Jaundice, hepatitis and cirrhosis of the liver - symptoms, diagnosis and treatment

Author:

Nikonov Mikhail Yurievich

3.00 (Votes: 3)

Many of us begin to think about the state of our health only when we hear an alarm bell from it, or even several. This also applies to the liver, the hottest organ of our body, which bears special responsibility for numerous and very important processes occurring in it.

For example, our liver courageously takes on the first “blow” of toxic substances, allergens and other substances that are unsafe for us (including metabolic products), practically transforming them into safer ones and ready for elimination from the body. It also comes with an excess of hormones, vitamins and other elements that are beneficial to us in normal doses.

On the other hand, the liver accumulates reserves of useful substances (for example, glycogen, vitamins and microelements) to regulate carbohydrate metabolism and a large amount of blood (in case of emergency compensation for blood loss). The liver also synthesizes hormones and enzymes, blood plasma proteins, cholesterol and lipids, bile (including the specific pigment bilirubin), without which our body simply could not exist.

What is jaundice

First of all, by jaundice we should not mean a specific disease (for example, hepatitis, as many people think), but a whole symptomatic complex that arises as a result of pathological processes in the liver and some organs. Essentially, jaundice is an excess amount of bilirubin in the body, which is externally manifested by the sclera, mucous membranes and skin becoming yellow.

Normally, bilirubin is formed in the liver and spleen from hemoglobin as a result of the breakdown of red blood cells, after which it is converted by the liver into bile and excreted from the body. With jaundice, the normal process of conversion and excretion of bilirubin is disrupted, so it remains almost completely in the blood, slightly excreted through the kidneys and skin.

People with:

neoplasms in the liver;
congenital anomalies of the bile ducts;
pathological processes in the liver and gall bladder;
the presence of parasitic organisms;
postoperative complications;
post-reaction to certain medications.

Jaundice

Hepatitis

22670 November 26

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Jaundice: causes of occurrence, what diseases it occurs with, diagnosis and treatment methods.

Definition

Jaundice is a condition in which the skin and mucous membranes turn various shades of yellow. Moreover, not in all cases this indicates pathological processes in the body.

Types of jaundice

There are false and true jaundice. False jaundice occurs when carotenes accumulate in the skin due to excessive consumption of carrots, beets, oranges, pumpkin, or when certain drugs are ingested (acriquine, picric acid, etc.).

True jaundice is a consequence of an increase in the concentration of total bilirubin in the blood plasma.

Jaundice discoloration of the skin and icterus (yellow pigmentation) of the sclera occur when the concentration of total bilirubin in the blood plasma is more than 35-45 µmol/l. The milk of nursing women, pleural and pericardial effusion, ascitic fluid, and semen may have a yellow tint.

The clinical picture and duration of true jaundice depend on the underlying disease, against the background of which an increase in blood bilirubin developed.

There are:

1. Hemolytic (prehepatic) jaundice:

jaundice due to genetic diseases (hereditary microspherocytosis, hereditary stomacytosis, etc.);
autoimmune (acquired) hemolytic anemia.

2. Parenchymal (hepatic) jaundice:

caused by infectious diseases (viral hepatitis A, B, C, D, E; herpetic hepatitis, cytomegalovirus hepatitis, yellow fever, infectious mononucleosis, relapsing fever, intestinal yersiniosis, psittacosis, leptospirosis, salmonellosis, pseudotuberculosis, etc.);
caused by non-infectious diseases (acute alcoholic hepatitis, drug-induced hepatitis, liver cirrhosis, poisoning with oxidizing agents based on nitric acid, hydrazine and its derivatives, chloroethane, ethylene glycol).

3. Constitutional jaundice
(Gilbert syndrome, Crigler–Najjar syndrome, Dabin–Johnson syndrome, Rotor syndrome).

4. Mechanical (subhepatic) jaundice

occur against the background of cholelithiasis, cholangitis, cicatricial strictures of the extrahepatic bile ducts, cancer of the head of the pancreas, major duodenal papilla, and gall bladder.

Hemolytic jaundice is characterized by moderate manifestations, lemon staining of the skin, sclera and mucous membranes, a slight enlargement of the liver and often a noticeably enlarged spleen. Anemia is observed.

