Sclerae and skin icteric

Ictericity (or jaundice) is a condition in which the skin, mucous membranes, and sclerae of the eyes become yellow in color. This is due to the accumulation in the skin and other tissues of the pigment bilirubin, which is formed when red blood cells (red blood cells) break down. Normally, bilirubin is eliminated from the body through the liver and biliary tract.

Icidity can be an important symptom that indicates problems in the body, so if it appears, you should see a doctor for diagnosis and to determine the cause. Treatment depends on the underlying condition that caused the condition.

Causes of the icteric

Here are some of the main causes of icterus:

1. Hepatitis: Liver diseases such as viral hepatitis (hepatitis A, B, C, etc.), as well as alcoholic hepatitis and other types of liver inflammation can increase bilirubin levels in the blood.
2. Gallstone disease: The presence of gallstones in the gallbladder or biliary tract can block the flow of bile and cause a buildup of bilirubin.
3. Hemolytic anemia: This is a condition in which red blood cells are destroyed faster than they are made. As a result, bilirubin is released into the blood in large amounts.
4. Liver cirrhosis: Long-term liver damage, including cirrhosis, may lead to impaired liver function, including bilirubin metabolism.
5. Genetic disorders: Rare inherited diseases, such as Gilbert syndrome and others, can cause abnormalities in bilirubin metabolism
6. Drug-induced liver damage: Some drugs, especially if used long-term or improperly, can cause liver damage and increased bilirubin levels.
   • Acetaminophen (paracetamol): Long-term and/or excessive use of acetaminophen may cause liver damage,.
   • Sulfonamides: Some antibiotics such as sulfamethoxazole, etc., may cause allergic hepatitis.
   • Tetracyclines: Prolonged use of tetracyclines can cause liver damage.
   • Methotrexate: This drug, used in the treatment of cancer and a number of other diseases, can cause liver dysfunction.
   • Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs): With prolonged and excessive use of NSAIDs, liver abnormalities may develop.
   • Amoxicillin/clavulanate (Augmentin): This antibiotic may cause allergic hepatitis and icterus.
   • Isotretinoin (Accutane): Using this medication to treat acne can cause liver damage.
   • Valproic acid medications (e.g., Depakote): Use of these medications to treat epilepsy and bipolar disorder may cause liver dysfunction
   • Allopurinol (Ziloric): The use of allopurinol to treat gout may cause liver abnormalities.
   • Statins: Some cholesterol-lowering drugs (such as atorvastatin) may cause liver damage.
   • Tranquilizers and some sleep medications: Prolonged use of some anxiolytic and sleeping medications can have adverse effects on the liver.
7. Biliary diseases: Various diseases of thebiliary tract, including cholecystitis and sphincter of Oddi dysfunction, can lead to impaired bile excretion and consequent icterus.
8. Pancreas: Diseases of the pancreas, such as pancreatitis, can affect the processing of bilirubin.
9. Dabin-Johnson and Rotor syndrome: These are rare genetic disorders that can cause chronic icterus.
10. Posthemorrhagic anemia in newborns: Newborns sometimes develop icteric anemia due to inadequate liver maturity and function.

Pathogenesis

Ictericity, or jaundice, is due to the accumulation of the pigment bilirubin in the body, which is formed as a result of the destruction of old red blood cells (red blood cells) and must be processed and eliminated from the body through the liver and biliary tract. Pathogenesismay be due to disorders of this process and includes the following main steps:

