialist. For chronic diseases, follow the regime and dietary guidelines.

Lotin Alexander, medical columnist