In acute viral hepatitis, dull aching pain in the right hypochondrium and in the joints is disturbed, the temperature rises, appetite decreases, and the patient experiences weakness. Yellowness of the skin, dark urine and insufficiently colored feces appear. There may be bruises on the skin as a result of hemorrhages. Skin itching is not typical for acute viral hepatitis, since sufficient evacuation of bile through the bile ducts is ensured. When interviewing a patient, it is possible to identify a risk factor for developing the disease (contact with patients with hepatitis, recent surgical operations, blood transfusions, injections and manipulations associated with damage to the skin and mucous membranes).

With obstructive jaundice, the clinical picture may begin acutely or develop gradually.

With the acute onset of the disease (cholelithiasis), colicky pain suddenly appears in the right hypochondrium radiating to the right and to the back, chills, and fever. Then jaundice and skin itching occur. With the gradual development of the disease (cancer of the head of the pancreas), the patient may be bothered by moderate dull or pressing pain under the right costal arch, nausea, belching, and weight loss. Palpation of the abdomen reveals pain in the right hypochondrium. The yellowness of the skin gradually increases, the urine becomes dark in color, the feces become lighter, as less bilirubin is released into the intestines.

Constitutional jaundice is characterized by moderately severe intermittent (periodic) jaundice. Selective staining of the skin of the face, nasolabial triangle, palms, soles and axillary fossae is noted. Jaundice occurs or worsens after physical or mental stress, exacerbation of a concomitant disease, or alcohol intake. The liver and spleen do not increase in size.

As a result of long-term toxic effects of high concentrations of bilirubin on the body, damage to the central nervous system develops, foci of necrosis form in parenchymal organs, the cellular immune response is suppressed, and anemia occurs. Children may experience serious complications: kernicterus, mental retardation, cerebral palsy.

Possible causes of jaundice

True jaundice is the result of an imbalance between the formation and excretion of bilirubin. The cause of this disorder may be increased formation of bilirubin (hemolytic jaundice), a failure in its transportation to liver cells and excretion by these cells, as well as deterioration in the binding processes of free bilirubin (parenchymal jaundice). Obstructive jaundice occurs as a result of deterioration in the secretion of bilirubin through the extrahepatic ducts.

The basis of the mechanism of development of hemolytic jaundice

lies hemolysis (increased destruction of red blood cells), when the life span of red blood cells is significantly shortened, sometimes to several hours. Hemolysis can be intravascular and extravascular. Intravascular hemolysis occurs as a result of mechanical destruction of red blood cells in small blood vessels (marching hemoglobinuria), turbulent blood flow due to dysfunction of prosthetic heart valves, as a result of incompatibility of red blood cells in the AB(0), Rhesus or any other system, due to direct toxic effects ( snake venom), etc.

Extravascular hemolysis occurs in the spleen and liver as a result of the capture and destruction of altered red blood cells. The spleen is capable of capturing and destroying slightly altered red blood cells, the liver – red blood cells with major disturbances.

Hepatic (parenchymal) jaundice

are caused mainly by damage to hepatocytes (liver cells). In some cases, this syndrome is associated with damage to liver cells and stagnation of bile, for example, in acute and chronic viral hepatitis. In others, the release of bilirubin is impaired (with cholestatic jaundice, cholestatic hepatitis, primary biliary cirrhosis).

Obstructive (mechanical) jaundice occurs when there is a disturbance in the outflow of bile through the extrahepatic bile ducts.

, enzymopathic or constitutional jaundice occurs

. The most common is Gilbert's syndrome, which develops against the background of impaired uptake of free bilirubin and its binding to glucuronic acid due to deficiency of the enzyme glucuronyltransferase.

In 60-80% of newborns, yellowness of the skin is observed, which appears on the 2-3rd day of life.

Jaundice in newborns can be caused by a high release of red blood cells during childbirth, a high content of fetal hemoglobin, rapid destruction of bilirubin after birth, and a deficiency of conjugating enzymes in the liver. In this case, the rise in bilirubin levels does not reach critical values, and the child’s condition remains satisfactory.

Breast milk jaundice (jaundice from mother's milk) is not considered a pathology and is associated with the baby's body's reaction to the fats contained in breast milk. This condition develops on the 3rd-7th day after birth, when the baby already receives a sufficient amount of mother’s milk. Stopping breastfeeding for 24-48 hours leads to a sharp decrease in bilirubin and a decrease in the severity of jaundice. If the baby continues to receive breast milk, jaundice persists for 4-6 weeks, then gradually decreases - the condition of the skin and mucous membranes returns to normal by the 12-16th week of life.

