Suprahepatic jaundice is characterized by a sharp increase in the level of bilirubin in the blood, followed by yellowing of the skin, mucous membranes and eyeballs. The disease is provoked by a malfunction of the erythrocyte system, in which erythrocyte decay is observed, which leads to an increase in bilirubin.
The liver does not have time to process and remove the liver pigment, which first penetrates the bile ducts and intestines and then circulates further through the body. Often a disease develops against a background of infectious, autoimmune diseases, poisoning, and may have a genetic factor.
Disease feature
Often, a yellowish skin tone is caused by problems with the bile ducts and liver, when these organs can not bind the released bilirubin and remove it from the body in a natural way. However, it also happens that these organs function quite normally, but bilirubin still accumulates in large quantities.
A similar condition is possible with suprahepatic jaundice. A similar pathology is characterized by excessive destruction of blood cells, when red blood cells break up, and hemoglobin is converted to bilirubin, which does not have time to process and penetrates back into the blood. The pathogenesis of suprahepatic jaundice can be associated with malaria, croupous pneumonia, as well as other diseases that provoke an increased breakdown of red blood cells.
The skin becomes lemon yellow, there is a strong pallor of patients, but there is no itching characteristic of other forms of jaundice. Blood tests show no elevated bilirubin levels. Among the symptoms of suprahepatic jaundice, swelling of the spleen should be distinguished, which can be detected by palpation, but the liver remains normal in size. The disease can be congenital and acquired.
Congenital suprahepatic jaundice is a disease characterized by the presence of problems with red blood cells, when a significant number of red blood cells are destroyed, and new cells are formed insufficiently. Normally, red blood cells live for about 4 months, and with the occurrence of such a disease - a maximum of 3 weeks. In this case, the destruction of red blood cells in the liver, blood vessels, bone marrow, spleen occurs.
With acquired suprahepatic jaundice, red blood cells are destroyed in the spleen. In children, such a violation is mainly due to adaptation to a new unusual environment. In adults, the disease occurs with blood diseases or other health problems.
Disease in infants
The suprahepatic and subhepatic jaundices of newborns are divided into physiological and pathological. The physiological form of the disease passes independently after 1-1.5 weeks. However, if during this time the symptomatology of the disease does not go away or other signs join, then this may indicate a pathology. In this case, you need to urgently consult a doctor. The first symptoms of jaundice appear in the baby on the second day after birth.
Physiological jaundice is not dangerous, since it arises as a reaction of the body to a sharp breakdown of hemoglobin with defective liver function, which cannot cope with its main task. The pathogenesis of suprahepatic jaundice in children is the same as in adults. A pathological form of the disease can be provoked by such factors as:
- thyroid problems;
- congenital pathologies;
- immaturity of liver cells;
- Rhesus conflict of mother and child;
- infectious liver diseases;
- complication of diabetes during pregnancy.
Often, the main cause of suprahepatic jaundice is a Rhesus conflict, since the cells of the mother's body attack the fetal cells throughout pregnancy, recognizing them as pathological. Basically, the first signs of the disease appear in the hospital, which increases the chances of a positive outcome and helps prevent the development of complications.
For suprahepatic jaundice, the presence of symptoms such as:
- yellowness of the sclera of the eyes and skin;
- pallor;
- lethargy.
There are several different forms of hemolytic jaundice in a newborn baby, in particular such as:
The anemic form of the disease is quite easily tolerated by the child, since it is only a short-term period of the aggressive effect of the mother’s antibodies on the fetus. At the same time, signs such as pale skin, anemia, an increase in the size of the spleen and liver are noted.
Basically, the development of suprahepatic jaundice is the result of prolonged exposure to maternal antibodies on the child. The edematous form is considered very dangerous and can lead to the death of the baby. In this case, there are such symptoms of suprahepatic jaundice, such as:
- severe anemia;
- enlarged liver, spleen, heart;
- deterioration of the liver;
- problems with heart;
- swelling;
- fluid accumulation in the pleural cavity and abdomen.
Due to edema, the weight of a newborn child exceeds the norm by 2 times. In addition, the occurrence of ascites, significant bruising is characteristic. Often there is pericarditis and pleurisy, which also occurs due to severe swelling.
The icteric form of the disease occurs when antibodies begin to attack the cells of an already formed organism. In this case, the newborn baby is completely healthy. Symptoms increase gradually, and the peak manifestation of the disease reaches about 4 days after the birth of the baby. It is worth noting that the sooner signs of jaundice begin to appear, the heavier the clinic. After some time, the baby's skin begins to turn yellow, and the spleen, liver and lymph nodes increase.
The signs of jaundice and bilirubin increase so that over time the skin becomes dark yellow, almost brown or with a slight greenish tint, and the bilirubin levels in the blood are growing rapidly. Basically, the disease lasts about a month.
