Cholestatic jaundice
Introduction
Introduction to cholestatic jaundice Cholestatic jaundice refers to the higher than normal values of bile acid and bilirubin in the blood due to cholestasis. The so-called cholestasis is caused by various harmful factors, such as hepatocyte excretion of bile dysfunction, inhibition of bile secretion, or intrahepatic and extra-biliary obstruction leading to slowing or stagnation of bile flow. Cholestatic jaundice is mainly caused by combined direct bilirubin. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: biliary cirrhosis, common bile duct stones, edema
Cause
Causes of cholestasis of jaundice
Tumor (30%):
Tumor is a disorder in which the body of a local tissue loses its normal regulation at the gene level under the action of various carcinogenic factors, resulting in abnormal clonal hyperplasia.
Stones (20%):
A solid mass formed in the lumen of a catheter or a luminal organ (such as the kidney, ureter, gallbladder, bladder, etc.) in a human or animal body. Mainly found in the gallbladder and bladder, renal pelvis, can also be found in the lumen of the pancreatic duct, salivary ducts, etc., can cause luminal obstruction, affect the discharge of fluids in the affected organs, resulting in pain, bleeding or infection and other symptoms.
Inflammatory stimuli (20%):
Inflammation is a very common and important basic pathological process. The traumatic infection of the surface and most common diseases and frequently-occurring diseases of various organs (such as sputum, sputum, pneumonia, hepatitis, nephritis, etc.) are all inflammatory diseases.
Parasitic infections (25%):
Parasite refers to an organism that lives most of its life in another animal, called a host or host, and at the same time causes damage to parasitic animals.
Prevention
Cholestatic jaundice prevention
Intrahepatic cholestasis of jaundice is a clinical syndrome caused by various causes such as infection, drug poisoning, and immune damage. Therefore, it is necessary to prevent the disease from these causes.
Complication
Cholestatic jaundice complications Complications, biliary cirrhosis, common bile duct stones, edema
Common in intrahepatic stones, tumor thrombus, parasitic diseases, primary biliary cirrhosis, common bile duct stones, tumors, aphids and inflammatory edema.
Symptom
Cholestatic jaundice symptoms Common symptoms Liver enlargement Loss of appetite, fatigue, skin, itching, scratch, carotene, chest itching, biliary obstruction, jaundice, skin itching
First, medical history and symptoms
The disease is characterized by obstructive jaundice and no visible intrahepatic biliary obstruction. It can be caused by various causes such as drugs, viral hepatitis, alcoholism, pregnancy, familiality, etc. Sample and loss of appetite, fatigue and other phenomena, the patient should pay attention to the cause of the patient's onset of the diagnosis, pay attention to the identification of obstructive jaundice caused by hepatic biliary obstruction.
Second, experience discovery
Astragalus, skin itching scratches, liver enlargement.
Examine
Examination of cholestatic jaundice
1. Biliary pigment test items:
(1) Serum bilirubin: When cholestasis of jaundice, direct bilirubin (DBIL) can not be excreted from hepatocytes and capillary bile ducts, resulting in a significant increase in serum bilirubin, total bilirubin (TBIL) up to 510mol / Above L, DBIL is dominant, DBIL and TBIL ratios are often above 60%, and the highest is up to 90%. Calculous jaundice is often fluctuating, and cancerous obstruction is progressive jaundice, but ampullary carcinoma can cause a brief reduction in jaundice due to cancer ulcers.
(2) urinary bilirubin: when cholestasis of jaundice, cholestasis increases the intrahepatic bile duct pressure, leading to rupture of the capillary bile duct, DBIL can not be discharged into the intestine and reverse flow into the blood is discharged from the urine, so the urinary bilirubin test is positive.
(3) urinary biliary tract: cholestasis of jaundice due to intrahepatic and extrahepatic cholestasis, bile discharge into the intestine is blocked, intestinal bilirubin is reduced, the intestinal biliary circulation and leakage of the entry vein bilirubin is also reduced, so urine Reduced biliary discharge.
(4) Fecal gallbladder: In the case of cholestasis of jaundice, due to the reduction of bile discharged into the intestine, the fecal biliary tract is significantly reduced or completely absent, causing a decrease in fecal bilirubin which stays in the intestinal tract for further oxidation, making the fecal color lighter or even It is white clay color, which is characteristic of extrahepatic cholestasis.
