Jaundice is not an independent disease, it is only a symptom of some pathologies. In many cases, it can be physiological, that is, not associated with any disease (in newborns). The cause of this condition is an increase in bilirubin in the blood, which gives an icteric color to the skin, mucous membranes and sclera.
Jaundice: types
This condition is inextricably linked with the content of bilirubin in the blood. However, the reasons for its increase may be different. In some cases, establishing the cause makes it possible to suspect a pathology in the body, which requires immediate treatment. Depending on the variant of bilirubin metabolism disorders, several types of jaundice can be distinguished:
- Conjugative jaundice, which is a consequence of impaired binding of bilirubin. It is she who occurs in newborns.
- Parenchymal jaundice that develops in a number of liver pathologies. The defeat of the parenchyma of this organ (the death of functional cells - hepatocytes) makes it impossible to capture bilirubin and its furtherexchange.
- Obstructive jaundice, which appears when there is a violation of the outflow of bile. It is associated with diseases that contribute to the closure or narrowing of the lumen of the bile duct. This phenomenon occurs with cholelithiasis or tumor formation.
- Hemolytic jaundice is a pathology associated with the breakdown of red blood cells. Bilirubin is a pigment that occurs when hemoglobin breaks down, so increased erythrocyte lysis leads to an increase in its level.
- Nuclear jaundice is an independent and most dangerous type. It occurs if the fetus was exposed to hypoxia during development or asphyxia during childbirth. It can also be caused by infections in a pregnant woman. The danger lies in the fact that the pigment accumulates in the nerve cells of the brain, which leads to various neurological disorders and can even cause death.
Conjugational jaundice in newborns
Jaundice that occurs in newborns is physiological, as it is not associated with a pathological process. It develops, as a rule, 3-5 days after birth. Normally, red blood cells are subject to constant renewal, which is accompanied by hemolysis - their destruction. In adults, the liver is fully formed, so bilirubin, which is released during the decay of these cells, has time to bind and does not accumulate in the blood.
The clinical picture in infants is associated with intensive renewal of red blood cells and relative liver failure. This body is not yet fully formed,especially often such jaundice occurs in premature babies. Bilirubin begins to accumulate in the blood, and then accumulates in the skin and mucous membranes, giving them a characteristic color. The peak falls on the third or fifth day. These symptoms then subside as bilirubin metabolism gradually returns to normal.
What is this condition?
Conjugative jaundice (ICD-10) is not separately identified in the international classification. It is coded P59.0 as neonatal jaundice due to preterm delivery and is associated with hyperbilirubinemia. This process is described in more detail above.
The conjugation form of the disease occurs more often in children. This is transient jaundice in newborns, as well as a condition that develops in premature infants and children who have undergone asphyxia. The causes of the problem are often endocrine pathology and heredity (for example, Lucey-Driskop and Gilbert syndromes). This group also includes drug-induced jaundice.
Bilirubin - what is it?
This is the name given to the pigment, which is a product of the breakdown of hemoglobin. At a certain concentration, it leads to staining of the skin and mucous membranes. The level of bilirubin is the most important diagnostic criterion, since its increase allows you to identify any pathological process and begin treatment. The amount of pigment reflects the state of the liver and biliary tract.
Bilirubin is found in the bodyin two forms - direct and indirect. The first is the product of the transformation of the second. Indirect bilirubin is toxic and absorbed by fats. It is not excreted from the body. In case of metabolic disorders, this form can accumulate, exerting a toxic effect on the body. Normally, it turns into direct non-toxic bilirubin. Jaundice conjugation occurs due to a violation of its metabolism.
Bilirubin exchange
The source of this pigment is hemoglobin, the main component of red blood cells. As red blood cells break down, hemoglobin is released and broken down. This process is carried out by macrophages in specialized organs (bone marrow, liver and spleen). As a result of splitting, heme and globin are formed. The first is transformed into biliverdin, the precursor of indirect bilirubin. Its formation from biliverdin is associated with the activity of special enzymes, among which are cytochrome P-450, heme oxygenase. Next, indirect bilirubin is sent to the liver cells, where it binds to glucuronic acid. In this way, direct bilirubin is formed, which accumulates in the gallbladder, and then undergoes excretion into the duodenum. The intestinal microflora contributes to its recovery to urobilinogen. Its part is subject to absorption, the remains are converted into stercobilinogen and excreted in the feces, giving it a characteristic color.