With suprahepatic jaundice, bilirubin accumulates in the body and adversely affects the functioning of the heart, liver and nervous system. The child is very lethargic and refuses food. Cramps and breathing problems can sometimes occur.
With the development of the nuclear form of jaundice, the well-being of the child begins to deteriorate very sharply. In the case of severe intoxication and the lack of proper and timely treatment, convulsions become more frequent, trembling occurs in the limbs. Also among the signs it should be noted the tension and stiffness of the muscles of the neck. The child becomes almost motionless, he does not have facial expressions, his eyes roll down, and he only squeaks as a reaction to external stimuli.
Treatment of newborns should be immediate. The basis of therapy is the normalization of the spleen and liver in the process of binding and neutralization of bilirubin. To improve the well-being of the child, the use of complex treatment is required. During the treatment, medications and physiotherapeutic techniques are used. Blood transfusion may also be required.
Self-medication of a small child is strictly prohibited. If the first signs of suprahepatic jaundice occur in an infant, you need to contact a pediatrician-neonatologist. Improvement occurs almost immediately after the start of therapy.
One of the methods of therapy in infants is fluorescent lighting with a special lamp. It helps to convert bilirubin into a safe substance that is excreted from the body through physiological bowel movements. Treatment is carried out exclusively in a hospital. In this case, it is imperative to ensure all conditions for the safety of the procedure. The essence of the technique is that the child is placed in a special box or just under a lamp. In the process of treatment, frequent breastfeeding of the baby is required, since excess bilirubin is excreted with food debris.
If the level of bilirubin is significantly higher than normal, then it becomes very dangerous for the health and life of the child. In this case, he is shown a blood transfusion. To do this, donor blood is introduced through the umbilical vein, which helps to cleanse the body of a dangerous substance. This is the most extreme measure, since it is accompanied by various adverse consequences, so this procedure is performed in cases where other methods of therapy do not bring the desired result.
Causes of occurrence
Any kind of jaundice is not an independent disease, but only signals the presence of certain changes or disorders in the functioning of internal organs. Therefore, yellowing of the eyes and skin is characteristic not only for hepatitis, but also for many other diseases. The main cause of suprahepatic jaundice is a sharp jump in the level of bilirubin to its maximum value. A similar state provokes a large decay of red blood cells.
The etiology and pathogenesis of suprahepatic jaundice in adults are associated with:
- infectious causes;
- immune disorders;
- toxic effects;
- heredity.
With hereditary anemia, an abnormality in the structure of red blood cells is observed against the background of the occurrence of abnormal lipids and proteins. They visually change, and also have low resistance to changes in temperature and pressure.
The etiology of suprahepatic jaundice can be very different, but often the process is due to biochemical processes. Therefore, the identification of obstructive jaundice is not difficult. It is much more difficult to determine the causes of jaundice, as they are observed in many non-infectious and infectious diseases. The development of suprahepatic jaundice is a consequence of:
- gallstone disease;
- violations of the outflow of bile;
- blockages of the liver ducts;
- cholecystitis and other diseases of the gallbladder;
- pancreatitis and pancreatic destruction.
This form of the disease is associated with hemolysis and the accumulation in the blood of an unbound fraction of bile pigment - bilirubin. It is very important to timely recognize the course of the disease and conduct treatment.
The main symptoms
Regardless of the etiology of suprahepatic jaundice, the manifestation of the disease is practically no different. Among the main signs, it is necessary to highlight the staining of the mucous membranes and skin in yellow. The main symptom is a change in biochemical parameters in suprahepatic jaundice, namely an increase in the level of bile pigment (bilirubin) in the blood serum, which leads to icteric staining of tissues.
It should be borne in mind that yellowness of the skin can be due to other reasons. This may be due to the deposition of certain substances in the tissues, in particular when working in hazardous industries or taking acrychin.
For suprahepatic jaundice is characterized by the presence of such signs as:
- enlargement of the liver, which can be detected by palpation and ultrasound;
- staining of the proteins of the eyes and skin in a yellow tint;
- expansion of the veins of the esophagus;
- acute pain in the right side under the ribs;
- the appearance of a venous network on the skin of the abdomen;
- changes in the composition and color of feces and urine.
In addition, there is an increase in the spleen, severe pallor, increased production of red blood cells in the bone marrow. Among the characteristic manifestations of suprahepatic jaundice, it is necessary to highlight the intense color of feces. The liver can not normally cope with a large amount of bilirubin formed during the active decay of red blood cells. In this case, drawing pain in the spleen, chills, a sharp decrease in hemoglobin joins the main symptoms.
