Differential diagnosis of jaundice allows you to determine the cause of the problem and select the desired treatment. Yellowing of the skin, sclera of the eyes and other mucous membranes is often associated with problems in the functioning of the liver and gall bladder. However, a similar sign can be observed with the course of many other diseases.
An increase in bilirubin in the blood can be with hematological pathologies. To establish the exact cause of the problem and prescribe treatment, differential diagnosis of jaundice is required, during which all the features of pigment metabolism are necessarily taken into account.
Jaundice classification
In jaundice, there is an imbalance between the formation and excretion of bilirubin. This condition occurs for several reasons, on which the form of violation depends. The accumulation of bilirubin is very dangerous, since this violates the process of tissue enrichment with oxygen. As a result of prolonged toxic effects on the body, anemia develops, necrotic areas in the liver form, immunity deteriorates, and the nervous system is disturbed.
When conducting diagnostics, it is initially necessary to determine what type of jaundice belongs to, as well as what triggered its occurrence. According to the mechanism, such violations are divided into:
- hemolytic (suprahepatic);
- parenchymal (hepatic);
- mechanical (subhepatic).
Suprahepatic arises due to increased destruction of red blood cells. As a result of this, bilirubin accumulates, which the liver simply does not have time to process. Such forms are non-infectious in nature and act as a sign of autoimmune diseases, anemia, heart attack.
Hepatic jaundice is formed during the degeneration of hepatocytes. This occurs as a result of infectious lesions of the liver, which can be in the case of syphilis, hepatitis, salmonellosis. In addition, they can occur with cirrhosis of the liver or with prolonged exposure to various kinds of toxic substances, including alcohol. In terms of differential diagnosis of jaundice, this form is of the greatest difficulty, since there are many diseases that provoke such a violation.
The subhepatic appearance is formed as a result of partial or complete obstruction of the biliary tract. The cause of this may be cholecystitis, helminthic invasions, stones in the gall bladder, malignant tumors of the pancreas and gall bladder.
In a special group of doctors, constitutional jaundice is distinguished. They arise as a result of damage to liver enzymes. This species is not accompanied by liver damage and does not affect the patient’s well-being. Basically, they appear in childhood and young age. Often they can be once and for a short time, then quickly pass and no longer bother the patient.
Suprahepatic form
The suprahepatic form occurs as a result of the active destruction of red blood cells. As a result, a large amount of bilirubin is formed in the blood, and the liver simply does not have time to process it. The development of such a violation is provoked by genetic factors, but in some cases it occurs as a result of damage to internal organs, croupous pneumonia, malignant neoplasms, endocarditis and many other organs. A provoking factor may be poisoning with drugs or toxic substances. Often, with suspected hemolytic syndrome, differential diagnosis of jaundice is carried out in children up to a year, since at this age a similar problem is often observed. Symptoms may intensify in the cold or after prolonged hypothermia.
Without proper treatment, it can become chronic. Relapses occur quite often and are accompanied by severe intoxication of the body. Symptoms are not pronounced enough, since there is no severe itching and heaviness in the right hypochondrium. The disease is accompanied by such manifestations as:
- pale yellow skin tone;
- slight enlargement of the liver and spleen;
- normal or dark color of urine and feces;
- hepatic function is not impaired.
When conducting differential diagnosis of jaundice, you can detect signs of anemia, reduced resistance of red blood cells. Bilirubinemia is not determined, and only indirect bilirubin exceeds the norm, and the direct remains within the normal range.
Subhepatic form
The subhepatic form is associated with a violation of the outflow of bile and its reverse reflux into the liver. Among the main reasons, one can single out the presence of a stone in the gall bladder or spasm of sphincters, as well as malignant neoplasms.
Patients have pain in the abdomen, a sharp decrease in weight. The main symptomatology largely depends on the degree of overlap of the bile duct. In almost all patients, a grayish or greenish shade of the skin, as well as severe itching. With prolonged stagnation and the presence of stones and neoplasms, there is a severity and pain in the right side. Prolonged cholestasis is accompanied by an increase in liver size. Urine turns dark, and feces become light.
The differential diagnosis of obstructive jaundice is to study the amount of bilirubin in the blood, as well as cholesterol and alkaline phosphatase. When performing fecal analysis, bloody spots can be detected.