Lab tests may show that bilirubin is elevated. What means? The increase in its level may be associated with anydisease, so prompt diagnosis is required. A physiological increase in bilirubin levels is observed in newborns.
Clinical picture
Despite the fact that newborns are characterized by an increase in bilirubin, clinical manifestations are not recorded in everyone. A symptom of this condition is the appearance of an icteric color. It is detected not only on the skin, but also on the mucous membranes. Physiological conjugational jaundice passes without a trace, but if this does not happen, pathology should be suspected.
Diagnosis
Jaundice can be not only a physiological condition, but also a symptom of a disease. If a child has a specific coloration of the skin and mucous membranes, he needs constant monitoring by a pediatrician. Also in such cases, it is necessary to control the level of bilirubin. As a rule, in the first days of life, its amount reaches 60 µmol/l, but no more. Further, this level rises (for 3-7 days).
Usually, an increase in bilirubin is safe and does not have a toxic effect on the baby's body, but this level should not exceed the so-called boundary value - 205 µmol / l. Bilirubin is elevated - what does such a change mean? Jaundice is pathological and requires urgent treatment. If this indicator is within the normal range, but jaundice does not go away for a long time, it is considered conjugative, that is, the cause of the immaturity of the liver enzyme systems.
Treatment of conjugative jaundice
After theexamination determines whether jaundice is physiological or pathological. The first does not require any treatment and ends on its own and without a trace. Protracted jaundice (conjugation) also goes away on its own when the liver enzyme systems finally mature. However, if the amount of bilirubin exceeds a critical level, pathology should be detected. It could be viral hepatitis, bile duct obstruction, or hemolytic jaundice.
Viral hepatitis
Such a pathology can be transmitted to a child from an infected mother. As a result, the baby is born with viral hepatitis. The action of the virus in the early stages of fetal development can additionally cause physical abnormalities. A feature of the disease, unlike hepatitis in adults, is the most severe course. Pathology can manifest itself even before the onset of jaundice. Often there is an increase in temperature, loss of appetite and small catarrhal phenomena. In some cases, the preicteric period in infants is asymptomatic.
Hepatitis can be suspected by detecting changes in the color of urine and feces. A clinical blood test is characterized by a decrease in the level of leukocytes and the erythrocyte sedimentation rate. Monocytes also slightly increase. In the icteric form, there is a significant increase in bilirubin and thymol test. For early diagnosis of the disease, a study of the activity of liver enzymes is carried out. The severity of the process is indicated by a sharp decrease in prothrombin and an increase in ammonia.
Treatment of children is carried out, as a rule, in a hospital. Therapycombines antiviral drugs, hepatoprotectors, vitamins, and choleretic agents. Detoxification therapy is recommended. Among non-pharmacological methods that complement pharmacotherapy, bed rest and rest are needed.
Hemolytic jaundice
This pathology associated with hemolysis of erythrocytes is very dangerous. The reason is the discrepancy between the Rh factor of the mother and the child, that is, the Rh conflict. Pathology often leads to death - mortality is 60-80%. In addition, the presence of an Rh conflict can lead to spontaneous miscarriage.
Prevention
Pregnancy and breastfeeding can help prevent jaundice, and regular check-ups by a pediatrician are essential. If jaundice of prematurity still develops, regular monitoring of the level of bilirubin in the blood is necessary.
Patients with jaundice are characterized by a characteristic coloration of the skin and mucous membranes. This symptom may indicate the presence of a disease or reflect physiological changes in the body (transient neonatal jaundice).
Conclusion
When jaundice is detected, an immediate determination of the level of bilirubin and further diagnostics are made. Conjugational jaundice in newborns takes longer to resolve than transient jaundice, but is also safe. The specialist should reassure the parents and schedule an examination. As a rule, no complications are observed.
