Distribution of bilirubin in tissues with jaundice
Last reviewed: 23.04.2024
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Circulating bilirubin, associated with protein, hardly penetrates into tissue liquids with a low protein content. If the amount of protein in them increases, jaundice becomes more pronounced. Therefore, exudates are usually more jaundiced than transudates.
Xanthochromia of cerebrospinal fluid is more likely with meningitis; a classic example is Weil's disease (icteric leptospirosis) with a combination of jaundice and meningitis.
In newborns, jaundice staining of the basal ganglia of the brain (nuclear jaundice), caused by a high level of unconjugated bilirubin in the blood, which has an affinity for the nerve tissue, can be observed.
With jaundice, the bilirubin content of the cerebrospinal fluid is small: one tenth or one hundredth of the serum bilirubin level.
With severe jaundice, the intraocular fluid can be dyed yellow, which explains the extremely rare symptom - xanthopsia (patients see surrounding objects in yellow color).
With severe jaundice, the yellow pigment appears in the urine, sweat, seminal fluid, milk. Bilirubin is a normal component of the synovial fluid, it can also be contained in the norm.
Skin color of paralyzed and edematous parts of the body usually does not change.
Bilirubin binds easily to the elastic tissue. It is found in large quantities in the skin, sclera, the wall of the blood vessels, so these formations easily become icteric. This also explains the discrepancy between the severity of jaundice and the level of bilirubin in the serum during the recovery period in hepatitis and cholestasis.
Normal content of bilirubin in the blood: total - 0.5-20.5 μmol / l; conjugated (direct) - 0-4.3 μmol / l; unconjugated (indirect) - 0-16.2 μmol / l;
Visible jaundice appears with bilirubinemia 34 μmol / l. In the past, jaundice appears on sclera, in the sky and under the tongue. When viewing, you can distinguish the following shades of jaundice:
- orange-red (rubinicterus) or saffron-yellow with hepatic (parenchymal) jaundice;
- lemon yellow (flavinicterus) with hyperemia (hemolytic) jaundice;
- green (verdinicterus) with subhepatic (mechanical) jaundice;
- dark olive (icterusmelas) with a very long cholesta.
You should remember about false jaundice due to the violation of carotene metabolism and its deposition in the skin (with diabetes, hypothyroidism, excessive consumption of carrots, oranges), as well as yellow staining of the skin due to acrychin, rivanol. In these cases, there is no sclera of the sclera, and the palms and soles are predominantly yellow.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]