Consequences of jaundice suffered in childhood in women. What conditions and diseases cause jaundice in adults

Jaundice in newborns is not just often - but it happens almost always. Any mother will easily notice the first symptoms. The baby becomes unusually swarthy or as if filled with yellowness, the whites of the eyes turn yellow. What is it - a disease or a feature small child? This will become clear later, after a few days of observation. Most often, there is no reason for concern, this condition is due to some physiological characteristics of the body of a newborn child.

Why does jaundice appear?

Bilirubin is primarily to blame here.. What is it and where does it come from? Everything is pretty simple. A child who has not yet been born has special blood with special (fetal) hemoglobin. It transports oxygen blood vessels baby. When a baby is born, it begins to breathe with lungs. And then the composition of the blood changes: “live” hemoglobin appears in it, and fetal hemoglobin is destroyed. This is where bilirubin is formed. The child does not need it, and the small organism begins to get rid of it.

For a child, this is a very difficult task. Just like that, bilirubin cannot be removed. First, it enters the liver and mixes with special enzymes there, then it dissolves in the urine and even then it is easily excreted. If the liver fails and there is a lot of bilirubin in the blood, jaundice will begin.

Causes of pathogenic jaundice are completely different. They are most often caused by a violation of the outflow of bile from the body due to the following conditions:

blood type incompatibility;
Rhesus conflict;
viral damage to the liver;
genetic disorders metabolism;
hereditary diseases;
hormonal disorders;
mechanical damage to the biliary tract or liver.

VIDEO:

Norm of bilirubin

In the blood of a newborn baby, bilirubin should be from 8.5 to 20.5 µmol / l (micromoles per liter). The unit of measurement is quite complicated, but you can not delve into it. If it’s really interesting, the blood test takes place at the molecular level. If the results of the analysis show that the content of bilirubin is slightly higher than normal, the doctor understands that the baby's body does not have time to cope with the load. True jaundice occurs when the bilirubin level exceeds 35 µmol/L.

And yet it is different...

Why jaundice appears is already clear. And why in general there are difficulties with a conclusion of a bilirubin? Could this be a sign of pathology? Unfortunately yes. Doctors distinguish between two groups of jaundice - physiological and pathological. Consider all types of jaundice from the rarest to the most common.

Pathological types of jaundice

They are rare, but require mandatory medical supervision and treatment. With pathological jaundice, there is always additional symptoms. Some may be noticed by the mother or one of the relatives, others are recognized only by the doctor.

Hemolytic disease

Among all babies who develop neonatal jaundice, less than 1% are suffering from hemolytic disease. Her reasons:

Rhesus conflict between mother and baby (most often);
blood type mismatch (very rare);
antigen incompatibility (almost never occurs).

However, such jaundice is quickly recognized. The skin and sclera of the baby do not turn yellow in a few days, but almost immediately after birth. The child looks lethargic and sleepy. The doctor, examining the baby, will feel an increase in the spleen and liver. All these signs show that the newborn urgently needs help, and then the doctors begin to immediate treatment. The most severe case is kernicterus., in which bilirubin poisons the baby's brain.

Mechanical jaundice

Rare, but still pathological. There are several reasons for obstructive jaundice:

gallbladder problems;
violation of the patency of the bile ducts;
liver problems.

Most often, obstructive jaundice is caused by genetic disorders or birth injuries of the baby. The manifestations of this disease become noticeable when the baby is two to three weeks old. The skin at the same time looks not just yellow, but with a greenish tint. The baby's stool becomes abnormally light, almost colorless. The doctor will feel that the liver is thickened, and the spleen is enlarged. If obstructive jaundice is suspected, different additional examinations such as ultrasound. Treatment will depend on the type of pathology..

There are also border states when prolonged postpartum jaundice turns into pathology:

Conjugative jaundice associated with poor liver function. Liver enzymes do not bind bilirubin well and cannot cope with its removal from the blood.
Nuclear jaundice occurs with a sharp increase in the level of bilirubin during postpartum jaundice. In this case, bilirubin penetrates the nervous system and exerts its influence on it. toxic effect.
Hepatic jaundice appears when liver cells are damaged by viruses or bacteria.

Physiological jaundice

Now all doctors have recognized that this is not a disease, but one of the options for the normal state of a newborn child. However, even in this situation, the baby must be carefully monitored so as not to miss possible pathologies.

Breast milk jaundice

Another rare case. It occurs when a mother has a lot of estrogen in her milk (this is a female sex hormone). Then the baby's liver first of all begins to remove estrogen, and only then - bilirubin. In this case, the baby remains icteric for up to three months.. At the same time, the baby develops perfectly - he has a good appetite, sleep and weight gain and height. This condition is not dangerous and goes away on its own.

If a baby develops jaundice of breast milk, mothers often ask: isn't it better to wean the baby from the breast? There can be only one answer: no better! Yes, without breast milk, the baby will stop “turning yellow”. But how many useful and important things will he miss out on? So that breast-feeding need to continue.

neonatal jaundice

And finally, the most common type. This is jaundice, which appears in most children.. It is not a disease and does not require treatment. Such jaundice of newborns passes by itself and does not lead to complications. True, there is another view: if jaundice has appeared, then the baby’s liver is still overloaded. But the baby can be helped.

Symptoms

The main and indicative symptom of any type of jaundice is a change in the color of the skin and mucous membranes, the whites of the eyes. They become bright yellow, almost lemon in color.

