Jaundice What we need to know

21.02.2024

Jaundice is a condition in which the skin, sclera and mucous membranes take on a yellow color due to high concentration of the bile pigment - bilirubin in the blood. Bilirubin is a breakdown product of hemoglobin. In liver cells, indirect bilirubin bound to albumin is converted into direct bilirubin by the enzyme glucuronyl transferase. Direct (conjugated) bilirubin is a water-soluble substance and is excreted in the intestine with bile.

Jaundice in children and adults often has different causes.

Types of Jaundice

Depending on the stage of bilirubin metabolism, 3 types of jaundice are distinguished:

Prehepatic jaundice It develops when the production of bilirubin exceeds the ability of the liver to conjugate it. At this time, there is an increase in the concentration of unconjugated (indirect) bilirubin in the blood.
Intrahepatic jaundice It is also known as hepatocellular jaundice and is caused by insufficient functioning of liver cells. At this time, the concentration of both direct (conjugated) and indirect (unconjugated) bilirubin in the blood increases.
Posthepatic jaundice It develops during mechanical obstruction of bile secretion. Mechanical jaundice occurs during gallstone disease, obstruction of the bile duct or duct due to various reasons (stone, tumor). During mechanical jaundice, the concentration of conjugated (direct) bilirubin in the blood is particularly high.

Causes of Jaundice

The reasons for the development of jaundice are different at different times:

The causes of prehepatic jaundice are:

Hemolytic anemia
Disturbance of erythropoiesis (erythrocyte formation).
Blood "leakage" developed due to increased permeability of blood vessels in the tissues
estrogens
Gilbert's syndrome
Crigler-Najjar syndrome types 1 and 2
Hyperthyroidism
Malaria
Sickle cell anemia
Thalassemia

Intrahepatic or hepatocellular jaundice The reasons are:

Congenital enzymopathy
Liver viral infections
Liver cancer
Alcoholic liver damage and cirrhosis
Autoimmune liver disease
Medications
Gallstone disease
Intrahepatic cholestasis

The causes of posthepatic jaundice are:

Clogging of the bile ducts with stones
Pancreatic tumor
Gallbladder tumor
Pancreatitis
Biliary atresia

Symptoms

Jaundice may be the only symptom that indicates the presence of this or that pathology. The increase in the degree of jaundice is directly proportional to the severity of the condition.

In addition to jaundice, symptoms related to the causes of jaundice often appear:

stomach-ache
Chills
Dark urine
Itchy skin
weight loss
pathological sleepiness
Propensity to bleeding and bruising
vomiting blood

children

Jaundice in newborns begins a few days or weeks after birth. The yellow color appears first on the face, then it moves to the chest, arms and legs.

If the newborn has other symptoms along with jaundice, it is necessary to consult a doctor in time:

Darkening of the yellow color of the skin
Strong anger
Drowsiness
Insomnia
Withholding food
Decreased urine output
Involuntary eye movements

Causes of jaundice in children are:

Physiological:

Bilirubin accumulates in the process of hemoglobin breakdown. The enzyme system of the newborn's liver sometimes provides conjugation of bilirubin, and hyperbilirubinemia and jaundice develop. If the concentration of bilirubin in the blood does not exceed the critical limit and the clinical and objective data of the newborn are normal, jaundice does not need to be treated.

Rhesus conflict

When the blood group of the mother and the fetus differ, the mother is Rhesus negative and the fetus is positive. The mother's immune system produces antibodies against the fetal Rh factor, which migrate into the fetal circulation, causing hemolysis (breakdown of blood cells), hyperbilirubinemia, and jaundice.

Glucose-6-phosphate dehydrogenase deficiency.

The enzyme glucose-6-phosphate dehydrogenase participates in the functioning of red blood cells (erythrocytes), protecting them from oxidative processes. During enzyme deficiency, oxidative processes take place in erythrocytes, which lead to cell disintegration, release of hemoglobin and an increase in the concentration of its degradation products, including bilirubin, in the blood. The disease has a hereditary nature and is more often manifested in male newborns of African race and Mediterranean countries.

other pathologies

Affected jaundice in children may be detected prematurely or later:

internal bleeding
Sepsis
Viral or bacterial infection
Narrowing or absence of bile ducts
Abnormalities of red blood cells
Cystic fibrosis and others

Risk factors for the development of jaundice in children are:

Babies born before 37 weeks of gestation – the liver's enzyme system is immature and cannot convert bilirubin
The presence of jaundice in biological siblings increases the risk of developing jaundice in the newborn.

Adults

The most common cause of jaundice in adults is a reaction to medications or diseases that cause liver damage.

Causes of jaundice in adults:

Resorption of large hematomas
Hemolytic anemia
Medications: acetaminophen, penicillins, oral contraceptives, chlorpromazine, anabolic hormones.
Viral infections: hepatitis A, chronic hepatitis B and C, Epstein-Barr virus
Autoimmune diseases
Alcoholic liver damage
Genetic metabolic disorders
Gallstones
Cholecystitis
Gallbladder tumors
Pancreatic tumors
Non-alcoholic fatty liver dystrophy.

Diabetes and obesity are among the risk factors. Among the genetic pathologies, Gilbert's syndrome is worth mentioning - when the ability to convert bilirubin is disturbed, Dabbin-Jones syndrome and others.

In adults, jaundice may be accompanied by other manifestations:

Darkening of urine
fever or chills
Clay-like feces
Itchy skin
weight loss
Bloody vomit or stools
Black stools
Severe abdominal pain and soreness
Sudden drowsiness or psychomotor agitation
Spotty-nodular rash on the skin

Diagnosis

Jaundice is diagnosed based on the patient's anamnesis and objective-instrumental-laboratory data.

Bilirubin tests determine the concentration of different forms of bilirubin in the blood. In order to determine the cause of jaundice, it is necessary to perform liver function tests, viral hepatitis tests and, if necessary, imaging studies (ultrasound, CT, MRI). Coagulation tests are also performed, because liver damage is often accompanied by coagulopathy.

Diagnosis in newborns

Within 48 hours after birth, newborns are tested for bilirubin several times, with an interval of 8-12 hours.

A spectrometer is also used, which determines the level of bilirubin by the intensity of the yellow color of the skin.

Diagnosis in adults

Blood Tests:

Determination of bilirubin (total and direct)
Liver function tests (ALT, AST, GGT, ALP, albumin)
Hepatitis A, B, C tests
Laboratory diagnostics of concomitant diseases
Assessment of toxic effects of drugs
Coagulation tests

Visualization:

Abdominal cavity and liver ultrasound examination
Computed tomography
Magnetic resonance imaging

Liver biopsy

It is necessary to study biopsy material in cases of viral hepatitis, consumption of toxic or narcotic substances, as well as during bulky processes of the liver.