2. Other liver function tests:
(1) Serum alkaline phosphatase (ALP): serum ALP activity is obviously increased early in the case of stasis jaundice, even up to 10 to 15 times the upper limit of the reference value.
(2) Serum -glutamyltransferase (GGT): When biliary diseases such as cholelithiasis, biliary tract inflammation, and extrahepatic obstruction, GGT not only has a high positive rate, but also increases significantly, which can be as high as 5 to 30 times the upper limit of the reference value. This contributes to the differential diagnosis of hepatocellular jaundice and cholestatic jaundice.
(3) Serum total bile acid (TBA): Serum TBA assay has high sensitivity for the diagnosis of extrahepatic bile duct obstruction and intrahepatic cholestasis, including biliary obstruction, biliary cirrhosis, neonatal cholestasis, and gestational cholestasis. TBA in serum can be significantly increased.
(4) Serum 5'-nucleotide (5'-NT): 5'-NT increase is mainly seen in hepatobiliary diseases, but 5'-NT activity is significantly increased in cholestatic jaundice, generally 2 to 3 times that of normal people. This helps differential diagnosis of hepatocellular jaundice and cholestatic jaundice. In extrahepatic biliary obstruction, 5'-NT activity is generally parallel with ALP, but 5'-NT activity does not generally increase in short-term obstruction. When longer-term obstruction is removed, 5'-NT activity decreases faster than ALP. .
Diagnosis
Diagnosis and identification of cholestasis jaundice
diagnosis:
The following clinical features can be considered as cholestatic jaundice:
1. The concentration of bilirubin is gradually increased, generally around 171/mol/L (10mg/dl), and not more than 256.5mol/L (15mg/dl), and individual may exceed 513mol/L (30mg/dl). Among them, the combination of elevated bilirubin, accounting for serum total bilirubin >60%.
2. Urinary bilirubin is positive, and urinary biliary tract is reduced or disappeared.
3. The urinary biliary tract in the feces is reduced or absent. If the obstruction is caused by cancer around the ampulla, the feces may be black or occult blood positive due to bleeding.
4. Liver function test: The most obvious is the increase of alkaline phosphatase and -glutamyl transferase. Serum total cholesterol can be elevated, lipoprotein-X can be positive, long-term obstruction can increase serum transaminase and albumin decline, such as vitamin K deficiency can prolong prothrombin time, such as injection of vitamin K can make prothrombin time correct.
5. Other examinations: B-ultrasound and other tests are helpful for the diagnosis of cholestasis jaundice.
Differential diagnosis:
1. Hemolytic jaundice:
Because red blood cells are destroyed in a short time, the released bilirubin greatly exceeds the processing capacity of liver cells and jaundice occurs. The increase in serum bilirubin is dominated by indirect bilirubin. Such as neonatal jaundice, falciparum malaria or jaundice caused by improper blood transfusion, belong to this category. The latter may have symptoms of chills, fever, headache, muscle aches, nausea, vomiting, urine, soy sauce color, hemoglobinuria, but no bilirubin in the urine.
2. Hepatocyte jaundice:
Due to extensive damage to liver cells, the ability to treat bilirubin is reduced, resulting in the accumulation of unbound (indirect) bilirubin in the blood; at the same time, due to obstruction of bile excretion, direct bilirubin in the bloodstream is also increased. As the indirect and direct bilirubin in the blood increased, urinary bilirubin and urinary bilirubin also increased. Hepatitis caused by hepatitis and cirrhosis belongs to this category.
3. Obstructive jaundice:
Obstruction of bile excretion (can be caused by intrahepatic or extrahepatic lesions, often biliary obstruction), direct bilirubin in the gallbladder reverses into the blood and jaundice. Clinically, an increase in direct bilirubin levels in the serum can be detected, urinary bilirubin is positive and urinary biliary tract is reduced or disappeared. Because bile substances such as bilirubin are retained in the body, it can cause itching and bradycardia. The jaundice caused by cholelithiasis, tumors, etc., which oppresses the biliary tract, belongs to this category.