When more than two weeks pass, and the baby's skin has not acquired a normal color, you should consult a doctor. Before treating jaundice, an analysis will be prescribed for the level of bilirubin in the blood. The level of bilirubin depends on many factors and it is impossible to unambiguously interpret the results of the tests. The doctor will make conclusions about the state of health of the child according to big picture health status.

Symptoms pathological species jaundice manifests itself in a change in color skin. The differences are in the time of their appearance and some features of the manifestation:

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change in skin color appears immediately after birth;
in three or four days yellow becomes brighter, all symptoms increase;
yellowness of the integument persists for more than one month;
the onset of symptoms of jaundice is undulating: it will appear, then it will disappear;
in addition to yellow, skin color can also acquire a green tint.

In addition to the change in the color of the skin, other symptoms are added:

feces are discolored;
urine is dark in color
spontaneous bruising;
there is an increase in the liver and spleen;
the general well-being of the child is deteriorating.

With nuclear jaundice, the sucking reflex fades, severe drowsiness and convulsions occur.

If we are talking about pathology, then any therapy is prescribed by a doctor. Most often, the baby and mother go to the hospital, where they spend all necessary procedures . For example, if the mother and child have a different Rh factor or other signs of blood incompatibility, then transfusions are most often prescribed. In one procedure, the baby can replace up to 70% of total blood. AT difficult cases transfusions are repeated several times.

These measures help to get rid of pathological bilirubin, but can weaken the baby. Therefore, it is often prescribed complementary therapy: antibiotics, physiotherapy and so on.

Obstructive jaundice often requires surgical intervention. A well-founded decision is usually made by a whole commission of doctors who carefully examine the child and determine all necessary measures. Such treatment and rehabilitation are also carried out in a hospital setting.

If the jaundice is physiological, then it is more likely not about treatment, but about helping the baby. The child will cope with his condition faster if:

attach the newborn to the breast as early as possible (this stimulates metabolic processes);
full breastfeeding;
diet of a nursing mother so that the baby does not have digestive problems;
sunbathing;
walks in the open air.

The last point, unfortunately, cannot be fulfilled if it is cold outside. But in spring, summer or in warm autumn, take the baby to Fresh air is a must. In summer, in calm sunny weather, you can open children's arms and legs for a few minutes. This is especially useful in a light shade - for example, under a tree, so that diffused light hits the child. The main thing is that the baby does not freeze.

Such care for the newborn will perfectly help to remove bilirubin from child's body. As a result, the baby will not only have jaundice. The child will also become healthier and feel better.

The main way to treat and prevent neonatal jaundice is breast milk. That is why the newborn is applied to the breast from the first minutes. Colostrum (the first portions of breast milk) has a pronounced laxative effect. It promotes the excretion of a coloring matter (bilirubin) along with feces. Breastfeeding here the best medicine from jaundice.

Sometimes in addition to breast milk prescribe irradiation with a special lamp for the treatment of jaundice - phototherapy. During the procedure, the child's eyes are covered with a bandage or goggles and placed under a lamp. The course is 96 hours.

jaundice treatment lamp

During phototherapy, you may experience side effects. The child may develop drowsiness, the skin begins to peel off and there is a disorder of the stool.

Sunbathing has the same effect. The baby's body in the light begins to actively produce vitamin D. It speeds up the process of removing bilirubin from the blood.

With severe jaundice, glucose and activated charcoal tablets may be prescribed by the doctor. Glucose helps to improve the active functioning of the liver. Activated carbon absorbs like a sponge harmful substances including bilirubin. Further, coal, together with bilirubin, is excreted naturally with feces.

The doctor develops a method for treating pathological types of jaundice depending on the diagnosis. All factors and circumstances of the birth of a child are taken into account. The course of childbirth and pregnancy, mother's diseases, the results of tests and ultrasound. Sometimes consultation of narrow specialists is required; surgeon or endocrinologist.

Used in the treatment of jaundice different types therapy:

Antiviral.
Antibacterial.
Choleretic.
Detoxification.
Immune.

They are used both individually and in combination under close medical supervision. It depends on the causes of jaundice.

Consequences and problems

At pathological conditions It is impossible to predict how quickly the baby will recover. First of all, it all depends on the causes of the disease and its severity.. That is why it is especially important to observe the baby in the first days of life. What to pay attention to?

Jaundice arose a few hours after the birth of the baby (blood conflicts are possible).
The child develops poorly, he is sleepy and lethargic (a significant excess of bilirubin in the blood, including with hemolytic disease).
Jaundice is accompanied by convulsions, constant crying (this may be kernicterus). With such a diagnosis, the child may develop hearing impairment, motor pathologies, in the most severe case, the baby may die.
The newborn has birth trauma.

As soon as the newborn has jaundice, careful observation is necessary to prevent the development of pathologies. If the treatment is carried out on time, the baby will recover very soon and will grow up healthy..

Physiological jaundice does not cause any complications. It can last two to three weeks. Most babies get rid of jaundice when they are one month old. If the cause is in the mother's milk, then the condition may drag on for another one or two months. After that, the skin and eyes of the baby are completely freed from the yellow tint. All this time the child is fully developed. The main thing for him is the care of his mother, relatives and doctors. And then the baby will grow up healthy and happy.

Physiological jaundice in healthy children does not harm the body, does not affect further development child. Pathological jaundice increases the risk of occurrence and development of cirrhosis or liver cancer with age. In 90% of children who have had hepatitis in infancy, the consequences of jaundice remain for life. This is expressed in a weakened immune system and poor liver function.