1. Red blood cell destruction: Normally, red blood cells have a limited lifespan and periodically undergo physical deterioration and are phagocytized (engulfed) by macrophages in the spleen and other tissues. In various pathologic conditions, such as hemolytic anemia, mechanical destruction of red blood cells, or other factors, red blood cell destruction may increase.
2. Bilirubin release: When red blood cells break down, hemoglobin (containing iron) is released and converted to bilirubin. This bilirubin is called unconjugated bilirubin and is unable to dissolve in water, making it insoluble in the blood.
3. Transport of bilirubin: Unconjugated bilirubin must be bound to blood proteins to become soluble and be transported to the liver.
4. Metabolism of bilirubin in the liver: In the liver, unconjugated bilirubin undergoes a conjugation process in which it binds to glucuronic acid and becomes conjugated bilirubin, which can be excreted through the bile.
5. Excretion of bilirubin: Conjugated bilirubin is excreted from the liver into the biliary tract and enters the gallbladder, from where it enters the intestine. In the intestine, the bilirubin is exposed to microorganisms and urobilin is formed, which gives the stool its characteristic yellow color. Normally, bilirubin is eliminated from the body through the intestines.

Ictericity occurs when any of the steps in the metabolism of bilirubin is impaired:

• Bilirubin production: Increased destruction of red blood cells, as in hemolytic anemia, can increase bilirubin levels.
• Bilirubin conjugation in the liver: Liver lesions such as hepatitis or cirrhosis may reduce the liver's ability to conjugate bilirubin.
• Bilirubin transport: Disturbances in the binding of bilirubin to blood proteins can increase free bilirubin levels.
• Bilirubin excretion: Diseases of the biliary tract, such as cholelithiasis or mechanical obstructions in the pathway of bile, can lead to bilirubin retention and upward bacterial degradation.

Understanding the pathogenesis of icterus is important for the diagnosis and treatment of the underlying disease causing this symptom.

Symptoms of the icteric

The following are the main symptoms of icterus:

1. Yellow skin discoloration: The skin turns yellow or yellow-orange, especially noticeable on the face, fingertips, soles and palms. Skin color can range from pale yellow to deep orange.
2. Yellow coloration of mucous membranes: Jaundice also appears on the oral mucous membranes, tongue and throat. The mucous membranes become yellowish.
3. Yellow eyes: The sclerae (whites of the eyes) turn yellow, which is especially noticeable in the area of the whites of the eyes.
4. Light-colored stools: Patients with icterus may have light, discolored stools due to insufficient amounts of bilirubin entering the intestines and staining the stools.
5. Dark urine: Although icterus is characterized by yellow staining, patients' urine may be dark or have a deep color. This is because unconjugated bilirubin (which has not been processed in the liver) is excreted through the kidneys and stains the urine.
6. General weakness and fatigue: Some patients with icterus may experience general weakness, fatigue, and loss of appetite.
7. Other symptoms: Depending on the underlying cause of the icterus, patients may also experience other symptoms associated with the disease causing the jaundice.

Symptoms may vary in severity depending on the degree of impaired bilirubin metabolism and the underlying cause of the symptom.

Forms

Ictericity can have different types depending on its mechanism of onset and where it occurs. Here are some of them:

1. Hemolytic: This type of ichthyroidism is associated with increased destruction of red blood cells (erythrocytes). In hemolytic ichthyroidism, the skin and mucous membranes become yellowish due to increased release of unconjugated bilirubin. Causes include hemolytic anemias and genetic disorders.
2. Hepatocellular: This type of hiccup is associated with liver malfunctions that result in bilirubin not being processed normally. It can be caused by liver diseases such as hepatitis, cirrhosis, fatty liver dystrophy and others.
3. Subobstructive (mechanical): In this case, the cause of icterus is a disruption in the normal outflow of bile from the liver into the biliary tract. A mechanical obstruction, such as a gallbladder stone or tumor, can block the normal flow of bile, leading to a buildup of bilirubin. This type is called subobstructive because it is associated with a mechanical obstruction in the biliary tract.
4. Posthepatic: This type of icterus is associated with impaired excretion of bile from the gallbladder into the intestine. It may be caused by a blockage of the bile ducts inside or outside the gallbladder, such as gallstone disease.
5. Neonatal: This type of icterus occurs in newborns and is often associated with the normal processes of transition from fetal life to life outside the mother's womb. Premature or sick newborns may develop a more serious form of neonatal icterus requiring medical intervention.

