Jaundice refers to hyperbilirubinemia, the clinical manifestation of which is the yellowing of the sclera, skin, mucous membranes, and other tissues and body fluids due to an increase in bilirubin in the blood. When the serum bilirubin concentration is 17,1 to 34,2 umol (1 to 2 mg/d1), and the jaundice is not visible to the naked eye, it is called occult jaundice. If the serum bilirubin concentration is higher than 34,2umol/L (2mg/d1), it is called dominant jaundice.
I. Etiology.
1, hemolytic jaundice due to increased destruction of red blood cells and excessive bilirubin production.
2, hepatocellular jaundice caused by hepatocellular lesions resulting in derangement of bilirubin metabolism.
3, mechanical obstruction of the intrahepatic or extrahepatic biliary system, which affects the excretion of bilirubin and leads to obstructive (obstructive) jaundice.
4, congenital non-hemolytic jaundice that occurs when hepatocytes have certain congenital defects and cannot complete the normal metabolism of bilirubin.
Jaundice is a common sign in the neonatal period, and its incidence is generally considered to be about 50% to 70% in full-term infants, while it may be higher in preterm infants. Jaundice can be a physiological phenomenon (physiological jaundice) or an important symptom of a variety of diseases (pathological jaundice), while excessive elevation of unconjugated bilirubin can cause bilirubin encephalopathy (nuclear jaundice), which can cause early infant death or produce serious sequelae.
Second, neonatal physiological jaundice has the following characteristics.
1, the time of appearance of jaundice: appearing 2-3 days after birth.
2, the degree of jaundice: is mild to moderate yellowish, light apricot yellow or yellow-red with luster, progressing slowly.
3, time of peak jaundice: 4-5 days after birth.
4, serum total bilirubin value: full-term infants generally do not exceed 205.2umol / l preterm infants generally do not exceed 256.5umol / L.
5, jaundice remission time: generally in about 7-10 days after birth, full-term infants up to 2 weeks; preterm infants not more than 4 weeks.
6, concomitant symptoms: in addition to jaundice, no anemia or hepatosplenomegaly and other symptoms, the general condition of the infant is good. Jaundice in preterm infants may appear later, the degree can be heavier, and the remission time can be later. The bilirubin value of physiologic jaundice in newborns may vary according to ethnicity, region, perinatal maternal conditions, and individual newborns.
Physiologic jaundice generally does not require treatment, as long as early feeding, supplying sufficient heat and fluid, and maintaining adequate indoor air circulation and light, the jaundice can be reduced and recede faster.
Pathological jaundice
Diagnostic criteria Pathological jaundice should be considered when one of the following is present.
1, jaundice appears within 24 hours after birth.
2, total bilirubin generally full-term infants > 205.2umol / l, premature infants > 256.5umol / L.
3, jaundice progresses rapidly, with total bilirubin rising at a rate of more than 86umol / L every 24 hours.
4, conjugated bilirubin >26umol / L.
5, the duration of jaundice is prolonged (more than 2 weeks in term infants; more than 4 weeks in preterm infants), or physiological jaundice reappears after subsiding, or progressive aggravation.
Fourth, the classification of neonatal pathological jaundice.
1, hemolytic, prehepatic jaundice.
(1) congenital red blood cell defects, including defects in the red blood cell membrane, such as hereditary spherocytosis; defects in enzymes, such as glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, pyruvate kinase (PK) deficiency; and abnormal hemoglobinopathies.
(2) Acquired red blood cell defects, including immune, such as maternal-infant blood group incompatibility hemolytic disease; and non-immune, such as drugs, metabolic disorders, asphyxia, hypoxia, shock, acidosis, prematurity, vitamin E deficiency, erythrocytosis, hematoma, swallowed maternal blood, intestinal obstruction, hypothyroidism, hypopituitarism, and infants born to diabetic mothers.
2, hepatocellular, hepatic jaundice: deficiency of the liver enzyme system in newborns, common diseases include: various infections (such as umbiliculitis, pneumonia, sepsis, and impetigo, fungal infections, enteritis and other respiratory infections, neonatal hepatitis syndrome), breast milk jaundice; less common are: congenital non-hemolytic jaundice, including two types.
3, obstructive, post-hepatic jaundice: common obstructive jaundice in the neonatal period is biliary obstruction and neonatal hepatitis syndrome. Biliary obstruction includes intrahepatic or extrahepatic biliary atresia and stricture, congenital common bile duct cysts, and bile mucus (bile embolus) syndrome.
Jaundice in Chinese medicine is characterized by yellowing of the face and skin of the whole body, with the eyes in particular being yellow. The “Ling Shu? On the diagnosis of disease ruler: “body pain and slightly yellow, tooth dirt yellow, claw nail yellow, jaundice.” The source of miscellaneous diseases rhinoceros candle: “The eye yellow is said to be jaundice, because the eye is the clan veins gathered, the heat of the meridians on the eyes, so the eye yellow.” Its onset is mostly related to dampness, such as feeling the evil of the season or diet; or fatigue and internal injury caused by damp heat or cold dampness blocked in the middle jiao, fumigation or stasis blocking the liver and gallbladder, forcing the bile does not follow the normal path and overflow in the skin, then jaundice can be produced.
Jaundice is different from yellow fat. The “Classes of evidence and treatment”: “jaundice yellow eyes, the body is not swollen. Yellow fat more swollen, its color yellow with white, eyes as before, fatigue and less spirit. Although the source of the disease belongs to the same spleen, but jaundice by the damp heat and depression and become; yellow fat is damp heat is not yet very much, more worms and food accumulation caused by and labor injuries also become yellow fat, can eat easy to hunger, fatigue and weakness, commonly known as off power yellow, this and insect food jaundice outside.” Clinical jaundice can be divided into two categories: Yang Huang and Yin Huang. Yang yellowness can be divided into dampness and heat, heat and toxicity, biliary tract obstruction; yin yellowness is divided into cold and dampness and stagnation of blood stasis and other evidence.
V. Common symptoms.
1, damp-heat implication: yellow eyes and body yellow, bright color, or see fever, thirst, heart chagrin, body tiredness, abdominal distension and fullness, less food and dullness, aversion to greasy, nausea and vomiting, urine deep yellow or short red, constipation, yellow tongue coating, smooth pulse.
2.Heat poisoning: deep yellow body and eyes, sharp color, rapid onset, jaundice deepens rapidly, strong heat, restlessness, or delirium, epistaxis, blood in stool, skin rash, thirst for cold drinks, abdominal distension and drowsiness, red and vivid coating on the tongue, pulse string or string count.
3, biliary tract obstruction: yellow body and eyes, appearing faster, hot and cold exchanges, right hypochondriacal pain traction to the back of the shoulder, nausea and vomiting, bitter mouth and dry throat, aversion to grease, deep yellow urine, gray stool, red tongue with yellowish coating, string pulse.
4.Cold and damp internal obstruction: yellow body and eyes, dull color like smoke, cold fear and cold limbs, fatigue, stuffiness or abdominal distension, dullness, loose stools, light mouth and no thirst, unfavorable urination. Pale, fatty tongue with white greasy coating and moist, slow pulse.
5.Stagnation of blood stasis: yellow and obscure color of the body and eyes, painful swelling of the hypochondrium, refusal to press, or ascites, exposure of veins in the abdominal wall, red blood strands in the neck and chest area, black stool, hidden blue tongue or light tongue with petechiae, stringent and astringent pulse.
6. Spleen deficiency and blood deficiency: yellowish and lusterless skin, fatigue, palpitations and insomnia, dizziness, claw and nail dishonor, pale tongue, moist and thin pulse.