Transferred nuclear jaundice in the future can lead to deafness, complete or partial paralysis, mental retardation. The toxic effect of high levels of bilirubin on the nervous system has the most severe consequences.

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Jaundice is a symptom, not an independent disease. Doctors came to this conclusion a long time ago.

Therefore, it is necessary to deal not with the elimination of yellowness of the skin, but with the causes of this phenomenon. Among them, cholecystitis and cirrhosis of the liver can be especially noted.

Jaundice can also occur due to damage to the liver, which can be mechanical or chemical. Often this symptom occurs due to a blockage. biliary tract and disorders of the gallbladder.

The most serious consequence of jaundice is the destruction of liver cells. In addition, with this disease, the removal of waste blood from the body is disturbed. Often there are problems with cardiovascular system or digestive organs.

Timely determination of the cause of jaundice will lead to a quick recovery of the patient, and without any serious consequences. To take the load off this vital important body must also adhere strict diet. If these requirements are not met, mass death of liver cells can occur. The most successful relief from jaundice usually occurs on early stages illness.

Why does the symptom appear?

The main causes of jaundice are viral infections. Also this phenomenon can occur due to various pathologies of the liver and biliary tract.

Symptoms in adults occur when there is a violation of the outflow of excess bilirubin from bile and the development of liver dysfunction. Thus, bilirubin enters directly into the bloodstream. This leads to yellowing of the skin and mucous membranes. The patient also complains of severe itching.

Jaundice can result from the rapid breakdown of red blood cells. It also often occurs as a reaction to certain medications.

With unexpressed symptoms of jaundice, the color of urine practically does not change. When jaundice becomes apparent, urine may turn bright yellow or dark brown.

Consequences for adults

The most common consequences of jaundice in adults are complications in the gallbladder and damage to liver cells. The lack of patency of the biliary tract leads to liver dysfunction. Thus, she is no longer able to remove bilirubin from the body.

Lack of proper treatment is accompanied by the development of hepatitis, hepatic coma as well as diseases bile ducts. The appearance of jaundice leads to indigestion.

Fats, others nutrients and vitamins are simply not absorbed by the body. Long-term persistence of jaundice can lead to such phenomena as diarrhea, constipation, nausea, pruritus, skin rashes and flatulence.

With jaundice caused by viral hepatitis, the patient may develop fibrosis, cirrhosis, and liver cancer. Inflammatory process in the gallbladder, if left untreated, often leads to the development of a chronic disease of this organ. This is expressed in the formation of sediment, stones, sludge and other problems.

Jaundice in pregnant women in the early stages of pregnancy is a serious danger to the unborn child. Another dangerous consequence may be the development of liver dystrophy. In men and women, the consequences of jaundice are also expressed in a weakened immune system and a possible relapse of the disease.

Seeing a doctor when the very first symptoms of jaundice develop will protect you from many diseases of the liver and gallbladder. You can also prevent their complications.

Consequences for children, infants

In infants, jaundice is manifested in the form of staining of the skin and mucous membranes in a bright yellow color. This disease occurs in many newborns. It requires careful medical supervision of the baby so that jaundice does not turn into a pathology with serious consequences.

In most newborns, jaundice is a physiological phenomenon. It often resolves naturally without treatment or complications. But in certain cases pathological jaundice develops. The condition of the baby in this case worsens and he may need medical attention.

Consequences for newborns:

the development of albuminemia due to a decrease in the amount of albumin due to high bilirubin in blood;
toxic poisoning of the body;
development nuclear jaundice, which leads to convulsions, the development of deafness in the newborn and mental retardation;
involuntary muscle contractions and loss of motor control.

If the diagnosis is not made in time and treatment is prescribed, the consequences can be very serious.

Prevention measures

At various forms ah jaundice, you need to constantly be monitored by a doctor who will determine the type of jaundice and prescribe proper treatment. It is important to maintain a healthy lifestyle and avoid alcohol completely. You should also strictly follow a sparing diet and take vitamins.

Conclusion

With the appearance of yellowness of the skin and mucous membranes, it is necessary to look for the causes of this phenomenon.
This symptom can be associated with serious pathologies of the liver, gallbladder, diseases of the cardiovascular system and digestive organs.
The most common consequences of jaundice in adults are gallbladder complications, liver damage, hepatitis, hepatic coma, indigestion, fibrosis, cirrhosis, and liver cancer.
At the first symptoms of jaundice, you should consult a doctor to eliminate the risk of developing serious complications.

Gastroenterologist, Hepatologist, Infectionist

Engaged in diagnostics, prevention and treatment of stomach ulcers, gastritis, hepatitis, dysbacteriosis, diarrhea, esophagitis, pancreatitis, flatulence, constipation, colitis and other diseases of the gastrointestinal tract.

The liver is one of the main organs in the human body. Its main task is to protect and cleanse the body of harmful toxic substances and waste products, as well as to produce bile.

The state of the liver should be given Special attention. If you suspect the development of diseases of this organ, you should immediately consult a doctor. Among the most common problems associated with abnormalities in the liver, there is a disease such as jaundice.

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General description of the disease

First of all, you need to understand what jaundice is.

This pathology is a disease that cannot be overlooked. A sick person has a yellow color of the skin, mucous membranes and whites of the eyes.