Hemolytic disease of newborns is caused by incompatibility of the blood of mother and fetus for various antigens, when the body of a pregnant woman produces antibodies that penetrate the placental barrier into the blood of the fetus and cause destruction (hemolysis) of its red blood cells. The intensity of jaundice depends on the level of bilirubin - when critical numbers are reached, this enzyme can affect neurons in the brain, resulting in the development of bilirubin encephalopathy (kernicterus).

Which doctors should I contact?

If jaundice appears, to clarify the diagnosis and determine further treatment tactics, the patient should consult a general practitioner, or if the patient is a child. In the future, a consultation with a hematologist, an infectious disease specialist, may be indicated.

Diagnosis of jaundice

To determine the cause of jaundice, a set of laboratory and instrumental examination methods is performed (according to indications):

clinical blood test with determination of hemoglobin concentration, number of erythrocytes, leukocytes and platelets, hematocrit and erythrocyte indices (MCV, RDW, MCH, MCHC), leukoformula and ESR (with microscopy of a blood smear in the presence of pathological changes);

Types of jaundice

Depending on the reasons that caused jaundice, it is divided into forms:

physiological (neonatal) - usually occurring in newborns (more often in weakened or premature infants) due to the adaptation of an immature enzyme system to new environmental conditions;
parenchymal (liver) - usually occurring when the structure and function of liver cells (hepatocytes) are disrupted due to neoplasms and drug effects on the liver, or hepatitis or cirrhosis;
hemolytic (suprahepatic) - usually occurring when red blood cells are destroyed and indirect bilirubin increases in anemia, lymphocytic leukemia, lymphosarcoma or tropical malaria;
conjugation – usually occurring when the liver is exposed to provoking factors and congenital pathologies;
mechanical (subhepatic) - usually occurring when direct bilirubin increases due to the inability to remove it through bile ducts blocked (by stones, tumors or helminths).

According to the duration of its course, jaundice is divided into:

spicy;
protracted;
chronic.

Consequences of jaundice

In most cases, physiological jaundice goes away completely without causing any harm to the child. Consequences can develop only after pathological forms of jaundice - with insufficient or incorrect treatment. In such cases, children may be delayed in development and suffer serious damage to the nervous system.

Children who have suffered any form of pathological jaundice must be observed by a pediatrician and a pediatric neurologist!

The Healthy Family Clinic offers a rental service for a special phototherapy lamp, which is used to treat jaundice in newborns at home. Taking into account the need for special care and care for the newborn, the mobile device allows you to reduce the level of bilirubin without disrupting the baby’s daily routine. Unlike traditional equipment, modern technology has many advantages:

Safety for the life and health of the baby: the combination of green and blue rays prevents overheating of the body and also does not have a negative effect on the child’s eyes;
Compactness and mobility: the device weighs no more than three kilograms and has an ergonomic fiber-optic cushion, which allows you to transport equipment at home;
Easy to use: the photo lamp has a timer and a safety thermostat, so it automatically controls the duration of the procedure and the intensity of radiation!
All permits and certificates;
Free delivery throughout Yekaterinburg! Delivery throughout the Sverdlovsk region is possible.

The basis for using a photolamp is the recommendation of a pediatrician. During an individual consultation, the doctor will determine the intensity, duration, and also establish a procedure scheme.

In addition, the baby’s parents can order an express test to measure bilirubin levels at home. A healthcare professional will help parents install and use the lamp correctly.

Diagnosis of jaundice

Typically, the danger is not caused by jaundice itself, but by the pathologies that caused it. As a result of intoxication of the body with bilirubin, a serious failure of its various systems can occur, and in young children - mental retardation. Therefore, accurate diagnosis of this condition is so important, for which they carry out:

comprehensive ultrasound of the abdominal cavity and retroperitoneal space;
laboratory blood tests (general and biochemical blood tests);
liver functional studies;
liver biopsy.

Why does the symptom appear?

The main causes of jaundice are viral infections. Also, this phenomenon can occur due to various pathologies of the liver and biliary tract.

Symptoms in adults occur when the outflow of excess bilirubin from bile is disrupted and liver dysfunction develops. Thus, bilirubin enters directly into the bloodstream. This leads to a yellow coloration of the skin and mucous membranes. The patient also complains of severe skin itching.

