Gulsot hos vuxna: orsaker, diagnos och behandling

Jaundice in an adult is manifested by a specific icteric appearance of the cutaneous and mucous membranes.Often, the external eyeball( sclera) is involved in the process.This symptom can be a companion of various diseases.

Table of contents: Main cause and types of jaundice in adults What conditions and diseases cause jaundice in adults Diagnosis of diseases that lead to jaundice Symptoms of jaundice in adults Treatment of diseases with jaundice in adults Folk medicine and jaundice in adults Complications Diet for jaundice and preventionHer appearance Prognosis and prophylaxis of jaundice in adults

Main cause and types of jaundice in adults

Change in normal skin color to icteric - a consequence of a violationigmentnogo exchange, in particular - bilirubin - a substance produced during the decay of red blood cells.Bilirubin accumulates in the blood, it poisons the body and colors the skin in characteristic color tones.

Doctors use pathogenetic( by the mechanism of occurrence) and clinical classification of jaundice.

The following is distinguished:

• prehepatic ( suprahepatic) jaundice - hemolytic, resulting from blood diseases);
• hepatic ( parenchymal) - develops as a result of liver diseases;
• Acupuncture ( mechanical) - in which there are obstacles for removing bilirubin from the liver.

Each type of jaundice is characterized by the most typical shades of color on the skin:

• yellow with the addition of reddish - appears with liver variants of jaundice;
• yellow with lemon tones - characteristic of blood diseases on the background of hemolysis( disintegration of blood cells);
• dark green - characterized by the presence of mechanical barriers to the outflow of bile.

What conditions and diseases cause jaundice in adults

For a correct understanding of the mechanism of jaundice development, it is necessary to establish the causal dependence of the basic forms of this condition.

Supernumerary jaundice is the result of the process of decomposition and decay of red blood cells.It leads to a buildup of bilirubin in the blood, with the "recycling" of which the liver is unable to fully cope.

Note: bilirubin consists of two main types.The first is free ( indirect, insoluble, unconjugated) toxic complex that is bound to blood proteins and circulates freely in the bloodstream.The second - not free ( direct, soluble, conjugated), formed by binding in liver cells of the first type with glucuronic acid.It is not toxic and in the bile is secreted into the intestine.

In the superhepatic version of jaundice, the growth of total bilirubin is due to the increase of exactly free bilirubin, as liver cells do not cope with its binding.This poisonous substance leads to poisoning the body.

The main type of diseases that cause epileptic jaundice are hemolytic anemia( with the destruction of blood cells): familial hemolytic jaundice, thalassemia, sickle cell anemia, etc.

hemolysis causes malaria, some autoimmune processes.

Hepatic jaundice is caused by damage( alteration) of liver cells( hepatocytes), intrahepatic bile capillaries.The process of destruction of hepatocytes accompanied by an increase in blood levels of bilirubin, against the increase of free bilirubin.

Development of hepatic jaundice cause:

• infectious viral hepatitis( acute and chronic forms);
• hepatitis of different etiology;
• cirrhotic changes in the liver against a background of chronic alcohol poisoning, other toxic and medicinal lesions;
• infectious mononucleosis;
• Gilbert syndrome;
• Leptospirosis;
• cancer( hepatocellular) of the liver;
• autoimmune diseases that damage the hepatic tissue.

Subhepatic jaundice develops with the presence of a disturbed outflow of bile from the intra- and extrahepatic bile ducts.This disorder provokes a mechanical obstruction to biliary tract( blockage, obturation).

Normal bile output can be restrained:

• gallstones( concretions);
• cystic formation;
• pancreatitis( inflammation of the pancreas);
• tumors of the pancreas, liver, gall bladder, 12 - duodenum;
• congestion of parasites;
• lymphogranulomatosis;
• complications after the transfer of operations on the liver, bile ducts, pancreas;
• atrophic processes in the biliary tract;
• spasm and narrowing( stenosis) of the sphincter of Oddi( a circular muscle that regulates the output of bile from the common bile duct - choledoch into the intestine).

Mechanical jaundice gives characteristic changes in the biochemical analysis of blood.The level of bilirubin increases mainly due to the direct fraction.Indirect form can be within normal limits, or slightly increased.In urine, bilirubin is also detected.

Diagnosis of diseases that lead to jaundice

Patients, in determining the cause of jaundice, undergo a screening that begins with a doctor's examination and questioning.

