Hyperbilirubinemia - Symptoms and Treatment

hyperbilirubinemia Treatment primarily depends on its pathogenic variants, symptoms, and should be directed to treatment of the underlying disease that caused the symptoms of hyperbilirubinemia.Ballroom with symptoms of hyperbilirubinemia immediately hospitalized with a view to a final clarification of the diagnosis and active treatment.Exceptions to this rule are patients with Gilbert's syndrome with hyperbilirubinemia who specifically seek to reduce hyperbilirubinemia should not be.In these patients, the focus is on the prevention of the symptoms of liver disease, as well as a decrease in physical and neuropsychiatric loads.It is recommended for the treatment of hyperbilirubinemia full 4x meals a day 1 - 2 times a year, month course of treatment choleretic tea.

All other patients with hyperbilirubinemia prescribed diet № 5, wherein fats are restricted, but contains a sufficient amount of carbohydrates, proteins and vitamins.It is useful to drink plenty of liquids, especially mineral water ( "Borjomi"

, "Essentuki" number 4, number 17, and others.).The food should be at least 5 - 6 times a day for the treatment of hyperbilirubinemia.

hyperbilirubinemia - treatment in the clinic

mode hyperbilirubinemia patients should be bed or polupostelnym.Toxic effects of high concentrations of bilirubin with hyperbilirubinemia can be reduced by including in complex medical treatment of symptoms of hyperbilirubinemia drugs antioxidant action (tocopherol, ascorbate, cystamine, ionol et al.).In severe hyperbilirubinemia it is recommended to treat the symptoms intravenous glucose, sometimes in combination with subcutaneous injections of insulin;gemodez.

to prevent and treat the symptoms of hemorrhagic syndrome administered vitamin K, menadione, ascorbic acid, B vitamins, calcium chloride.When symptoms of parenchymal and intrahepatic hyperbilirubinemia due to immunological processes, carried out a relatively short course of treatment with glucocorticosteroids (12 - 30 days) in small doses (30 mg / day).

In the absence of mechanical symptoms of hyperbilirubinemia may be administered for the treatment of cholagogue (holosas et al.), And the presence of infection in the bile ducts - antibiotics for the treatment of hyperbilirubinemia.Bile can be improved by duodenal intubation.This symptom is a painful and persistent pruritus in patients with cholestatic jaundice facilitated by treatment with warm baths with vinegar, baking soda, carbolic acid;rubdown with a weak solution of carbolic acid or camphor alcohol.With the same purpose, you can assign the drug inside bromine, atropine, pilocarpine.

blood concentration of bile acids in the symptoms of hyperbilirubinemia can try to reduce, by acting on the mechanism of intestinal and hepatic circulation.To do this, patients are administered drugs that bind bile acids in the intestine - cholestyramine 12 - 16 grams per day, Bilignin 5 - 10 g (1 - 2 teaspoons) 3 times a day for 30 - 40 minutes before meals with water.Treatment of patients with obstructive jaundice is usually surgical.

Gilbert's syndrome in the treatment of symptoms of hyperbilirubinemia

Among fermentopaticheskih hyperbilirubinemia is the most common syndrome (disease) Gilbert and the adjacent Tracing syndrome (postgepatitny version of Gilbert's syndrome).This syndrome (disease) with symptoms of hyperbilirubinemia is more common in men in the second and third decades of life.Characterized by symptoms: periodic increase in the content of the plasma unconjugated bilirubin up to 85 - 140 mmol / l, and in most cases appears first in acute diseases of different nature (acute viral hepatitis, infectious mononucleosis, toxic liver disease of various etiologies, malaria, etc.), And aftersignificant physical or emotional stress, hypothermia, trauma, surgery, etc.

symptoms of hyperbilirubinemia due to inflammation (hepatitis, cirrhosis) or toxic (chemical poisoning, drug intolerance, etc.) hepatocellular lesions called hepatic (hepatocellular), or parenchymal.Damaged hepatocytes are not able to fully capture the bilirubin from the blood, bind to glucuronic acid and to allocate it to the biliary tract, and in need of treatment.