This is due to the fact that with some disorders occurring in the body, bilirubin accumulates in large quantities. AT normal condition it is produced by the spleen, it takes part in metabolic processes, and in parallel it exits the body, despite the fact that the normal level indicator remains unchanged.

If the metabolic chain is disturbed, this substance accumulates in the blood, which is why the yellowness of the skin and mucous membranes is formed.

Jaundice is a fairly common disease and is contagious. To prevent this from happening, it is important to know how jaundice can be transmitted in adults and to be extremely careful.

Echogenicity of the liver is increased what is it

Types and symptoms of pathology

Symptoms of jaundice in adults may differ depending on what form the pathology has. The classification of the disease is as follows:

1. Conjugation. In adults, develops as a result of long-term exposure negative factors on the liver, in addition, it can be a consequent complication of a congenital anomaly.
2. Hemolytic. The reason for the formation is a violation of the production of red blood cells and the utilization of bilirubin in the liver. It can act as an independent disease and be a symptom of other disorders of the body. The first signs of jaundice in adults are as follows:

pale skin;
yellow tint of the skin and mucous membranes;
pain in the right side;
reduced level of red blood cells.

Often the symptoms may be similar to those of iron deficiency anemia, - drowsiness, rapid fatigue, headaches, general weakness.

3. Hepatic. It occurs as a result of infection or viral infection liver. Accompanying symptoms:

lemon-colored skin, with time acquires a greenish tint;
stool is light;
appear spider veins on the body, red spots form on the palms;
the liver is noticeably enlarged;
possible pain in the right hypochondrium.

4. Obstructive jaundice occurs as a result of violations of the function of bile excretion. Bilirubin begins to be reabsorbed into the blood. Intoxication of the body occurs, which leads to changes in the color of the skin. Typical symptoms for this form of pathology:

discolored stools, dark urine;
dull pain in side;
skin, eye whites acquire a yellow color, gradually turning into earthy;
severe itching of the skin, which cannot be eliminated with conventional drugs;
nausea, sometimes accompanied by vomiting;
increased body temperature;
rarely, deposits of cholesterol on the eyelids can occur.

Obstructive jaundice

Reasons for development

Experts noted that there are enough a large number of reasons that can provoke this disease:

benign and malignant liver tumors;
complications arising after the operation;
congenital anomaly of the biliary tract;
violations in the functioning of these organs;
adverse effects of certain medications.

Often the development of jaundice can be associated with the defeat of the body with hepatitis A.

The risk group includes people of the following categories:

having sexual contact with an infected partner;
who have been in contact with a family member with jaundice;
who were in a region where there was an increased infection with the virus;
drug users.

How is the disease transmitted?

Due to hepatitis A, jaundice can be transmitted by the fecal-oral route through ingestion of contaminated water or food. provoke given type Pathologies can also cause intestinal infections by multiplying the virus in liver cells and spreading them to other tissues. It is impossible to re-infect with jaundice. As a result of the manifested complications, the nervous system may be affected.

Transmission of the type B virus is carried out mainly by the parenteral (infection through the blood) route. The development of the disease occurs in this case slowly and progresses for a long time. It is possible to transfer it to chronic form or cirrhosis.

Type C virus is also transmitted parenterally. The course of the disease is similar to the second type, however, in almost all cases it becomes chronic and provokes cirrhosis of the liver.

An adult can also become infected with jaundice by getting the virus through the blood. Infection in this way is possible as a result of blood transfusion.

Jaundice in men

In men, the disease proceeds in almost the same way as in women. But the reasons that provoked its development can differ markedly.

Be that as it may, it has long been noticed that men drink alcoholic beverages much more often, which is a direct path to the development of chronic intoxication caused by alcoholism, and after that to the appearance of cirrhosis of the liver. Such a complication can completely destroy the organ, and jaundice is only a concomitant pathology syndrome.

Serious complications include liver cancer. Life expectancy is thus significantly reduced. In only 20 percent of cases, the patient managed to live up to five years from the moment the pathology was discovered. When transplanting an organ, patients live for more than five years. But this happens only in 60 percent of patients who have had such an operation.

Diagnostic Measures

At the initial stage, the pathology may be asymptomatic. In most cases, the patient turns to a specialist already at the stage of the predominance of a yellow skin tone.

Diagnosis begins with the collection of general data: the study of the medical history, the collection of anamnesis. This stage allows you to determine how long ago changes in the body began to occur, the presence of itching and its characteristics, how long it lasts, whether there is a decrease in the patient's weight, what interactions with provoking factors (alcohol consumption, work with toxic substances) can be.

After that, the doctor conducts a physical examination:

hard liver indicates the possibility of a tumor;
subcutaneous deposits of cholesterol are visible;
the presence of spider veins indicates a chronic form of the disease.

Only having studied external manifestations, further pathology studies can be correctly determined:

General blood test and biochemical.
Determination for the presence of antibodies to the virus.
Testing for hepatitis types A and B.
detection of hepatitis C.

To the main methods diagnostic examination relate:

x-ray and endoscopy;
liver biopsy;
CT scan.

Treatment Methods

How to treat jaundice is determined by the attending physician. And only a specialist is able to correctly diagnose the disease.

Under no circumstances should methods be used. traditional medicine. This can cause irreversible consequences.

Treatment of jaundice in adults depends on what provoked the development of the disease. mechanical type pathology suggests drug therapy. Medicines are used to destroy excess bilirubin in the blood. In addition, a phototherapy session is scheduled.

