severe jaundice
Introduction
Introduction Astragalus, also known as yellow gallbladder, commonly known as yellow disease, is a symptom and sign of yellowing of the skin, mucous membranes and sclera due to elevated serum bilirubin. Certain liver diseases, gallbladder diseases, and blood diseases often cause symptoms of jaundice. Usually, when the blood bilirubin concentration is higher than 2-3 mg/dL (34-51), these parts will have a color that can be discerned by the naked eye. Recessive jaundice: 17~34, mild jaundice: 34~170, moderate jaundice: 170~340, severe jaundice: >340.
Cause
Cause
1. Hemolytic jaundice caused by excessive red blood cell destruction and excessive production of bilirubin.
2, hepatocellular carcinoma caused by abnormal bilirubin metabolism caused by hepatic jaundice.
3, mechanical obstruction of intrahepatic or extrahepatic bile duct system, affecting the excretion of bilirubin, leading to obstructive (obstructive) jaundice.
4, hepatocytes have certain congenital defects, can not complete the normal metabolism of bilirubin and congenital non-hemolytic jaundice.
Examine
an examination
Related inspection
Liver function test direct bilirubin total bilirubin (TBIL, STB) abdominal plain film
Physical examination
1. Yellow staining of tissues such as skin and sclera. When jaundice is deepened, urine, sputum, tears and sweat are also yellow-stained, and saliva generally does not change color.
2. The color of urine and feces changes.
3, gastrointestinal symptoms, often abdominal distension, abdominal pain, loss of appetite, nausea, vomiting, diarrhea or constipation and other symptoms.
4, the performance of bile saltemia, the main symptoms are: skin itching, bradycardia, abdominal distension, fat leakage, night blindness, fatigue, listlessness and headache.
Laboratory inspection
Biochemical and immunological cancer markers, such as carcinoembryonic antigen (CEA), CA19-9, ferritin, 1 antitrypsin, etc., contribute to the etiological diagnosis of cancerous obstruction, but are not specific. Blood: serum transaminase is generally not significantly increased, with mild or moderate elevation in secondary hepatocyte damage; serum bilirubin is significantly increased, up to 510/mol/L in complete biliary obstruction ( 30mg / dl) or more, wherein the combined bilirubin accounts for more than 35% (up to about 60%). Calculous jaundice is often fluctuating; cancerous jaundice is often progressively deepened, but those caused by ampullary cancer can cause a brief reduction in jaundice due to cancerous ulcers. Serum alkaline phosphatase (ALP), gamma glutamyltransferase (GT), cholesterol (bile acid and lipoprotein-X (LP-X), etc. were significantly increased. Urine: dark urine, urinary bilirubin positive , urinary bile reduced.
Image inspection
Abdominal X-ray, gallbladder and biliary angiography, abdominal B-ultrasound and abdominal CT, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC).
Diagnosis
Differential diagnosis
Neonatal jaundice may be physiological or pathological, although it is manifested as jaundice, but there is a difference between the two, which can be identified by the following characteristics.
Neonatal physiological jaundice is generally not deep and has the following characteristics:
1 Astragalus usually begins to appear 2-3 days after birth.
2 The jaundice gradually deepened and reached its peak on the 4th-6th day, and gradually eased later.
3 newborns born in full-term, jaundice usually disappears 2 weeks after birth, premature infants generally disappear 3 weeks after birth.
4 The degree of jaundice is generally not deep, the skin color is pale yellow, jaundice is often limited to the face and upper body. The general condition of the child is good, the body temperature is normal, the appetite is normal, the color of urine and urine is normal, and the growth and development are normal.
5 assay serum bilirubin exceeded normal 2mg / dl, but less than 12mg / d1. If the child's jaundice is the case, parents do not have to worry.
Pathological jaundice is caused by diseases, which causes abnormal metabolism of bilirubin. It occurs in a specific period of neonatal period, which makes physiological jaundice obviously aggravated and confused with physiological jaundice, which makes the diagnosis of jaundice difficult. . However, pathological jaundice has some characteristics that are different from physiological jaundice:
1 The appearance of jaundice is too early and appears within 24 hours after birth.
2 The jaundice disappeared too late, lasted too long, exceeded the normal regression time, or the jaundice had subsided and appeared again, or the jaundice gradually retreated after the rush hour and progressed progressively.
3 The degree of jaundice is too heavy, often affecting the whole body, and the skin mucosa is obviously yellow.
4 When checking serum bilirubin, bilirubin exceeds 12 mg/dl, or rises too fast, and rises more than 5 mg/dl per day.
5 In addition to jaundice, accompanied by other abnormal conditions.
Therefore, when a child has jaundice, if any of the above five aspects, it should be highly valued by parents, so that pathological jaundice can be found early for timely treatment.
