Monday, March 12, 2012

Jaundice (icterus)

Jaundice, or icterus (lat. Icterus) indicates a symptom that manifests itself in yellow skin and whites of the eyes, which is due to elevated levels of bilirubin.
The clinical picture is manifested more or less pronounced yellowing of the skin and visible mucous membranes, or something darker urine, and occurs when the serum bilirubin concentration over 30 mmol / l. There are several reasons why serum concentration increases, and why is there an imbalance in the amount of occurrence of bilirubin conjugation and its extraction in the liver and excretion of bilirubin into the intestine.

Yellowing is usually manifested only when the concentration of conjugated serum bilirubin greater than 30 mmol / l, is usually first noticed as yellowing scleral conjugated bilirubin has a higher affinity for the loose tissue, and the faster and more accumulates. Once the long-term persistence of elevated levels of bilirubin that color may be greenish-yellow, which is explained by partial oxygenation of bilirubin biliverdin.

Common Causes of jaundice are haemolytic jaundice, hepatocellular jaundice and obstructive jaundice.

Hemolytic jaundice

This form of jaundice is due to shortened life span of red blood cells and their consequent increase in the dissolution. In the latter case, if the quantity of bilirubin exceeds the capabilities of conjugation in the liver, the bilirubin seum grows, there is a visible yellowing of the skin and mucous membranes, bilirubin in urine is not, but the increased value Urobilinogen in it. In addition to direct signs hemolytic jaundice, in terms of shortening life, there are indirect signs: an increased number of reticulocytes, the increased value of LDH-1 isoenzyme in plasma, a decrease in haptoglobin, anemia, and splenomegaly.

Hepatocellular jaundice

In this form of jaundice skin can be intensely yellow, is more pronounced yellowing of sclera, urine is dark and there is always a bilirubin, stool is normal color. The total value of conjugated bilirubin was significantly elevated seum. With these changes, the clinical picture is dominated by fatigue, weakness, anorexia, dull pain under right rib cage, splenomegaly, hepatomegaly, skin changes in the form of erythema or spider nevi and ascites. This clinical picture is distinctive and almost always indicates acute hepatitis, cirrhosis of the liver and tumorous processes of the liver.

Obstructive jaundice

The name indicates that the main cause of this disease some mechanical obstacle in the flow of bile, and depending on its localization talking about intrahepatalnoj ekstrahepatalnoj or cholestasis. In addition to yellowing of the skin and mucous membranes, the clinical picture we find distinctive changes in the form of yellow: aholi─Źna chair, bilirubin is present in the urine, and often itchy skin.

From this description kratog forms of jaundice and their main characteristics can be concluded that the occurrence of yellowing of the skin and mucous diagnosis should be suspected in several diseases: hepatitis, liver cirrhosis, tumoti liver, pancreas, gall bladder and bile duct, sepsis and malaria. Based on clinical and basic laboratory findings that indicate significant changes in hematological, elevated bilirubin in the urine seum, elevation of transaminases, immunological tests to detect the cause of hepatitis, and all available radiological methods of primary gastrointestinal tract provides a definitive diagnosis, and selects the required medicament or surgical treatment.

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