1 Jaundice is not the name of a disease, but a result of a clinical manifestation of a variety of diseases, so the symptoms are also very different, in the hospital according to the causes of jaundice and different treatment modalities, patients are also classified into different departments for treatment, bringing a lot of inconvenience to the patient’s treatment process, to introduce the knowledge of jaundice, I hope to give you some help. Jianfeng Xue, Department of Hepatobiliary, Pancreatic and Liver Transplantation, First Affiliated Hospital of Zhengzhou University
2 Jaundice is caused by an increase in bilirubin in the blood due to various reasons, resulting in yellowing of the skin, sclera, mucous membranes, urine, etc. It is sometimes accompanied by white stools, fever, anemia, abdominal pain, weakness, lack of appetite and other manifestations.
When the total bilirubin is 34 μmol/L, jaundice can be detected clinically; however, if the serum bilirubin level is elevated but lower than 34 mmdl/L, no yellow staining can be seen with the naked eye, and this state is called occult jaundice or subclinical jaundice.
3 jaundice according to the etiology and pathogenesis, can be divided into ① hemolytic jaundice; ② hepatocellular jaundice; ③ cholestatic jaundice (obstructive jaundice). According to the treatment method is divided into ① surgical jaundice; ② medical jaundice.
4 metabolism of bilirubin: aging or immature red blood cells, or some heme-containing proteins, etc. will produce bilirubin during metabolism or after being destroyed, which is insoluble in water and cannot be excreted into the urine through the glomerulus, called indirect bilirubin or non-conjugated bilirubin; indirect bilirubin combines with glucuronic acid under the action of some enzymes to form direct bilirubin or called conjugated bilirubin, which is soluble in It is soluble in water and can enter the urine, mostly and as a component of bile through the bile duct into the intestine, part of it is excreted and part of it is reabsorbed in the intestine before entering the blood circulation.
From the above bilirubin metabolism we can understand the causes of jaundice: ① hemolytic jaundice; refers to the destruction of red blood cells too much; ② hepatocellular jaundice; refers to the destruction of liver cells, too much bilirubin in the liver cells into the blood. ③ biliary jaundice (obstructive jaundice), the biliary tract is blocked, the bilirubin secreted by the liver cannot enter the intestine, and when the biliary tract pressure is higher than a certain pressure, the bilirubin flows back into the blood to form jaundice.
5 From the causes of jaundice we can understand: hepatocellular jaundice and hemolytic jaundice mostly require medical treatment, while cholestatic jaundice mostly requires surgical treatment, of which there is, of course, crossover. For example, obstructive jaundice due to sclerosing cholangitis in cholestatic jaundice requires medical treatment, while hereditary spherocytosis in hemolytic jaundice requires surgical removal of the spleen to remove the site where the abnormal red blood cells are destroyed. Interventional therapy is a minimally invasive treatment modality chosen only when the patient’s general condition is poor and cannot tolerate surgery, when surgery in the advanced stage of the tumor is not therapeutic, and when the patient strongly disagrees with surgery.