Changing the color of the skin or mucous membranes is one of the body's reactions to pathology. Often it indicates changes in the liver or the breakdown of blood cells. Such disorders are manifested by jaundice. This is one of the most common clinical syndromes. Jaundice can develop at any age and indicate a variety of pathologies. In some cases, it is considered normal. However, in diseases, this syndrome serves as an indicator that serious disorders have already occurred in the body. Therefore, it is important to identify the cause of the discoloration of the skin and eliminate it as soon as possible.
The concept of jaundice syndrome
Jaundice is not a type of disease, as many people think. This is just one of the signs of pathology. Moreover, it can develop with a variety of diseases. Among them are infections, cancer, parasitic invasions, genetic disorders, blood loss. To understand what is the cause of this phenomenon, a pathogenetic classification of jaundice has been developed. It is based on the mechanism of development of this syndrome. By understanding how the disorder formed, it is easier for clinicians to find the underlying cause of the pathology.
Jaundice is accompanied not only by external manifestations, but also by changes in the biochemical blood test. This disorder is called hyperbilirubinemia. With a change in the color of the mucous membranes and skin, the level of this indicator increases several tens of times. The level of bilirubin is also the basis for the classification of jaundices. This is another criterion that helps doctors make a differential diagnosis for this syndrome. Jaundice is also classified according to severity and etiology. Only by finding out the cause of the change in the color of the skin, the doctor will be able to prescribe adequate treatment.
Classification of neonatal jaundice by etiology
Most parents note that their baby's skin at birth had a slightly yellowish tint. After a few days, this passes and the child turns pink. This is a completely normal reaction of the body to changes in the environment. This condition is called physiological jaundice in newborns. It develops as a result of the immaturity of the liver and the breakdown of fetal hemoglobin, which is converted to bilirubin. Neonatal jaundice in the absence of diseases disappears on the 10-14th day. However, if there are no changes in skin color, you should think about the presence of a pathology and consult a pediatrician.
Unfortunately, pathological jaundice syndrome is often observed in children in the first months of life. Etiological factors can be as follows:
- Prematurity.
- Diseases of the endocrine system in the mother or newborn.
- Heredity.
- Fetal hypoxia during pregnancy or childbirth.
- Hemolytic disease associated with Rhesus conflict in mother and child.
- The use of certain drugs that adversely affect the baby's body.
Depending on the provoking factor, drug, hereditary, hypoxic and other types of neonatal jaundice are distinguished. Regardless of the cause that caused the development of this syndrome, pathological hyperbilirubinemia requires treatment. Otherwise, an excess of bile pigment can lead to serious brain damage. To prevent this from happening, special conditions must be observed in the hospital.
Newborn jaundice: classification by location
You can track the degree of damage not only by laboratory parameters, but also by clinical data. It is also useful for evaluating the effectiveness of ongoing therapy. For this purpose, pediatrics uses the classification of jaundice according to a 5-point system (according to Cramer). It is based on the localization of the pathological syndrome. The doctor examines the baby and runs along his skin, revealing exactly where there is jaundice. If it is localized only on the mucous membrane of the eyes and face, then this is regarded as 1 point according to Cramer. This means the first degree of severity. With the spread of jaundice on the body, 2 points are set. The next degree is a change in skin color to the elbows and knees of the baby. At 4 points, jaundice extends to the limbs of the child. The extreme degree is considered a change in the color of the skincover of palms and feet.
The more points, the higher the level of bilirubin in the blood. Thanks to Kramer's classification, it becomes easier for a doctor to evaluate the effectiveness of therapeutic measures over time. This helps to avoid the daily blood draw from the baby.
Types of jaundice in adults
For the adult population, there is a special classification of jaundice. It is based on the pathogenesis of this syndrome. According to the mechanism of development, the following types of jaundice are distinguished:
- Suprahepatic. Its pathogenesis is similar to transient neonatal syndrome. The development of suprahepatic jaundice is associated with an accelerated breakdown of red blood cells. Therefore, in another way it is called hemolytic.
- Hepatic (parenchymal) jaundice. It is associated with damage to hepatocytes in acute and chronic inflammatory processes. At the same time, the liver cannot cope with the transport and capture of bilirubin formed in the body.
- Mechanical jaundice. Occurs due to various pathologies. Among them - calculous cholecystitis, pancreatic cancer, parasites. In another way, it is called subhepatic and obstructive. It develops as a result of stagnation of bile.
You can determine the type of pathological syndrome using a biochemical blood test. By the level of free and conjugated (direct) bilirubin. Such a classification of jaundice helps the doctor to navigate and narrow the circle of diseases accompanied by this syndrome. In addition to a biochemical blood test, they perform a CBC, a study of feces and urine, as well as an ultrasound scan.hepato-duodenal zone.