It should be remembered that the cause of the development of pathology can be malnutrition. Thus, the complex necessarily includes a diet correction, a specially designed diet is prescribed, which involves the use of more low-fat foods.

It is strictly forbidden to eat fried and spicy dishes. Boiled, baked products or raw are prescribed for use. During treatment, it is necessary to strictly follow all the doctor's instructions, otherwise the disease may go into a conjugated form.

Preventive actions

It is obvious that after a person has been ill with jaundice, he can lie in wait various consequences. After all, this is not independent disease but only a symptom of other pathologies. That is why the disease is easier to prevent than to deal with its treatment for a long time. Preventive measures include the following:

in order to prevent infection with hepatitis, which is transmitted by airborne droplets, it is necessary to always wash your hands with soap before eating, it is also necessary after visiting the toilet;
vegetables, fruits should also be washed and heat treatment, especially if purchased in self-service stores;
it is better to reduce the use of raw water to a minimum;
contact with the blood of other people should not occur, therefore it is not recommended to use other people's manicure accessories and razors, cosmetic procedures should be carried out only in verified places where sterilization rules are observed;
during sexual intercourse it is better to use a condom, especially for relationships with unfamiliar people;
to prevent jaundice that develops against the background of infectious mononucleosis, you can not use someone else's dishes and it is better to exclude kisses.

Jaundice is a pathology that indicates that violations are possible in the liver and gallbladder.

At the first sign of yellowing of the skin, you should immediately seek medical attention. medical care. Only a specialist is able to correctly determine the cause of the development of pathology and prescribe the correct treatment.

And some secrets...

A healthy liver is the key to your longevity. This body performs a huge number of vital functions. If the first symptoms of a disease of the gastrointestinal tract or liver were noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stool you just have to take action.

Jaundice in adults is a consequence various diseases, which lead to a violation of the excretion of bilirubin and its accumulation in the blood. Translated from French, the term jaundice means "yellow", which clearly explains the main visual sign pathological process, namely, icteric coloration of the skin, sclera and mucous membranes. Jaundice is not a disease, but only characteristic symptom the underlying disease, which is most often associated with liver damage.

Causes of jaundice

To understand the mechanism of development of jaundice and the causes that cause it, one should dwell in more detail on the role of the bile pigment bilirubin in this process. It is formed as a result of biochemical changes associated with the transformation of hemoglobin. First, free (indirect) bilirubin is formed, which is characterized by toxicity, inability to dissolve in water and be excreted from the body. Its molecules bind to blood proteins and circulate freely in the blood.

In liver cells, free bilirubin binds to glucuronic acid molecules and forms a second variety - bound (direct) bilirubin, the properties of which change dramatically. It loses toxicity, becomes water-soluble, acquires the ability to pass the renal filter and is excreted in the bile through the intestines or in the urine.

Problems begin when the process of metabolism and excretion of conjugated bilirubin is disrupted and its level in the blood rises.

What conditions provoke the accumulation of bile pigment in tissues and blood? Doctors distinguish several main areas:

physiological reasons;
viral infections;
sharp and chronic diseases internal organs.

Physiological causes are associated with dysfunction of the liver, gallbladder and bile ducts. The cessation of the outflow of bile from the hepatic ducts or blockage of the biliary tract by a stone causes a violation of metabolic processes and provokes the development of a characteristic symptom.

Infection various types viral hepatitis (A, B, C) leads to damage to liver tissues and yellowness of the skin and sclera. In addition, jaundice may appear as a result of alcohol or drug intoxication of the body, cirrhosis, cholelithiasis, malignant neoplasms or severe autoimmune disease.

Forms of jaundice in adults

There are many varieties of jaundice, some of which occur only in newborns, others occur as a characteristic symptom. serious illnesses. In medicine, a classification has been adopted that takes into account the mechanism of the development of the disease. According to her, there are several main forms of jaundice:

suprahepatic(hemolytic) jaundice- associated with the breakdown of a large number of red blood cells (hemolysis), which leads to a sharp increase in the level of free bilirubin in the blood. It is toxic and if the liver cannot cope with its binding, characteristic signs of intoxication of the body develop. The skin becomes lemon-colored, the severity of symptoms increases as the accumulation of toxic compounds in the blood continues. Hemolytic jaundice is caused autoimmune diseases, anemia, malaria (tropical), lymphosarcoma, poisoning with poisons or toxic drugs, blood transfusion procedure (if the groups do not match).
Hepatic jaundice may be true or false. Yellowness of the skin is considered false if it occurs not due to a disease, but due to the excessive use of products with high content carotene (carrots, citrus).

True hepatic jaundice is caused by damage to the liver parenchyma and intrahepatic bile ducts. At the same time, liver cells (hepatocytes) cannot completely process the incoming bilirubin and part of it enters the bloodstream, causing a characteristic yellowing of the sclera, skin and mucous membranes. The hepatic form of jaundice develops with diseases such as leptospirosis, Infectious mononucleosis, cirrhosis, viral hepatitis, malignant tumors, intoxication of the liver with poisons.