In addition, the following is assigned:

• biochemical blood test( particularly bilirubin level studies).Normally, the total bilirubin of the upper limit does not exceed 20 μmol / l, the indirect bilirubin - 17 μmol / l, and the direct - not more than 2.5 μmol / l;
• Fibrogastroduodenoscopy( FGDS);
• ultrasound of the liver, ducts, bladder, pancreas;
• X-ray examination of the liver and bile duct;
• MRI;
• immunological assays, allowing to determine the presence and level of immunoglobulins characteristic of infectious hepatitis.

Symptoms of jaundice in adults

The picture of the disease depends on the underlying disease and the complications that led to the development of jaundice.But at the same time, we can distinguish a number of similar symptoms, characteristic of jaundice. These include:

• increase in body temperature, which is not removed by antipyretic agents;
• frequent, loose stools;
• dark urine, fecal decolorization in infectious hepatitis;
• itchy skin sensation;
• general weakness due to intoxication, which is accompanied by nausea and vomiting;
• pain( permanent, or paroxysmal) in the right upper quadrant, weight loss;
• decreased appetite, bitterness in the mouth;

Note: clinical picture can complement the specific symptomatology peculiar to specific diseases that caused jaundice in a patient.

Directions for the treatment of jaundice in adults

The choice of treatment plan depends on the underlying disease that caused jaundice and the severity of the patient's condition.This determines the need for inpatient treatment( in the therapeutic or surgical departments) or the possibility of outpatient therapy.

Patients undergo :

• Detoxification treatment - is prescribed for acute forms of pathology, accompanied by severe intoxication.Duration and volume of infusion therapy is decided individually, based on the patient's condition and laboratory diagnosis( especially with infectious hepatitis, acute and chronic alcohol poisoning, drug-induced liver damage, drug complications).
• Treatment with antibiotics - is indicated in cases of infectious-bacterial causative factors that led to jaundice.Be sure to carry out the previous definition of the sensitivity of the microbial flora to antimicrobial drugs.It is very important to adhere to treatment regimens, high doses and conduction of concomitant antifungal therapy.
• In diseases that lead to jaundice in the presence of hepatocyte damage, the positive effect is provided by hepatoprotectors, protecting and restoring liver tissue.
• Anemia in most cases requires hematotherapy ( natural blood and its preparations, as well as transfusion of plasma and blood substitutes).
• The oncologist chooses the tactics for the treatment of the neo-educational process( surgical treatment, chemotherapy, radiotherapy).
• Surgical treatment of - is indicated in the presence of a large number of large stones in the gall bladder, ducts.Plastic surgery is performed in the anomalies of bile ducts and after complications against the background of previous surgery.Sometimes a liver transplant is used.
• Immunotherapy .
• In severe cases, therapy with with hormonal drugs .

Folk medicine and jaundice in adults

Treatment with traditional medicine in acute icteric period is ineffective, it should be used in the phase of extinction of the disease and in chronic current processes between exacerbations.

Complications of diseases that cause jaundice in patients

The appearance of jaundice can also be attributed to complications of diseases.And the consequences, which can occur against the background of the jaundice, may be different.

More often, the pathologies occurring with jaundice often lead to:

• anemia;
• chronization of the main process;
• development of benign and malignant processes;
• acute and chronic hepatic insufficiency;
• shock, against the background of pain syndrome;
• of hepatic encephalopathy;
• lethal outcome in severe cases.

Diet for jaundice and prevention of its appearance

In hospitals, patients suffering from diseases with icteric manifestations receive diet No.5 according to Pevzner.

The ration includes:

• increased volume of liquids - juices and compotes of neutral and sweet fruits, mineral waters without gas, sweet drink;
• viscous and sparing porridge, jelly, mashed potatoes;
• dried bread, lean meat in boiled form, or steamed( cutlets, meatballs), low-fat boiled and baked fish;
• cheese and low-fat cottage cheese, casseroles, pudding;
• jujube and fruit marshmallow;
• is limited - oils;
• fresh, sweet fruit.

During the illness should be abandoned:

• all types of conservation;
• fatty foods( meat and dairy, fish);
• fried, which is categorically contraindicated in jaundice;
• chocolate, cocoa, coffee, dough products, seasoning, spices;
• of any kind of alcohol.

Prognosis and prevention of jaundice in adults

The outcome of an illness associated with jaundice depends on the cause, shape and severity of the process.With well-organized treatment, in most cases it is possible to achieve a cure of the patient or a significant improvement in his condition.

With the preventive purpose, in order to avoid the development of jaundice, it is necessary to consult a specialist in a timely manner.In chronic diseases - to comply with the regime and dietary settings.

Alexander Lotin, medical reviewer