As a result, untreated, increases in serum content of unconjugated (indirect) bilirubin.In addition, for symptoms of degeneration of liver cells is reversed diffusion of conjugated (direct) bilirubin in the bile ducts and into the blood capillaries.This pathological mechanism causes an increase in serum levels of conjugated (direct) bilirubin, as well as the symptoms and reducing the isolation giperbilirubinurii stercobilin feces.

In total, in case of damage of the liver parenchyma cells in serum levels of unconjugated and conjugated bilirubin may rise to 4 - 10 times or more.When liver parenchymal lesions dramatically reduced ability of liver cells to capture bile acids from the blood, causing them to accumulate in the blood and are excreted in urine.

hyperbilirubinemia - symptoms

development of symptoms of hyperbilirubinemia

symptoms of hyperbilirubinemia occur with increased formation of bilirubin, as well as in violation of its transport in the liver cells and ekskretirovaniya these cells or in violation of the processes of binding free bilirubin (glucuronidation, sulfurizing and so on.d.).Free (unconjugated) bilirubin hyperbilirubinemia under slightly soluble and toxic;he detoxified in the liver by the formation of soluble diglucuronide - pairing of bilirubin with glucuronic acid (conjugated or direct bilirubin).

High concentrations of bilirubin with symptoms of hyperbilirubinemia inhibit oxidative phosphorylation processes and reduce the consumption of oxygen, leading to tissue damage and the need for treatment.Toxic effects of high bilirubin concentrations manifested symptoms of central nervous system, the emergence of foci of necrosis in the parenchymal organs, suppression of cell-mediated immune response and the development of anemia due to hemolysis of red blood cells and others.

symptoms of hyperbilirubinemia due to increased formation of bilirubin is noted in the excessive hemolysis (eg, in hemolytic anemiaduring hemolytic crisis, extensive hemorrhages, infarcts, lobar pneumonia).This form is called hyperbilirubinemia suprarenal or hemolytic hyperbilirubinemia.If it causes symptoms of jaundice, the latter has a similar name.

Pathogenic variants of jaundice

Skin Colouring

Itching

Bilirubin blood

urobilin urine

Bilirubin urine

stercobilin

conjugated

unconjugated

1. suprarenal (hemolytic)

Pale yellow with a hint of lemon

No

+

++++

++++

-

++++

2. Constitutional (fermentopaticheskaya)

Yellow

No

-

++++

++

-

+

3. hepatocellular (parenchymal)

orange, bright yellow

unstable, easily

++++

++

+++

++++

+

4. Cholestatic

4.1 .Vnutripechenochnaya (parenchymal cholestasis syndrome)

reddish-greenish

Steady agonizing

++++

++

+

++++

+ -

4.2.Subhepatic (mechanical, obstructive)

dark gray-greenish (earthy), turning into black

Steady agonizing

+++

+

+ -

++++

stage hemolysis hyperbilirubinemia

in the initial stage of hemolysis symptoms of hyperbilirubinemia can not be, because the liver is able to metabolize and excrete bilirubin in the bile is in excess of 3 - 4 times its products under physiological conditions.Above hepatic (hemolytic) hyperbilirubinemia develops when the exhausted liver reserve opportunities.With an average degree of hemolysis, hyperbilirubinemia symptoms are mainly due to unconjugated bilirubin, while massive hemolysis - unconjugated and conjugated bilirubin.The latter may cause giperbilirubinuriya symptoms.Unconjugated bilirubin does not penetrate healthy renal filter and does not appear in the urine.

Hyperbilirubinemia caused by genetic defects of liver enzymes involved in the elimination of plasma free bilirubin glucuronidation and called fermentopaticheskimi (constitutional).They usually occur without symptoms of liver damage, and haemolysis, are not accompanied by disability and are fatal if appropriate treatment.