Symptoms of jaundice directly depend on the form and stage of the disease. In some patients, the signs of the disease are subtle, in others they are pronounced and significantly worsen the general condition of the patient. Jaundice may be accompanied by the following manifestations:

At hepatic form the patient complains of lack of appetite, drawing pains in the region of the right hypochondrium, constant nausea feeling of bitterness in the mouth. The skin, whites of the eyes, mucous membranes, palms become yellowish-red, and the body is covered with spider veins. In severe cases, vomiting occurs, appears liquid stool, the temperature rises. characteristic feature Liver damage is discoloration of feces and darkening of urine. Intoxication of the body is accompanied by intense skin itching, weakness and specific symptoms that accompany a particular disease.
Mechanical jaundice has similar symptoms, but in this case the patient's condition worsens with intense, sharp pains in the right hypochondrium, which occur when the bile ducts are blocked. Hepatic colic may not let go for a long time, while the pain radiates to the shoulder, under the scapula and supraclavicular region. The skin on the face becomes yellow-green in color. Skin itching it is so unbearable that the patient can comb the skin until the blood.
Prehepatic jaundice accompanied by intoxication of the body, lemon color of the skin, yellow staining of the sclera of the eyes and mucous membranes. AT laboratory tests blood, there is a drop in the level of hemoglobin (anemia) and red blood cells. The liver and spleen increase in size, which causes constant pain in the right hypochondrium. In severe cases, excess bilirubin can cause damage to the nervous system and increase the risk of dangerous complications.

Symptoms of infectious jaundice are caused by hepatitis viruses. Infection occurs through the blood, biological media or by household means (Botkin's disease).

How is jaundice transmitted in adults?

In fact, jaundice can only be contagious if it has infectious nature and the cause of its appearance are viral hepatitis of various etiologies.

Viral hepatitis A (Botkin's disease)

Hepatitis A is not without reason called "a disease dirty hands", since this type of virus is easily transmitted when there is a violation sanitary and hygienic norms, through contaminated food, unwashed fruits, dirty water.

Incubation period with this disease lasts from 15 to 50 days. During this time, the virus enters the bloodstream, multiplies and, entering the liver, damages hepatocytes, causing symptoms of the disease. The disease usually has an acute onset, sharp increase temperature, nausea, vomiting, the appearance of liquid discolored stools, abdominal pain, pronounced yellowing of the skin and sclera.

Depending on the state immune system, the disease can last about a month. In the future, the body develops immunity, which lasts throughout life. Hepatitis A does not usually cause severe consequences and ends with a full recovery.

Viral hepatitis B

A dangerous and insidious disease that develops imperceptibly, without pronounced symptoms, but often becomes chronic, ending in severe complications (cirrhosis, liver cancer). The virus is usually transmitted parenterally, then father-in-law through contact with infected blood and other biological fluids(sperm, urine). In this case, the incubation period can be 6 weeks, and it can take six months before the first signs of jaundice appear.

Viral hepatitis C

In case of violation of the rules of sterility during medical manipulations, from a sick mother to a child or sexually. This disease is also characterized by long undercurrent, which is not accompanied by severe symptoms. The incubation period ranges from several days to 6 months. Severe forms of hepatitis C are accompanied by cirrhotic lesions of the liver, which cause the characteristic yellowness of the skin.

Diagnostic methods

When a yellow color of the skin appears, it is necessary to consult a doctor as soon as possible and undergo an examination to clarify the diagnosis and find out the cause of the appearance of such a symptom. Main diagnostic methods are:

general and biochemical blood test;
stool and urine tests;
immunological studies for the determination of antibodies to the hepatitis virus;
Ultrasound of the liver, gallbladder, ducts, pancreas;
endoscopic method (FGDS);
fluoroscopy;
MRI or CT of the liver;
liver biopsy.

Liver biopsy is used in exceptional cases, since this method of diagnosis is rather painful and difficult to tolerate by patients. It is prescribed for suspected cancer. During the procedure, a puncture is made in the abdominal cavity, a piece of liver tissue is taken and sent to histological examination.

- most informative method research to determine the form of jaundice. So, with hemolytic jaundice, there is a decrease in the resistance of erythrocytes with an increase in indirect bilirubin. Hepatic jaundice is accompanied by a decrease in the prothrombin index and albumin levels with an increase in transaminases and the level of direct bilirubin in the blood. If obstructive jaundice occurs, a blood test will show an increase in the activity of alkaline phosphatase with an increase in the level of cholesterol and conjugated bilirubin in the blood.

Treatment of jaundice in adults

Therapy methods largely depend on the cause, causing jaundice, its form and severity of manifestations. Most often, a patient with jaundice is hospitalized in a hospital, in mild cases, treatment is carried out on an outpatient basis.

The main directions of treatment of patients with jaundice is drug therapy, the use of physiotherapy methods, surgical intervention(with obstructive jaundice), as well as adjusting lifestyle and following a certain diet that reduces the load on the liver.

With infectious jaundice, the treatment regimen is based on the use of antiviral drugs that destroy the virus. In addition to the main treatment, drugs are prescribed that support liver function and promote the regeneration of its cells. These are drugs based on plant extracts, essential phospholipids, choleretic and anti-inflammatory agents. Botkin's disease (hepatitis A) is a contagious disease, so patients with a similar diagnosis are isolated from others and the necessary treatment is carried out in the infectious diseases departments of hospitals that limit visits.

Used for hemolytic jaundice hormone therapy drugs - glucocorticoids. AT difficult cases resort to removal of the spleen. Obstructive jaundice caused by blockage of the bile ducts or tumor growth is treated surgically. To remove stones, they are currently trying to use endoscopic methods which practically do not cause complications and significantly reduce the rehabilitation period.