Laboratory methods for differential diagnosis of obstructive jaundice are supplemented by instrumental. Patients are prescribed ultrasound, laparoscopy and liver biopsy. It is recommended to additionally make an x-ray of the digestive system and biliary tract. Intrahepatic cholangiography may also be required.
Liver form
The parenchymal form of the disorder is associated with a violation of the hepatocytes. It occurs as a result of various diseases, in particular, such as:
- cirrhosis of the liver;
- viral hepatitis;
- alcohol intoxication;
- mononucleosis.
Can cause a pathology can be a cancer or chronic hepatitis. Since there are many diseases accompanying parenchymal syndrome, the differential diagnosis of jaundice is of certain complexity. For each pathology, certain signs are characteristic. Hepatologists make a diagnosis during an external examination, as there is an increase in the size of the spleen and liver, as well as a yellowish tint of the skin and mucous membranes.
When conducting a laboratory examination, an excess of bilirubin norm can be detected. Additional methods are also used for the study, in particular the bromosulfalein test, as well as a radioisotope examination. Additionally, laparoscopy and liver biopsy may be required.
The main types of diagnosis
Differential diagnosis of diseases with jaundice is a difficult task even for a qualified specialist. When determining the types of pathology, the doctor focuses on the results of a visual examination and patient complaints. Laboratory and instrumental examination techniques will help determine the causes of the disease and prescribe the correct treatment.
Differential diagnosis of physiological and pathological jaundice begins with determining the level of bilirubin in the blood, as well as alkaline phosphatase. Then you need to measure the number of reticulocytes and red blood cells. The main sign of hemolysis is an excess of reticulocytes, as well as a change in the shape of red blood cells. If hemolysis has not been confirmed, then in this case, the likelihood of congenital jaundice is taken into account.
In the diagnosis of hepatic impairment, signs of intoxication are important. It is also important to collect the patient’s medical history, in particular, information about the long-term consumption of alcohol or medications, as well as the patient’s contact with toxic substances.
Differential diagnosis of viral hepatitis and obstructive jaundice is based on a blood test for antibodies to hepatitis antigens, and serological markers are also required. In addition, you need to pay attention to the existing symptoms. To diagnose subhepatic jaundice, mainly instrumental methods are used, and if a tumor is suspected, a biopsy is required.
Disease in children
Jaundice in children is common enough, but this is not a cause for concern, since only in 10% of cases this is a sign of a serious illness. When conducting differential diagnosis of neonatal jaundice, it must be remembered that such a manifestation has several different forms, namely:
- physiological;
- conjugation;
- galactosemia;
- hemolytic.
Physiological jaundice is associated with a weak activity of the glands, as well as an indicator of a large amount of indirect pigment. 3-5 days after the birth of the baby, she passes on her own for 2 weeks. In premature infants, this period is 3-4 weeks. The general state of health is not violated, and the internal organs are normal. In this case, the differential diagnosis of jaundice in newborns implies a visual examination of the child, as well as laboratory tests.
The conjugation form is hereditary. In this case, discoloration of bile and feces is observed. With liver diseases and a decrease in the amount of bile secreted, yellowness of the skin, white feces, dark color of urine, as well as the presence of bilirubin pigment in the analyzes are observed. In this case, the differential diagnosis of jaundice in children implies laboratory tests and determination of the level of aldolase and transaminase.
Galactosemia is a hereditary disease of the newborn, characterized by a violation of the conversion of galactose to glucose. The liver exceeds normal sizes and this is accompanied by frequent spitting up and vomiting of the child. Hemolytic disease implies that the destruction of red blood cells of a newborn occurs due to incompatibility with maternal blood antigens.
Pregnant Disease
In women during pregnancy, icteric syndrome is quite rare, and this may be due to pregnancy pathologies, and also occurs against the background of concomitant diseases. It is worth remembering during the differential diagnosis of obstructive jaundice that such a manifestation may be associated with the course of:
- intrahepatic cholestasis;
- acute hepatosis;
- preeclampsia.
With intrahepatic cholestasis, outflow of bile is difficult. Manifestations begin with skin itching and are accompanied by pain in the upper abdomen, fever and vomiting. The principles of differential diagnosis of jaundice are based on laboratory tests to determine the number of leukocytes and bile pigments. The diagnosis is confirmed by ultrasound.