Jaundice can result from the rapid breakdown of red blood cells. It also often occurs as a reaction to taking certain medications.

With unexpressed symptoms of jaundice, the color of urine practically does not change. When jaundice becomes obvious, the urine may turn bright yellow or dark brown.

What is hepatitis

Hepatitis is an inflammatory process in the liver under the influence of a provoking (in most cases viral) agent, causing damage to its tissues.

Today, hepatitis is considered one of the most common infectious diseases after ARVI, influenza and chickenpox. Most often, the disease is diagnosed in young people aged 15-30 years (especially those prone to unprotected sex and drug use), another “risk group” is usually represented by medical specialists who have direct contact with blood (including infected people).

Consequences for children, infants

Most often, yellowing of the skin in infancy does not cause health problems.

In infants, jaundice manifests itself as a bright yellow coloration of the skin and mucous membranes. This disease occurs in many newborns. It requires careful medical monitoring of the baby so that jaundice does not turn into a pathology with serious consequences.

In most newborns, jaundice is a physiological phenomenon. It often resolves naturally without treatment or complications. But in certain cases, pathological jaundice develops. In this case, the baby’s condition worsens and he may require medical attention.

Consequences for newborns:

development of albuminemia due to a decrease in the amount of albumin due to high bilirubin in the blood;
toxic poisoning of the body;
the development of kernicterus, which leads to convulsions, development of deafness in the newborn and mental retardation;
involuntary muscle contractions and loss of motor control.

If the diagnosis is not made in a timely manner and treatment is prescribed, the consequences can be very serious.

What are the symptoms of hepatitis

It must be remembered that the symptoms of hepatitis can be vivid, but sometimes they can be almost completely absent (giving time for the undetected disease to become chronic). However, quite often all types of hepatitis are characterized by common symptoms of any intensity:

jaundice;
change in urine color (darkening to brown)
pain (often pressing) in the liver area;
indigestion (nausea, vomiting with a bitter taste, diarrhea or constipation);
weakness and increased fatigue;
increased body temperature and headache;
skin itching;
increased liver size.

Hepatitis classification

In its form, hepatitis can be acute or chronic.

Depending on the provoking factor, hepatitis is divided into:

infectious (caused by viruses or bacteria);
toxic (when the body is poisoned with alcohol, chemicals or drugs);
autoimmune (caused by autoimmune pathologies);
radiation (for example, as a consequence of radiation therapy).

Viral hepatitis, in turn, is divided into types (depending on the virus that provokes the disease):

hepatitis A (Botkin's disease) - transmitted through contaminated food and water, with an incubation period of 2-6 weeks, after the disease giving lifelong immunity to this type;
hepatitis B - transmitted through unprotected sexual contact and through open access to blood (at home, dentistry, cosmetology, etc.) using unsterilized instruments, with an incubation period of 1.5-6 months, the duration of the acute disease is from 6 to 8 weeks (with recovery in 90% of cases) and rare transition to chronic;
hepatitis C is the most dangerous type, transmitted in the same way as hepatitis B, but with almost unnoticeable symptoms, which is why the disease can proceed unnoticed by the patient for years in a chronic form, leading to cirrhosis and liver cancer;
hepatitis D – transmitted in the same way as hepatitis B and C, but developing only after infection with the hepatitis B virus, easily becoming chronic and ending in cirrhosis of the liver;
hepatitis E is transmitted in the same way as hepatitis A, with similar symptoms, usually common in African and Asian countries.

Prevention measures

Avoiding hepatitis A infection is much easier if you follow certain rules.

Measures to prevent jaundice:

compliance with personal hygiene rules;
monitor the timely cleaning of premises where people live and work;
vegetables, berries, fruits must be washed thoroughly;
limit swimming in open waters;
Use purified or boiled water for drinking and cooking.

Vaccination is recognized as the most effective way to prevent hepatitis A, which protects against jaundice for up to 20 years. The vaccine is safe and is given twice.

When holidaying in developing countries where sanitary conditions are poor, you need to be careful. It is not recommended to drink water, eat food that is prepared in poor sanitary conditions, wash raw vegetables and fruits thoroughly, and it is better to peel them.

What is liver cirrhosis

Liver cirrhosis is a pathological and chronic process in the liver, as a result of which its parenchymal tissue is replaced by fibrous connective tissue (stroma). There is also a structural restructuring of the vascular bed and a decrease in the number of normally functioning hepatocytes (liver cells).

