Jaundice (jaundice) is a common symptom and sign that occurs as a result of elevated bilirubin concentrations in the serum due to impaired bilirubin metabolism. It manifests clinically as a yellow staining of the sclera, mucous membranes, skin and other tissues. Jaundice can also occur in certain hematologic diseases, pancreatic diseases, obstetric diseases, and neonatal diseases (congenital jaundice).
In addition, jaundice can also be seen in newborns with physiological jaundice, breast-feeding infant jaundice and jaundice due to hypothyroidism, etc.; if jaundice occurs after the application of certain drugs, it is called drug jaundice. Jaundice treatment principles because of the causes of jaundice are many, so in the treatment should be mainly for the cause, only when the cause is eliminated, jaundice can be reduced or subside.
(1) If jaundice is considered to be due to hemolysis, the cause of the hemolysis should be actively eliminated. In severe cases of hemolysis, appropriate blood transfusion therapy is available.
(2) If the jaundice is caused by hepatocyte degeneration and necrosis, liver protection therapy should be actively carried out, but since the efficacy of various liver protection drugs is not exact, only one or two should be used, and too many liver protection drugs should not be used, otherwise the physiological burden of the liver will be increased; if the jaundice is caused by toxic hepatitis, reduced glutathione therapy can be applied to accelerate the detoxification function of liver cells. Glycine, potassium magnesium menthylate and other drugs are now commonly used to reduce jaundice. Certain Chinese medicines such as gardenia yellow, bitter ginseng or bitter yellow have anti-inflammatory, choleretic and yellowing-reducing effects, and can be used as appropriate.
(3) If it is clear that extrahepatic obstructive jaundice is caused by bile duct stones, duodenoscopic papillary muscle lithotomy or surgical treatment should be performed in a timely manner; if it is caused by cancerous obstruction or bile duct extrinsic neoplastic compression, early surgical treatment should be performed. If there is no indication for surgical treatment, percutaneous intrahepatic dilated bile duct puncture with catheter placement for bile drainage or duodenoscopic placement of nasobiliary drainage is feasible to reduce symptoms.
(4) Treatment of intrahepatic cholestasis can be applied in addition to prednisone or prednisolone or phenobarbital or ursodeoxycholic acid, if the efficacy is not satisfactory.
As an interventionalist, the main treatment for obstructive jaundice is endobiliary stenting + drainage tube for bile drainage.
Causes of obstructive jaundice.
Inflammation, stones, tumors.
Symptoms.
(1) Dark yellow, yellow-green or greenish-brown skin, with pruritus of the skin is common, a few patients with bradycardia.
(2) Urine is dark and resembles strong tea, stool becomes lighter in color, and in case of complete extrahepatic biliary tract obstruction stool is white clay color.
(3) Increased total serum bilirubin, mainly direct bilirubin.
(4) Decreased or absent urobilinogen in the urine.
(5) Positive bilirubin in the urine.
(6) Increased serum alkaline phosphatase, γ-glutamyl transpeptidase and total cholesterol, and positive lipoprotein-X.
Treatment.
Common bile duct stones: ERCP duodenal papillotomy + bile duct lithotomy is preferred for treatment, which is less invasive. If combined with intrahepatic bile duct multiple stones can also choose surgical stone extraction treatment.
If inflammation leads to obstructive jaundice due to common bile duct stenosis, bile drainage should be the mainstay, and PTCD is preferred. ERCP bile drainage can also be performed.
Tumor: surgical resection is preferred in the early stage. If complete resection is not possible, PTCD or ERCP stent implantation + drainage tube drainage should be chosen.