Recently, many patients have been asking about unexplained bilirubin elevation, but what can cause it?
Elevated bilirubin is commonly seen in the following conditions.
1, hepatocellular jaundice
Hepatologists so first mention this condition, various liver diseases, such as viral hepatitis, drug-related liver disease, autoimmune hepatitis, genetic metabolic liver disease can cause bilirubin elevation. Cirrhosis and liver cancer can also cause elevated bilirubin.
Hepatocellular jaundice is characterized by elevated direct and indirect bilirubin, and other liver enzymes may also be elevated, and if liver function is not compensated, the white/globule ratio may be inverted. In patients with liver failure, bilirubin can often be greater than 171 μmol/l. Moreover, the level of bilirubin can reflect the degree of liver damage, and this type of jaundice is mainly treated with etiology and liver protection.
2, hemolytic jaundice
The so-called hemolytic anemia can be understood as red blood cells break down and the hemoglobin inside becomes bilirubin after metabolism. Hemolytic jaundice is characterized by elevated indirect bilirubin, jaundice is generally mild, and there is no itching of the skin.
It is common in the following two categories: common in hematologic disorders
(1) Congenital hemolytic anemia, such as thalassemia and hereditary spherocytosis.
(2) Acquired hemolytic anemia: autoimmune hemolytic anemia, G6PD, neonatal hemolysis, paroxysmal sleep hemoglobinuria, snake venom, mushroom poisoning, etc.
Hemolytic jaundice is characterized by a predominance of elevated indirect bilirubin, jaundice is usually mild, and there is no skin pruritus.
3.Obstructive jaundice
As the name implies, jaundice caused by biliary obstruction, which can be divided into intrahepatic and extrahepatic.
(1) Common causes of extrahepatic bile duct obstruction are bile duct stones (the most common), bile duct inflammatory edema, tumors, roundworms and congenital biliary atresia, etc.; and common pancreatic diseases caused by extra-biliary compression of the common bile duct obstruction, such as pancreatic head cancer, etc.
(2) Intrahepatic bile duct obstruction can be divided into intrahepatic obstructive bile depression and intrahepatic bile depression. The former is commonly seen in intrahepatic bile duct sediment-like stones, cancerous emboli (mostly hepatocellular carcinoma), and schistosomiasis; the latter is commonly seen in capillary bile duct viral hepatitis, drug biliary depression (such as chlorpromazine, methyltestosterone, oral contraceptives, etc.), bacterial sepsis, recurrent jaundice during pregnancy, primary biliary cirrhosis, and a few after cardiac or abdominal surgery, etc.
Obstructive jaundice (bile depression jaundice) is characterized by a predominantly elevated direct bilirubin accompanied by pruritus, significantly elevated alkaline phosphatase and glutamyl transpeptidase in liver function indicators, and lighter stool color or white clay color in severe obstruction. Later, with the aggravation of liver function damage, indirect bilirubin will also be significantly elevated.
4, the last, but by no means the least important one.
Congenital jaundice refers to elevated bilirubin caused by a congenital defect in the metabolism of bilirubin. This type of jaundice is not rare clinically. The following four types of jaundice are common in this category
(1) Gilbert syndrome: The most common hereditary bilirubin elevation syndrome in clinical practice. The pathogenesis is due to impaired uptake of unconjugated bilirubin by hepatocytes and insufficient glucuronosyltransferase in hepatocyte microsomes. The disease is characterized by normal liver function tests, with the exception of elevated bilirubin. Key point: How is this disease diagnosed? A liver puncture biopsy is possible (not recommended because it is an invasive test); or by sequencing the causative gene (performed in some hospitals, but more expensive). About treatment: No treatment is usually needed, do not overexert yourself.
(2) Dubin-Johnson syndrome: The cause of jaundice is a dysfunction in the transport and secretion of unconjugated bilirubin to the capillary bile ducts after the conversion of unconjugated bilirubin into conjugated bilirubin in the hepatocytes. The diagnosis and treatment of these syndromes are similar to those of gilbert.
(3) Rotor syndrome: Jaundice occurs due to partial impairment of the uptake of unconjugated bilirubin by hepatocytes and the excretion of conjugated bilirubin into the capillary bile ducts. The disease is characterized by increased serum unconjugated and conjugated bilirubin, and the prognosis is generally good.
(4) Crigler-Najjar syndrome: Jaundice occurs due to the lack of glucuronosyltransferase in the hepatocyte particles, which prevents the conversion of unconjugated bilirubin into conjugated bilirubin.
This shows that there are many causes of elevated bilirubin. It may be liver disease, it may not, it may require treatment, it may not. Consult your doctor if you experience persistent elevated bilirubin on physical examination.