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Factors determining the severity of jaundice
Last reviewed: 23.04.2024
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Even with complete obstruction of the biliary tract, the severity of jaundice can vary. Following a rapid increase in serum bilirubin level after about 3 weeks begins to decrease, even if obstruction persists. The severity of jaundice depends both on the production of bile pigment, and on the excretory function of the kidneys. The rate of formation of bilirubin from the heme may vary; it is possible to produce, in addition to bilirubin, other products that do not enter diazorection. Bilirubin, mostly unconjugated, can also be excreted from the serum of the intestinal mucosa.
With prolonged cholestasis, the skin acquires a greenish shade, probably due to the deposition of biliverdin, which does not participate in diazo reaction (Van den Berg), and possibly other pigments.
Conjugated bilirubin, which can dissolve in water and penetrate body fluids, causes more jaundice than unconjugated. The extravascular space of the body is larger than the intravascular space. Therefore, hepatic-cellular and cholestatic jaundice is usually more intense than hemolytic jaundice.
There are the following types of jaundice:
- Superhepatic (hemolytic).
- Hepatic (parenchymal).
- Subhepatic (mechanical).
With superhepatic jaundice, the erythropoietic system is primarily affected, there is an increased disintegration of erythrocytes, hyperproduction of bilirubin and insufficient capture by its liver.
In hepatic jaundice, the pathological process is localized in hepatocytes, cholangiols, there is an isolated or combined violation of the capture, conjugation and excretion of bilirubin from liver cells.
With subhepatic jaundice, the pathological process is localized in the extrahepatic bile ducts, bilirubin is excreted through the bile ducts with its entry into the blood, and there is a decrease in the excretion of the pigment from the hepatocytes.
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