Development mechanism
The mechanism of suprahepatic jaundice may be due to increased decay of red blood cells, stagnation of bile, liver damage, or a combination of all these factors. When conducting diagnostics, it is necessary to take into account the peculiarity of pigment exchange disorders. This form of the disease is due to the fact that in a healthy person, approximately 1% of red blood cells decay daily. With the breakdown of hemoglobin in the blood, bilirubin is formed in the cells, which does not dissolve in water, is not excreted in the urine. However, at the same time, it is well soluble in fats, therefore, it accumulates in subcutaneous fat. Over time, bilirubin, moving along the intestine and accumulating in the colon, turns into a pigment that stains the feces in brown. This can be determined during the examination.
In case of impaired liver function in the blood, the level of bilirubin increases. The mechanism of development of suprahepatic jaundice is triggered if the pigment does not enter the bile capillaries, but back into the space inside the liver, and then into the blood. However, another variation is also possible. In addition, a chronic course of the disease is also possible.
Jaundice can occur as a result of a violation of the patency of the bile ducts, for example, when blocked by stone. At the same time, bile pigment - bilirubin - accumulates in the blood. Thus, according to the development mechanism, suprahepatic, subhepatic and hepatic jaundice are distinguished. The determination of its type is carried out with differential diagnosis.
Pathophysiology
Serious damage to hepatocytes is characteristic of suprahepatic jaundice. This type of disease can also occur with hepatitis of various etiologies, cirrhosis of the liver, as well as other diseases that occur with necrosis of cells of this organ. In this case, quite characteristic signs of the development and course of the disease appear. In case of severe symptoms, a comprehensive diagnosis is necessary.
Diagnostics
The primary diagnosis of suprahepatic jaundice, namely a visual examination is carried out to determine the presence of yellowness of the skin and sclera of the eyes. Then, to confirm the diagnosis, apply such techniques as:
- analysis of urine and blood;
- antiglobulin test;
- bone marrow puncture;
- ultrasound diagnosis of the liver and biliary tract.
With suprahepatic jaundice, blood biochemistry is prescribed primarily, since this analysis allows you to determine the level of bilirubin. A biochemical blood test is performed by taking blood from a vein in the morning strictly on an empty stomach. If the blood formula is changed, then the patient is additionally prescribed liver tests, which will show dangerous abnormalities in the functioning of the liver. The antiglobulin test allows you to determine the presence of antibodies to red blood cells. If there is a suspicion of an infectious lesion of the liver, then a laboratory blood test for hepatitis is prescribed.
It is worth noting that it is the suprahepatic form of jaundice that is diagnosed most easily. This is explained by the fact that the symptoms of the disease are quite pronounced. The skin has a lemon color against a background of severe pallor, and there is no skin itching characteristic of other types of jaundice.
In blood tests, an increased content of indirect bilirubin is noted, while the direct remains normal. The cholesterol level and liver tests also remain within the normal range. Only a comprehensive diagnosis allows you to determine the peculiarity of the course of the disease, as well as prescribe a comprehensive treatment.
Treatment
Therapy is comprehensive and can be conservative or surgical. When choosing a technique and prescribing drugs, bilirubin indicators and the severity of the pathology course are necessarily taken into account.
Treatment of suprahepatic (hemolytic) jaundice is based on the elimination of the causes that provoked this disease. Conservative therapy implies:
- the use of antibacterial drugs;
- glucocorticoids;
- conducting phototherapy.
In order to reduce the signs of intoxication, glucose or saline is injected. If the disease was triggered by various autoimmune processes, then the introduction of glucocorticosteroids, in particular such as Dexamentazone or Prednisolone, is indicated. In addition, immunosuppressants are prescribed.
In some cases, transfusion of individual blood components may be performed. This procedure is very rarely used when the level of bilirubin rises very much. Direct transfusion is practically not used. Simultaneously with blood transfusion, phototherapy is prescribed, which helps to convert indirect bilirubin to non-toxic. Irradiation is carried out using white or blue fluorescent lamps. In severe forms of the disease due to biochemical defects of red blood cells, removal of the spleen is required.
Since an increase in bilirubin in the blood can be triggered by several different reasons, treatment is carried out by several specialists at once. Hemolytic forms of the disease relate mainly to blood diseases, therefore, a consultation with a hematologist is required. A toxicologist examination is also required, since jaundice can be triggered by poisoning with hepatotropic toxins. In any case, the subhepatic form of the disease requires the consultation of a surgeon or oncologist surgeon.
Etiotropic therapy is also required, aimed at eliminating the root cause that provoked the pathology.If the outflow of bile is prevented by gallstone, then treatment implies an operation during which a foreign body is removed. However, it is worth remembering that etiotropic treatment is not always possible. Despite the fact that the cause of hereditary subhepatic jaundice is always known, there are no treatment methods that can eliminate existing defects in the genes that lead to premature destruction of red blood cells.