It is important to emphasize that any form of icterus requires medical evaluation and diagnosis to identify the underlying cause and prescribe appropriate treatment.

Diagnostics of the icteric

Diagnosis of icterus includes a number of clinical and laboratory methods aimed at determining the cause of this symptom and the degree of impairment of bilirubin metabolism. Here are the main methods of diagnosis:

1. Physical Examination: The physician performs a visual examination of the patient, paying attention to the color of the skin, mucous membranes and sclerae of the eyes. This allows the presence and degree of icterus to be assessed.
2. History: The doctor asks questions about medical and family history and possible risk factors that could explain the cause.
3. Clinical blood tests: Laboratory blood tests play an important role in diagnosis. They include the following parameters:
   • Total bilirubin: Measured to determine the level of bilirubin in the blood. High levels of unconjugated bilirubin may indicate hemolytic anemia or liver problems.
   • Direct (conjugated) bilirubin: This parameter assesses liver and biliary tract function. High levels of direct bilirubin may indicate biliary tract problems.
   • Total Protein: Measured to detect changes in protein levels in the blood, which may be associated with some liver diseases.
   • Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST): These enzymes are related to liver function. Elevated levels may indicate liver damage.
4. Abdominal ultrasound: Ultrasound can be used to visualize structures of the liver, gallbladder and bile ducts to help identify possible mechanical obstructions.
5. Computed tomography (CT) or magnetic resonance imaging (MRI): Theseimaging techniques are used to evaluate abdominal organs, including the liver, gallbladder, and pancreas, in more detail.
6. Liver biopsy: In some cases, it may be necessary to take a sample of liver tissue for a more accurate diagnosis and evaluation of the liver.

Diagnosis depends on a detailed review of the patient's medical history, clinical findings, and laboratory tests.

Differential diagnosis

Differential diagnosis consists of determining the cause of jaundice, ruling out other possible pathologies and establishing an accurate diagnosis. Here are some conditions that may manifest with icterus and require differential diagnosis:

1. Hepatitis: Viral hepatitis (hepatitis A, B, C, etc.) can cause hepatocellular icterus due to inflammation of the liver.
2. Gallstone disease: The formation of stones in the gallbladder or bile ducts can lead to mechanical (subobstructive) icterus.
3. Liver cirrhosis: Prolonged liver damage can lead to cirrhosis, which can cause hepatocellular icterus.
4. Alcoholic liver damage: Alcoholic liver damage can cause hepatocellular icteric disease.
5. Hemolytic Anemia: Hemolytic anemias, such as anemia associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency, may cause hemolytic icterus.
6. Porphyria: This is a group of genetic disorders of porphyrin metabolism.
7. Posthepatic icterus: Blockage of the biliary tract by gallstones, tumor, or stricture may cause subobstructive icterus.
8. Neonatal icturia: Neonates may experience icturia and a physiologic jaundice period that is distinct from more serious conditions.
9. Drug ichtericity: Some medications can cause ichtericity, especially with prolonged or improper use.
10. Alcoholic Hepatitis: This is an acute form of liver damage caused by alcohol and may manifest with hepatocellular icterus.

Differential diagnosis is performed using clinical and laboratory methods, such as blood tests, ultrasound, computed tomography, biopsy and others. This makes it possible to identify the underlying cause of this condition and prescribe appropriate treatment.

Treatment of the icteric

Treatment of icterus depends on the underlying cause of this condition. In most cases, treatment is aimed at eliminating the underlying condition. Here are some methods of treatment:

1. Treatment of the underlying condition: If the icterus is caused by hepatitis, gallstone disease, cirrhosis, hemolytic anemia, or other medical conditions, treatment is aimed at eliminating the underlying cause. This may include the use of antiviral medications, surgical removal of gallstones, treatment of anemia, etc.
2. Diuretics: In mechanical icterus caused by biliary tract blockage, medications to help improve bile excretion may be prescribed. This may include choleretic agents.
3. Phototherapy: Phot otherapy may be used in newborns with neonatal icterus, also known as "physiologic jaundice". This treatment involves exposing the skin to special light to help break down excess bilirubin in the blood.
4. Liver Transplantation: In cases of severe liver disease such as cirrhosis, liver transplantation may be a necessary treatment measure.
5. Drug treatment: In some cases, treatment of icterus may involve taking medications to improve liver function or reduce the level of bilirubin in the blood.

