Jaundice in infectious diseases

Jaundice (Greek icterus) - yellow staining of the skin and mucous membranes as a result of the accumulation of bilirubin in the blood serum and its subsequent deposition in tissues due to a violation of the dynamic balance between the rate of its formation and excretion.

Normally (in the Jendrashik method), the total bilirubin (total bilirubin) in serum is 3.4-20.5 μmol / l, indirect (unconjugated, or free) bilirubin - up to 16.5 μmol / l, direct ( conjugated, or bound) to 5.1 μmol / L.

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Causes of jaundice

The syndrome of jaundice develops in many infectious diseases, especially in icteric forms of acute viral hepatitis A, B, C and E. Acute viral hepatitis of mixed etiology (mainly viral hepatitis B and viral hepatitis D, other combinations are extremely rare) as well as with superinfection with hepatitis viruses in patients with chronic hepatitis.

Causes of jaundice

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Symptoms of jaundice

Superhepatic jaundice. The main sign is an increase in the content of indirect bilirubin in the blood. This makes it easy to distinguish it from the hepatic and jaundice. Superhepatic jaundice can be a consequence of:

• increase in the formation of bilirubin (hemolysis of erythrocytes);
• violations of bilirubin transport (disruption of binding with albumin);
• disturbance of metabolism (conjugation) of bilirubin in hepatocytes.

Symptoms of jaundice

Classification of jaundice

• On the mechanism of development:
  • suprahepatic (hemolytic);
  • hepatic (parenchymal);
  • hepatic (mechanical, or obturational).
• In terms of severity:
  • light (total bilirubin in serum up to 85 μmol / l);
  • moderate (total bilirubin 86-170 μmol / l);
  • expressed (total bilirubin above 170 μmol / l).
• By the duration of the current:
  • acute (up to 3 months);
  • protracted (from 3 to 6 months);
  • chronic (more than 6 months).

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Diagnosis of jaundice

Jaundice is an isolated symptom that is only considered in conjunction with the patient's complaints, other examination and examination data. Jaundice is most easily detected when examining a sclera in natural light conditions. Usually it occurs when the concentration of bilirubin in the blood serum is 40-60 μmol / l (exceeding the normal values by 2-3 times). The level of bilirubinemia indicates not the severity of the course of the liver disease, but the severity of jaundice.

An important role belongs to the epidemic anamnesis, which suggests a correct diagnosis already at the stage of the patient's interview. Find out its age, nature of work and occupational hazards. For a number of infectious diseases that occur with jaundice, travel to endemic regions, to rural areas, contacts with wild and domestic animals, soil, bathing in the water, hunting or fishing, etc. Are important. Be sure to find out the presence, nature and sequence of the appearance of concomitant clinical symptoms.

Diagnosis of jaundice

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Treatment of jaundice

Actually jaundice, especially caused by an increase in direct bilirubin, does not serve as an object of therapeutic measures. In contrast, indirect bilirubin, being a fat-soluble compound, can have a damaging effect on certain structures of the nervous system with a high lipid content. It can occur when the concentration of indirect bilirubin in the blood serum is more than 257-340 μmol / l. In premature infants, with hypoalbuminemia, acidosis, the appointment of a number of drugs that compete in the blood for their association with albumin (sulfonamides, salicylates), bilirubin has a damaging effect even at a lower concentration. Therapeutic measures aimed at reducing the intensity of jaundice, usually carried only to newborns and young children with a high content of unconjugated bilirubin in the blood serum (Krigler-Nayyar syndrome, etc.).

Treatment of jaundice