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It is also additionally recommended to use diuretics, saline solutions, colloids. These drugs help cleanse the blood. To restore the liver, hepatoprotectors are required, which are used as part of complex therapy. The most common means are essential phospholipids, which contribute to the restoration of the functioning of this organ. Bile is diluted with choleretic drugs, and vitamins are introduced to strengthen the walls of blood vessels.
Treatment of the suprahepatic form at the initial stage is necessarily carried out in a hospital. It is important to constantly be under the supervision of a doctor so that pathological changes in the level of bilirubin, as well as liver functionality, can be detected in a timely manner.
Surgical intervention is prescribed very rarely when there is a high degree of tissue damage. For the treatment, alternative methods can also be used, which are auxiliary and are used together with traditional medicine. The most popular are recipes based on kelp, burdock, sorrel, milk thistle and other herbs from which decoctions are prepared. As a choleretic agent, dandelion roots and flowers, freshly squeezed vegetable juices are used. The use of alternative methods of therapy must be agreed with the attending physician.
Dieting
A patient with jaundice must strictly adhere to the doctor's recommendations regarding nutrition, which will help relieve the liver. Most difficult to digest animals and refractory fats. It is strictly forbidden to consume spicy, fried, salty, fatty, smoked food. All types of alcohol are strictly prohibited.
It is best if the basis of the diet is oatmeal or buckwheat, low-fat varieties of fish or meat, heat-treated vegetables, crackers. It is also possible that macaroni of durum wheat and low-fat dairy products are present in the diet. Food should contain many vitamins and minerals. Additionally, if necessary, the doctor may prescribe a vitamin complex.
It is necessary to normalize the diet. It is recommended to eat 5-6 times a day in small portions. Chew food thoroughly. Diet therapy has a very important place in the treatment of diseases of the liver and biliary tract. The main goal of the diet is to reduce the load on the liver. It is recommended to increase fluid intake if there are no contraindications.
Prognosis after treatment
The prognosis after treatment of adult patients is quite good. If the disease was triggered by intoxication of the body, then after a complete cleansing of the blood, all available signs disappear almost immediately. With autoimmune causes of subhepatic jaundice, treatment with glucocorticosteroids gives a very good effect.
The most favorable prognosis will be if treatment was started at the initial stages of the course of the disease. Re-occurrence of jaundice is possible with the development of gallstone disease, therefore, one of the important areas of therapy will be the normalization of metabolism. It is very important to follow dietary nutrition and all the doctor's prescriptions.
After eliminating the root cause of the disease and correcting nutrition, the process of production and removal of bilirubin from the body is fully restored. With proper and comprehensive treatment, the breakdown of red blood cells and an increase in the level of bilirubin in the blood are stopped. If jaundice was provoked by Gilbert's syndrome, then no special treatment is required, since it does not pose a danger to human health.
Possible complications
If jaundice occurs after the 29th week of pregnancy, then there is a high risk of miscarriage or death of the fetus. With untimely help, the child dies. If you start treatment in time and do not deviate from the doctor's recommendations, then most likely the disease will be completely overcome and will not leave any additional ailments and complications. If the baby suffered bilirubin encephalopathy, and he did not receive medical attention, the consequences may be partial or complete hearing loss, developmental delay, paralysis.
In adults, a complication of jaundice can provoke the development of many different diseases, in particular such as:
- pancreatitis
- sepsis;
- cholangitis;
- cirrhosis of the liver;
- renal failure.
In addition, complications can be associated with diseases that provoked the development of jaundice. Cholangitis, especially a purulent type of disease, is usually triggered by gallstone disease.
Prophylaxis
To reduce the risk of jaundice, preventive measures must be taken. As a preventive measure, only those drugs that have been prescribed by a doctor should be taken. It is necessary to undergo a diagnosis if a blood transfusion was performed and after that a yellowing of the skin appeared.
During pregnancy, you must strictly follow all the doctor’s prescriptions, eat well and eliminate bad habits. If, when registering with a woman, a negative Rh factor of blood was found, then it should be immediately included in the risk group. In this case, computer diagnostics and monitoring of the level of antibodies in the blood are carried out.
The main diagnostic method is ultrasound, since using this technique you can determine the thickness of the placenta, its degree of growth, and the state of the spleen and liver. A determination of possible fetal hypoxia is also required. Every trimester, a pregnant woman should be tested for antibodies. In this case, there is every chance of having a healthy baby with well-developed organs. The baby's body can easily cope with an increase in bilirubin, and the signs of jaundice are weak or completely absent.
In the first week after the birth of the child, it is recommended to arrange for him sunbathing. On the second day, you need to put the baby in a sunny place for 10 minutes and carry out a similar procedure 1-2 times a day. However, everything must be done very carefully, protecting the eyes from bright sunlight, and the skin from burns.