Increased bilirubin in blood and urine - what it means, norms. Causes and symptoms of elevated bilirubin. Treatment of elevated bilirubin in the blood and urine in adults and children

Normally, almost all bilirubin is excreted with the feces, the miser amount of substance falls into the blood. Increased bilirubin in the blood is called hyperbilirubinemia. Provocate this condition can a variety of reasons: some do not harm health and do not require drug treatment, others need urgent correction. The main symptom hyperbilirubinemia is the yellowing of skin and / or scler.

Next, consider the process of metabolism of bilirubin, varieties of yellow, the reasons for the increase in bilirubin in people of different ages.

Bilirubin is raised - what does

Bilirubin is an erythrocyte decay product, one of the components of the bile, yellow-red pigment. It happens unrelated (indirect, non-conjugated) and related (direct, conjugated). Hyperbilirubinemia indicates a violation at one of the stages of its metabolism.

Unbound bilirubin is produced in the spleen as a result of the splitting of the erythrocyte components. The resulting substance is insoluble in water, fat soluble and is toxic for the cells of the body. In order to "neutralize" indirect bilirubin and remove it from the body, it is necessary to convert it to conjugated bilirubin. For this, indirect bilirubin binds to albumin protein, the latter delivers bilirubin to the liver. In addition, bilirubin in the complex with albumin is not able to penetrate the cells and pass through the filtration department in the kidneys.

The bound bilirubin is synthesized in the liver as a result of the interaction of indirect bilirubin and glucuronic acid. This substance is water-soluble and non-toxic. Water soluble bilirubin, along with bile, enters the 12-point intestine and moves along the digestive tract. In the small intestine, the conjugated bilirubin is converted into urobilinogen, 10 percent of which through the portal vein enters the blood, and the remaining 90 percent are directed into a fat intestine.

One half of the urobilinogen that fell into the blood again falls into the liver, and after the 12-rift intestine and moves further along the digestive tract. The second half is absorbed into the bloodstream, passes through the filtration department in the kidneys, is converted to urobilin, giving urine yellow and excreted in urinous.

In the colon, urobinogen is converted first in Sterkobilinogen, and after the sterkobilin, which is displayed along with the feet. It is Schokobilin that gives the crash masses a brown color.

Diagnosis of elevated bilirin

• Technology of quantitative determination of bilirubin fractions in newborns. Allows you to quickly and accurately determine the concentration of bilirubin in the blood. It is possible to use capillary blood.
• Urine analysis (Harrison sample). The method is based on the conversion of bilirubin in biliverdin and the interaction of the latter with the fushe reagent. The presence of Bilirubin in Urin is evidenced by the acquisition of a green or blue color liquid.
• Biochemical blood test for elevated bilirubin. The amount of non-conjugated and conjugated bilirubin is determined, as well as their total amount - common bilirubin. Blood is taken to study from Vienna. Before passing, you can not play sports, nervous, eat liquid, "heavy" food, alcoholic beverages. After the last meal, the food must pass at least 4 hours, to optimally take an analysis of an empty stomach.

Increased bilirubin - norm

• The value of the content of bilirubin in the blood varies depending on the age of the patient. The floor does not have a value: the indicators of the elevated bilirubin in women and men are the same. Significantly declared a reduced level of bilirubin. This indicates the presence of iron deficiency anemia or pronounced misfortunes of useful substances caused by starvation.

• Bilirubinuria is a condition in which bilirubin in the urine is increased. Normally, the urine of a healthy person contains a direct bilirubin derivatives, but their concentration is so insignificant that it is not detected using diagnostic samples.

Elevated bilirubin - reasons

Hemolytic (adapter) jaundice as the causes of elevated bilirubin

Erythrocytes live no more than 4 months, because their destruction and further education of bilirubin occurs constantly. In case of excessive destruction of red blood cells, a healthy liver does not have time to bind non-conjugated bilirubin, and adherent jaundice arises.

In the blood test, the bilirubin is generally elevated or normal, non-conjugated bilirubin increased, conjugated - normally.