Acute hepatosis is observed in the last months of pregnancy. In this case, acute pain, vomiting, heartburn and high fever are observed. An increase in white blood cells is detected in the blood, as well as a violation of blood coagulability.
Gestosis requires an early diagnosis, since there is a very high mortality rate. It develops mainly in the 3rd trimester and is characterized by swelling, increased pressure, indigestion, and abdominal pain. With obstructive jaundice, differential diagnosis can be supplemented by a biopsy.
Treatment features
To conduct quality therapy, it is necessary to determine the form of the course of the violation. The clinic is necessarily taken into account in the diagnosis of obstructive jaundice. Differential diagnosis helps not only determine the form of the disease, but also select the most optimal treatment technique.
Therapy is prescribed exclusively by the attending doctor, depending on the degree of complexity and duration of the course of the disease. A very important test is blood, feces and urine. Therapy should be aimed at preserving the liver, preventing the development of cirrhosis, as well as protecting others from infection with hepatitis. Among the general methods it is necessary to highlight such as:
- diet therapy;
- taking drugs to increase immunity;
- intake of vitamins;
- plasmapheresis;
- phototherapy;
- application of folk methods.
All drugs and folk remedies should be taken only after the appointment of a doctor. In addition, preventive measures should be taken, especially if there is a predisposition.
Drug therapy
When treating jaundice, the doctor must prescribe the use of medications, in particular such as:
- antiviral agents;
- medicine against viral hepatitis - “Glamivudine”;
- antibacterial drugs in the presence of inflammation in the gallbladder;
- enzymes for improving digestion - Pancreatin, Creon;
- vitamin complexes;
- hepatoprotectors;
- antihistamines;
- improvement of the metabolic function of the liver - Heptaral, Essential;
- antispasmodics - “Dibazol”, “No-shpa”.
Adult treatment involves the installation of droppers and injection drugs. All these manipulations are related to classical drug therapy.
Folk techniques
Alternative methods of treatment can facilitate the patient's well-being during the period of subsidence of acute symptoms, or during a chronic course. Juice therapy has a good effect, and beetroot juice with a few drops of lemon is usually used. Pumpkin juice is also good.
To cleanse the liver of toxic substances, herbal preparations are used, which are prepared from yarrow, mint and chamomile. A good effect is exerted by horseradish root, as it contains a lot of vitamin, minerals, and essential oils. To do this, grind the root, add water, insist for a day, and then take it throughout the day.
Phototherapy
With obstructive jaundice, differential diagnosis and treatment tactics largely depend on the characteristics of the course of the disease. Medications are prescribed along with phototherapy sessions. They mean that under the influence of ultraviolet pigment destruction occurs, and the patient's well-being is normalized.
Ultraviolet lamps are used to treat adults, but bright sunlight is also able to bring a good effect. A similar procedure is used to treat the jaundice of a newborn. The lamp has the most optimal irradiation spectrum, as a result of which bilirubin becomes water-soluble and non-toxic.
Dieting
Comprehensive treatment for jaundice includes dieting. Nutrition should be high-calorie, balanced and consist of dishes that will not harm the liver. Consume all the dishes you need warm and fresh. Vitamins, proteins and iron must be present in the daily diet.
Food must be fractional, therefore, you need to eat 5 times a day. During the treatment period, you can only consume:
- crackers and dry bread;
- lean meat and fish;
- vegetable and cereal soups;
- cereals and stewed vegetables;
- low-fat dairy products;
- sweet jelly and stewed fruit.
During the treatment, you must definitely consume fresh berries and fruits. Be sure to exclude heavy and spicy dishes from your usual diet in order to prevent the development of complications.
Prophylaxis
Preventive measures largely depend on the cause of the occurrence. There is no definite prophylaxis, since jaundice has mainly a genetic predisposition. To prevent infection with an infectious type of jaundice, contact with a sick person should be excluded. To prevent the formation of non-infectious jaundice, it is necessary to observe such preventive measures as:
- refusal to drink alcohol;
- avoidance of contact with chemicals;
- take medications only as prescribed by the doctor.
In addition, you need to eat right, lead an active lifestyle, regularly undergo preventive examinations.