Eng / JAUNDICE
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Differential diagnosis of jaundice Acute liver failure
Lecture for 5th year students of the Faculty of Medicine Associate Blazhnaya L.P.
Jaundice
–staining of the skin and mucous membranes in yellow due to the accumulation of the bilirubin pigment in the blood serum and its subsequent deposition in the tissues due to a violation of the dynamic balance between the rate of its formation and excretion.
Causes of icteric coloration of the skin -
deposition in the tissues of chemicals (acrikhin)
- excess intake of carotene (carrot, orange)
Violation of the metabolism of bilirubin, an increase in bilirubin in the blood serum (true jaundice).
Scheme of pigment metabolism is normal
1 hemoglobin breakdown
the formation of free fat-soluble bilirubin
2.its accumulation in the space of Disse and capture by hepatocytes
3. connection of bilirubin with glucuronic acid and transformation into water-soluble bound bilirubin
Scheme of pigment metabolism is normal
4.excretion of bound (direct) bilirubin through the biliary pole of the hepatocyte into the lumen of the bile capillary
5. entry through the biliary tract into the lumen of the duodenum - the conversion of bound bilirubin into stercobilinogen and urobilinogen, its absorption in the intestine and trapping by hepatocytes with excretion into the bile capillaries.
The normal amount of bilirubin in the blood (according to the Yendrashik method):
total bilirubin -3.4 -20.5 µmol / l, indirect bilirubin - up to 16.5 µmol/l direct bilirubin -0-5.1 µmol/l
On examination, jaundice is detected at a bilirubin level of -40-60 µmol / l (2-3 norms)
Types of jaundice according to the mechanism of pigment metabolism disorders
suprahepatic (hemolytic)
Parenchymal (hepatic)
Subhepatic (mechanical)
suprahepatic (hemolytic)
Result:
increased breakdown of red blood cells
increased production of bilirubin
insufficiency of the function of capturing bilirubin by the liver.