Treatment should be supervised by a physician who will determine the most appropriate treatment method based on diagnosis and evaluation of the patient's condition. Self-medication or improper treatment can be dangerous and can worsen the patient's condition.

Prevention

Prevention depends on its underlying cause. Here are some general measures that can help reduce the risk of icterus:

1. Vaccination: To prevent infectious diseases such as hepatitis A and hepatitis B, it is important to be vaccinated according to the recommendations of the vaccination program.
2. Avoiding alcohol: Alcohol consumption can harm the liver and contribute to various diseases, including cirrhosis. Limit your alcohol consumption or abstain from alcohol.
3. Healthy eating: A balanced diet that limits fat and cholesterol can reduce the risk of developing cholelithiasis and other diseases.
4. Avoiding contact with toxins: If you work with chemicals or toxic substances, follow safety rules and use protective equipment to minimize the risk of poisoning.
5. Chronic disease management: If you have a chronic condition such as diabetes or hyperlipidemia (high cholesterol), follow your doctor's recommendations and follow treatment guidelines to manage your condition.
6. Observe hygiene precautions: When working with infectious materials (e.g. In the medical field), observe hygiene precautions to prevent infection with an infection that could damage the liver.
7. Regular medical check-ups: Regular medical check-ups allow early detection and control of diseases that can lead to hiccups.

It is important to consult your doctor and follow his or her recommendations for prevention, especially if you have risk factors or a predisposition to developing liver or gallbladder related diseases.

Forecast

The prognosis of icterus depends on the underlying cause of the condition, the extent of organ damage, and the timeliness of treatment. In most cases, icterus can be successfully treated, especially if it is caused by temporary factors or infections such as hepatitis A.

The prognosis of chronic conditions such as cirrhosis or chronic viral hepatitis may be less favorable. In such cases, the icterus may recur and progress periodically, which may lead to deterioration of the liver and may even require liver transplantation.

For neonates with neonatal jaundice, the prognosis is usually favorable and the condition improves with age or phototherapy.

It is important to remember that proper diagnosis and treatment of the underlying disease causing the icterus play a crucial role in the prognosis. Patients with symptoms of jaundice should always see a physician for evaluation and treatment to determine the exact cause and develop a treatment plan to improve the condition.

Some popular books on gatroenterology and hepatology

1. "Yamada's Textbook of Gastroenterology" (Authors: Tadataka Yamada et al.) - This is one of the most authoritative guides to gastroenterology.
2. "Clinical Gastrointestinal Endoscopy" (Authors: Gregory G. Ginsberg et al) - A book about gastroenterologic endoscopy and diagnosis.
3. "Sleisenger and Fordtran's Gastrointestinal and Liver Disease" (Authors: Mark Feldman et al.) - A comprehensive guide to gastrointestinal and liver disease.
4. "Zakim and Boyer's Hepatology: A Textbook of Liver Disease" (Authors: Thomas D. Boyer et al.) - This is the authoritative guide to hepatology and liver disease.
5. "Hepatology: Diagnosis and Clinical Management" (Author: E. Jenny Heathcote) - A book covering the diagnosis and clinical management of liver disease.
6. "Oxford Textbook of Clinical Hepatology" (Authors: James S. Dooley et al.) - A comprehensive guide to clinical hepatology.

Literature used

Ivashkin, V. T. Gastroenterology. National guide / ed. By V. T. Ivashkin, T. L. Lapina - Moscow : GEOTAR-Media, 2018.