According to statistics, the global annual mortality rate from cirrhosis is about 300 thousand people, with a progressive upward trend. The disease most often affects men over 40 years of age, those prone to alcoholism, as well as patients with:

chronic hepatitis B, C and D;
pathologies complicated by fatty hepatosis;
some hereditary diseases (for example, hemochromatosis);
some autoimmune diseases;
toxic liver damage from chemicals.

What are the symptoms of cirrhosis

Symptoms of cirrhosis may be completely absent for quite a long time, or appear slightly. Most often, the disease can begin to manifest itself:

increased fatigue and decreased mental activity, weakness and irritability;
indigestion (a feeling of bitterness in the mouth, nausea and vomiting, flatulence and upset stool), especially in the morning;
pain in the right hypochondrium (increased after drinking alcohol or fatty foods, as well as during physical activity);
increased bleeding in the mucous membranes and subcutaneous hemorrhages (with characteristic spider veins at the top of the body and redness of the palms);
itchy skin and aching joints.

A long-term progressive disease is also characterized by:

decrease in body weight and muscle volume;
“protrusion” of the abdomen (against the background of thinning limbs with thickening fingertips) with an enlarged liver and spleen, ascites;
painful swelling of the joints;
jaundice;
decreased sexual function and secondary sexual characteristics.

Symptoms of jaundice in adults and children

The first symptoms of hepatitis A can be confused with a cold and the first stage of the disease can be missed.

Signs of jaundice at the first stage:

increased temperature, accompanied by fever, chills, which can last more than a week;
general weakness;
a feeling of aching in the muscles and bones is created;
the appearance of insomnia and other sleep disorders;
loss of appetite;
nausea and vomiting appear;
pain under the rib on the right;
discomfort in the stomach.

A distinctive sign of jaundice is pain under the rib on the right.

2-3 days after the first signs appear, the symptoms of hepatitis A become more pronounced, which are difficult to confuse with other diseases.

Symptoms of the icteric period:

darkening of urine;
the sclera of the eyes turn yellow;
yellowing of the skin;
Feces become discolored during defecation.

If you haven’t consulted a doctor before, you should definitely do so at this time.

Diagnosis of cirrhosis

Diagnosis of the disease is based on the results of a comprehensive examination of the condition of the liver and organic systems most closely related to its work, as well as establishing the causes of cirrhosis. To do this:

comprehensive ultrasound of the abdominal organs and retroperitoneal space (kidneys and adrenal glands), as well as portal vessels;
laboratory blood test (including biochemical, for the presence of hepatitis viruses, as well as a coagulogram);
esophagogastroduadenoscopy to identify dilated veins of the esophagus;
liver biopsy and scintigraphy.

Causes of the disease

In regions with poor sanitation conditions, the percentage of reported cases of hepatitis A is much higher.

The main causes of jaundice:

violation of personal hygiene rules;
poor sanitation;
ingestion of contaminated vegetables and fruits;
drinking contaminated water;
contact with a sick person;
being in places with large crowds of people.

Hepatitis A is most common in developing countries. In regions with developed economies, preventive measures and vaccination of the population are being carried out.

Treatment of cirrhosis

Typically, treatment of liver cirrhosis is aimed at stopping (in the initial stages of the disease) or slowing down progressive pathological processes. Conservative therapy is strictly individual and often consists of:

taking medications (hepatoprotectors);
following a diet (with the obligatory exclusion of alcohol, fatty and canned foods);
excluding physical and emotional overload.

Treatment of end-stage cirrhosis can only be associated with liver transplantation.

It must be remembered that only a preventive comprehensive ultrasound of the abdominal organs in most cases can help to recognize pathological changes in the liver in time, even before the first symptoms appear! Save your health!

Consequences and prognosis for obstructive jaundice

The prognosis will be favorable in cases where the treatment of jaundice was timely and correct. The behavior of the patient himself is also of great importance. If you adhere to the principles of proper nutrition and strictly follow all the doctor’s instructions, the risk of relapse or complications will be minimal. Otherwise, the likelihood of recurrent obstructive jaundice will be very high. In addition, the risk of developing concomitant diseases, for example, liver failure, liver cirrhosis, encephalopathy, sepsis, etc., will increase.