Treatment antibacterial drugs prescribed in the case when diseases of an infectious-bacterial nature lead to jaundice. The choice of the drug is carried out by a specialist after determining the sensitivity of the microbial flora to active substance medicinal product. When treating with antibiotics, it is very important to strictly observe the dosages and not interrupt the course of treatment, this is the only way to achieve a positive result.

With concomitant anemia, there is usually a need for hemotherapy, that is, a transfusion of blood, plasma, or blood substitutes. If jaundice is caused by neoplasms in the liver, the oncologist will choose the treatment tactics.

In the process of treating jaundice, not only tablet forms of drugs are used, injections, droppers and other methods are widely used. intensive care. For supporting general condition the patient is additionally prescribed vitamin complexes.

Efficiency drug treatment enhance phototherapy sessions. Application ultraviolet radiation helps to reduce the level of bilirubin in the blood and accelerate its excretion from the body. The procedure allows you to eliminate the characteristic yellowness of the skin. The course of UV treatment is usually 7-8 days.

diet therapy

To speed up recovery and cope with the disease, the patient is recommended a special diet that limits the intake of fat, spicy, fried, high-calorie, heavy foods. This will help relieve the burden on the liver and speed up the regeneration of its tissues. The basis of the diet should be products with high content protein (dietary meat, fish, eggs, low-fat cottage cheese), fruits, vegetables, fermented milk drinks. The diet must contain cereals, greens, vegetable oil, juices, mineral water without gas, green tea, fresh vegetable salads. Dishes are recommended to be steamed, boiled or baked.

Alcohol is completely excluded fast food, smoked meats, pickles, marinades, strong coffee, the use of pastries is limited, confectionery, sweets, chocolate. The attending physician or an experienced nutritionist should tell the patient about all the nuances of the diet.

Possible Complications

The consequences that occur against the background of jaundice can be very different. There is a lot of envy on the nature of the underlying pathology. In some cases, the following complications develop:

anemia;
liver and kidney failure;
chronic hepatitis;
, liver cancer;
internal bleeding;
blood poisoning (sepsis).

Severe complications can lead to death. Therefore, liver health should be given increased attention and follow preventive measures that can prevent the development of dangerous diseases.

Prevention

The risk of developing jaundice and concomitant diseases significantly reduced with the observance of preventive measures. Need to lead healthy lifestyle life, give up bad habits, carefully monitor nutrition and personal hygiene. Do not self-medicate and take medications without a doctor's prescription, as this approach to treatment can cause drug intoxication of the liver. Medicines should be taken in strict accordance with the instructions, avoiding overdose. Persons with severe liver damage (cirrhosis, hepatitis) taking certain medicinal groups should be completely prohibited.

Particular attention is paid to the prevention of hepatitis. To avoid infection with hepatitis A, it is necessary to thoroughly wash fresh vegetables and fruits before eating, drink only boiled water, wash your hands more often, especially after visiting public places and traveling on public transport.

An excellent preventive measure against hepatitis A and B is vaccination. Children are vaccinated against hepatitis in the hospital, in the first days of life. Adults who have not been vaccinated before should get vaccinated themselves and thereby protect themselves from infection. Against hepatitis C, unfortunately, such a measure of protection does not yet exist. But today, the development of a single universal vaccine is underway, which will help form strong immunity from all types of hepatitis after a single injection.

Vaccination against hepatitis is especially needed by people at risk. These include medical and social workers, educators and teachers, workers in the sphere of trade and catering. For those doctors who, on duty, come into contact with blood, biological media, or patients infected with hepatitis, additional vaccination is carried out.

Prevention against hepatitis B and C should be aimed at preventing infection during the visit beauty salons, dental offices, medical institutions where there is a high probability of contact with contaminated blood. Safety measures must also be observed during sexual intercourse, be sure to use barrier contraceptive methods and avoid random connections with unfamiliar partners.

Bilirubin is one of the key components of bile. Most of it is formed during the breakdown of hemoglobin. This process takes place in the liver, spleen, lymph nodes and bone marrow. In an adult, the amount of bilirubin formed can reach 300 mg per day. In the bloodstream, it can be of two types:

Free bilirubin may be toxic to cells. An increase in this fraction indicates an increased breakdown of red blood cells. Due to its physicochemical properties, unbound bilirubin penetrates the lipid membrane of cells, disrupting its basic functions.
Connected which is produced in the liver. It does not have toxic properties and enters the small intestine as part of bile. Most of is absorbed back into the bloodstream along with bile acid, the residue after a chain of chemical transformations is excreted from the body.

Causes

The cause of jaundice is an excess of bilirubin, which can appear with the following pathologies:

True jaundice occurs due to an imbalance between the formation of bilirubin and its excretion.

It is subdivided into the following forms:

suprahepatic, which is due to increased processes of bilirubin formation;
hepatic, the appearance of which is associated with a violation of the capture, binding and release of bilirubin by hepatocytes;
subhepatic, associated with a violation of the excretion of bilirubin in the composition of bile through the extrahepatic bile ducts.

AT pediatric practice there is jaundice in newborns, which occurs due to a change in the fetal type of hemoglobin to an adult. This condition is physiological.

Symptoms

The clinical picture of various forms of jaundice is similar, however, each of them has its own characteristics. Patients are usually concerned about the following symptoms:

yellowness of the skin;
violation of the general condition;
fatigue, irritability;
dyspeptic disorders;
changes in the color of physiological functions.

