Jaundice

The syndrome of jaundice is one of the most widespread syndromes of the digestive system pathology that based on the significant hyperbilirubinemia and bilirubin accumulation in the tissue and skin.

Etiology

Depending on the etiological factor there are the next forms of jaundice:

A. Exogenic (false) jaundice or xanthosis.

B. Endogenic (true) jaundice:

I. Suprahepatic (hemolytic):

1. Hereditary hemolytic anemia (talassemia, Minkovskogo-Shofara).

2. Acquired hemolytic anemia (autoimmune, posthemotransfusion).

3. Increased erythrocytes hemolysis on different diseases:

- infections;

- burns;

- tumors;

- hemorrhages (hematoms, infarctions);

- on diseases with deranged erythropoesis (B¹²-deficiency anemia, primary erythrocytosis, sideroplastic anemia).

II. Hepatic (parenchimatous):

1. Liver disease:

- different types of hepatitis;

- liver cirrhosis;

- tumor of the liver;

- Gilber's syndrome;

- Kriglera-Nayara syndrome;

- Dabina-Dgonsona syndrome;

- Rotor syndrome.

III. Subhepatic (mechanical):

1. Mechanical jaundice with tumor genesis:

- cancer of the pancreas;

- cancer of the major duodenal papilla;

- cancer of the bile bladder;

- cancer of the extra hepatic bile duels

2. Mechanical jaundice with non-tumor genesis:

- calculus cholecystitis.

Pathogenesis

Depending on the causes there are the next mechanisms of jaundice:

A. Exogenic (false) jaundice or xanthosis: xanthosis related with prolonged using of carotin (carrots), oranges, tangerines and administration of ethacridme lactate (rivanol), picric acid.

B. Endogenic (true) jandice:

I. Suprahepatic jaundice (icterus suprahepatica) occurs due to the excessive hemolysis of erythrocytes in the cells of the reticulohistocytic system (spleen, liver, bone marrow). Hemoglobin brakes down to the globin and hem. Bilirubin is formed from the released hem and accumulates in blood. Observe in malaria, sepsis, poisoning by hemolytic substances, inherited or acquired hemolytic anemia.

On suprahepatic jaundice - it is characterized by lemon-yellow tint, moderate intensity without itching of the skin and hematological signs of anemia and hyperbilirubinemia in suprahepatic jaundice: bilirubinemia - increased of total bilirubin mainly due to the unbound bilirubin.

II. Hepatic jaundice (icterus hepatica) occurs due to the damage of hepatocytes and disorders of their function (inversion of unbound bilirubin to bound), observe in acute and chronic hepatitis, poisoning and other liver diseases. On parenchymatous jaundice it is characterized by orange-yellow tint. In hepatic jaundice: bilirubinemia - increased of total bilirubin due to the unbound and bound fractions.

III. Subhepatic jaundice (icterus infrahepatica) occurs due to the accumulation of bilirubin (the product of gradual oxidation of bilirubin) resulted from partial or complete obstruction of the common bile duct in patients with stones in the gall bladder, cancer of the head of the pancreas, cancer of the major duodenal papilla. On obstructive jaundice - it is characterized by greenish-yellow tint, with early appearance of skin itching (may be before jaundice manifestation). In subhepatic jaundice - increased of total bilirubin mainly due to the bound bilirubin.