The concept of suprahepatic jaundice
Prehepatic jaundice is the result of the liver not having time to cope with its work and metabolize all the bilirubin formed in large quantities. The reason for its increased production is the hemolysis of red blood cells, that is, their destruction. In most cases, this happens due to congenital diseases of the hematopoietic system. In particular, with hemolytic anemia. This pathology is accompanied by the formation of antibodies to blood cells, as a result of which red blood cells are destroyed. Other causes of hemolytic jaundice can be: massive injuries, poisoning with various poisons. All this leads to the destruction of blood cells.
Hemolytic jaundice can be suspected by the lemon hue of the skin. Most often, such patients are pale due to the presence of anemia. Skin itching and hepatomegaly are absent. Some patients have an enlarged spleen. Urine and feces become darker in color due to the high content of pigments (uro- and stercobilinogen).
Causes of hepatic jaundice
Parenchymal jaundice is one of the main syndromes indicating liver damage. It is associated with the destruction or damage of hepatocytes. Causes of this syndrome include:
- Infectious pathologies. Among them are hepatitis, mononucleosis, leptospirosis, sepsis.
- Cirrhosis of the liver.
- Toxic effects on the body. In particular, chronic drug and alcohol intoxications.
Intrahepatic cholestasis syndrome develops in long-term diseases. It is characterized by obstruction of the small bile ducts. In this case, free bilirubin penetrates the lymphatic and circulatory system. This is accompanied by dark urine. Feces in patients with parenchymal jaundice, on the contrary, become discolored. This is of great importance for diagnosis.
Characteristics of obstructive jaundice
Prehepatic jaundice occurs due to blockage of the outflow of digestive juice. Tumors, large parasites or calculi serve as an obstacle. As a result, stagnation of bile and indigestion occurs. The disease is accompanied by skin itching, nausea and stool disorders. The classification of obstructive jaundice according to Halperin includes criteria such as total protein and blood bilirubin, as well as complications that develop as a result of the underlying disease. Points are assigned based on this. This allows you to evaluate the prognosis for obstructive jaundice. The classification was created for the possibility of setting the class of severity. The easiest is degree A, in which up to 5 points are scored. In the presence of complications, the prognosis worsens. Class B corresponds to 6-12 points. The patient's condition worsens markedly. In the presence of several complications and deterioration of blood counts, more than 15 points are scored. Class C corresponds to a severe degreegravity.
Change in laboratory parameters for jaundice
Assess the patient's condition using laboratory criteria. The classification of jaundice by the level of bilirubin helps not only to assess the severity of the disease, but also to make a differential diagnosis. It is more commonly used in pediatrics. Clinical and laboratory classification of neonatal jaundice is evaluated in the Cramer system. A mild degree corresponds to a change in the color of the scalp and sclera. In this case, bilirubin is less than 80 μmol / l. The higher the pigment level, the higher the Cramer score. With yellowness of the body, the level of bilirubin is 80-150 µmol / l. This corresponds to 2 points. The third degree of jaundice develops if the level of bilirubin is from 150 to 200 µmol / l. Clinically, this corresponds to a discoloration of the skin up to the knees and elbows. With the extreme severity of the syndrome, the level of bilirubin rises above 250 µmol/L.
Complications of icteric syndrome
In most cases, a high content of bilirubin does not threaten the body. The pigment does not harm the skin and internal organs. The causes of the patient's serious condition are: hemolysis of erythrocytes, liver damage and impaired bile outflow. Complications directly of hyperbilirubinemia are observed when the pigment penetrates into the brain. This condition is called nuclear jaundice. It is observed when the level of indirect bilirubin increases hundreds of times. Nuclear jaundice develops due to hemolytic disease of the newborn and variouscongenital pathologies of the hematopoietic system. She threatens with severe neurological disorders.
Differential Diagnosis for Jaundice Syndrome
To find out the cause of jaundice, pay attention to the color of the skin (lemon, orange) and the presence of other symptoms. The liver and spleen are palpated. It is important to determine the level of bilirubin. If only free pigment is elevated, erythrocyte hemolysis is the cause. In violation of the liver, the level of both unconjugated and direct bilirubin changes. Urine becomes darker and feces lighter. The level of stercobilinogen in the blood increases. Subhepatic jaundice is accompanied by itching and deterioration of the general condition. An increase in conjugated bilirubin is noted in the blood. To find out the cause of jaundice, various tests, ultrasound and CT of the abdomen are performed.