In addition to the above complaints, the patient may experience discomfort in the projection of the liver and gallbladder associated with inflammatory or oncological pathology.

Diagnostics

For a complete diagnosis of jaundice, in addition to a thorough history taking and examination, it is important to use all laboratory and instrumental methods.

Anamnesis

Questioning the patient allows you to determine:

occupational hazards(contact with rodents, exposure to toxic substances);
family history, allowing to suspect the presence of a hereditary pathology;
the presence of contacts with icteric patients;
injection or surgical procedures (especially blood transfusions) in the previous 6 months;
trips to hepatitis-endemic areas;
reception medicines that can cause the development of jaundice;
the nature of the onset of the disease;
alcohol consumption.

Inspection

During the examination by a specialist, the following signs draw attention to themselves:

icteric color of the conjunctiva, mucous membrane of the soft palate and lips, skin, which is especially well manifested in natural light;
weight loss, characteristic of tumor processes;
at hemolytic anemia pallor of the skin appears;
extrahepatic signs, which include spider veins, reddening of the palms, discoloration;
traces of scratches;
expansion of the umbilical veins;
free fluid in the abdominal cavity.

Palpation

Palpation helps to identify enlarged borders of the liver and spleen, although the size of the organs does not correlate with the stage of the pathological process. In addition to the value, determine:

Availability pain syndrome, which often accompanies acute inflammatory diseases. For chronic pathology pain is characteristic in the active stage of the process.
Tactile liver and spleen of dense consistency, with clear edges.
With blockage of the common bile duct, an enlarged gallbladder can be palpated.

Laboratory methods

Conducting a clinical blood test in patients with jaundice shows:

changes in the number of leukocytes, which decreases with the hepatic genesis of jaundice, increases in the case of a tumor process or cholangitis;
decrease in the number of red blood cells with the appearance in the general circulation immature forms indicates hemolytic anemia;
observed with hepatic jaundice.

AT biochemical analysis blood, the following changes are observed:

the level of total bilirubin rises, a change in its fractions occurs depending on the form of jaundice;
the level of albumins decreases;
markers of hepatocyte damage appear;
the activity of enzymes of the blood coagulation system decreases;
the concentration of free iron increases.

Instrumental diagnostic techniques

The most informative instrumental diagnostic methods include:

ultrasound examination of the abdominal organs;
computed tomography;
laparoscopy;
punch biopsy.

Let's take a closer look at each technique. Ultrasound procedure organs of the abdominal cavity refers to non-invasive methods and allows you to identify:

the exact dimensions of the liver and spleen;
stones in the gallbladder;
the nature of changes in the liver (diffuse or focal);
pathology of the pancreas or intestines;
changes in the patency of the bile ducts and the level of obstruction.

Computed tomography allows for differential diagnosis of subhepatic and hepatic jaundice. In this case, the main criterion will be the diameter of the intrahepatic and extrahepatic bile ducts. In addition to determining the level of blocking the outflow of bile, computed tomography allows you to determine its cause. The most frequent are:

cholelithiasis;
oncological pathology of the head of the pancreas;
enlarged hepatic lymph nodes.

Laparoscopy allows to more clearly visualize the nature of changes in the abdominal organs. Sometimes only this invasive method allows you to establish the level and nature of obstruction of the bile ducts.

You can also use laparoscopy to:

visualize changes in the gallbladder;
see the foci of tumor changes and excise required areas for histological examination.

The efficiency of laparoscopy can be improved by using radiopaque techniques.

Needle biopsy and further histological examination are performed in patients with an unclear diagnosis or when intrahepatic jaundice is suspected. Most often, the manipulation is carried out under the control of computed tomography or ultrasound. In case of violations of the blood coagulation system, a biopsy is done with sealing of the puncture channel.

If the patient's condition allows, then contrast methods are used for differential diagnosis. x-ray examination. They pose a certain danger to the patient (bleeding, bile entering the abdominal cavity), therefore, their implementation is carried out at the final stage of diagnosis in a surgical hospital.

Treatment

The volume of therapy for patients with jaundice depends on the cause of jaundice, the form and course of the pathology. Treatment can be divided into 2 groups:

conservative;
Surgical.

main direction conservative treatment is the effect on the cause of the disease.

Methods of conservative treatment:

therapeutic nutrition that can normalize the outflow of bile;
antiviral therapy;
corticosteroids;
antispasmodics;
hepatoprotectors;
detoxification solutions;
vitamins;
sedative drugs.

In addition to medical treatment, effective ways to combat excess bilirubin are:

plasmapheresis - blood purification from toxic substances;
phototherapy - the transfer of free bilirubin to bound due to the use of blue-violet radiation.

With inefficiency conservative methods treatment is carried out surgical removal causes of jaundice.

Complications

Complications are associated with the progression of diseases that caused the development of jaundice, and the direct effect of bilirubin on the body. The latter include:

toxic encephalopathy;
liver failure.

Young children may have mental retardation.

Prevention

Preventive measures for jaundice are aimed at preventing the diseases that cause it. For this you need:

observe the rules of personal hygiene;
avoid promiscuity;
timely pass preventive examination in the clinic;
limit alcohol consumption as much as possible.

Forecast

The prognosis for patients with jaundice depends on the underlying disease. With timely complex treatment is he favorable. However, the development of kernicterus in newborns, severe oncological or hereditary pathology, viral are factors that make the prognosis worse.

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