The causes of the occurrence:

• hemolytic anemia (both congenital and acquired);
• malaria;
• addison-Burmer disease;
• sepsis;
• rheumatic diseases;
• severe poisoning;
• glice invasions;
• hemolytic disease of newborns;
• reception of some medicines (many antibiotics, NSAIDs, aspirin, insulin and other).

Symptoms:

• rapid development of the disease;
• possible chills and fever;
• skin color light yellow;
• signs of anemia: pallor, weakness, reduced hemoglobin;
• an increase in the spleen, the liver, if increasing, is irrelevant.

Parenchimato (live-cell) jaundice as a cause of elevated bilirubin

This is a violation of the metabolism of bilirubin at the stage of its conversion from unrelated into the associated. It occurs in the case of damage to the liver cells: the amount of incoming indirect bilirubin does not exceed the norm, but due to the violation of the functioning of the patient body, in full convert unrelated bilirubin in the associated failure.

Also, with this form, the jaundice increases the level of direct bilirubin, due to the violation of the formation of bile or its outflow through intrahepatic bile ducts.

In the blood test, the common bilirubin is increased, indirect bilirubin is elevated or normal, direct bilirubin is increased.

The causes of the occurrence:

• all types of hepatitis;
• iCEROGEMORRAGIC leptospirosis;
• oncological diseases of the liver;
• cirrhosis of the liver;
• poisoning of hepatotoxic poisons;
• sepsis;
• dabind-Johnson syndrome;
• rotor syndrome;
• zhilbera syndrome;
• lucy-Driscoll syndrome;
• kriegler-Saular syndrome;
• pathology of the liver and reception of drugs using the same enzyme systems as unrelated bilirubin (contraceptives with estradiol, paracetamol, rifadine, morphine and other), consumption of alcoholic beverages.

Symptoms:

• the disease begins gradually, it is preceded by factors that contribute to the damage to the liver, nausea and the loss of appetite;
• reddish-yellow skin. Over time, the skin can acquire a greenish tint;
• full or partial bleaching feces;
• moderate skin itching;
• perhaps the darkening of urins, the appearance of fever, vomiting, pain in the right hypochondrium;
• the liver is usually enlarged, the spleen is increasing infrequently.

Mechanical (tune) jaundice as a cause of elevated bilirubin

This disorder occurs if the non-conjugated bilirubin is metabolized in normal quantities, transformed into the liver into the conjugated bilirubin, but can be derived due to problems with biliary tracts. The probability of the development of a litter jaundice is great if bilirubin is elevated in an adult or elderly person. In children, this disorder is extremely rare.

In the blood test, the common bilirubin is increased, indirect bilirubin in normal, bilirubin directly increased.

The causes of the occurrence:

• the presence of stones, the narrowing of biliary ducts;
• cyst or pancreatic swelling;
• acute pancreatitis, chronic inductive pancreatitis;
• portal biloopathy;
• myrizi syndrome;
• oncological diseases of bile ducts, stomach, pancreatic heads, large duodenal papilla, tumors or metastases in the liver.
• atresia of biliary tract is a rare congenital disease, in which the newborn is violated or biliary ways are not at all. Meets one of 15 thousand babies. Corrected surgically.

Symptoms:

• the disease slowly progresses with tumors, in other cases the development is rapid;
• greenish yellow skin;
• discoloration feces;
• urine of dark beer color;
• strong skin itching;
• nausea, vomiting, stool disorder;
• pronounced pain in the right hypochondrium or top of the abdomen;
• a bubble can be tested, an increase in the liver or spleen is uncharacteristic.

Physiological jaundice of newborns as a cause of elevated bilirubin

It is the main cause of an elevated bilirubin in a newborn. In the newly emerged by the baby, the hemoglobin level significantly exceeds the adult person. When decaying erythrocytes, immature liver enzymes do not cope with high bilirubin and skin yellow. Absolutely normal duration of physiological japless - 2-3 weeks.

The physiological jaundice is subject to 25 to 50 newborns out of 100.

Jaundice breastfeeding as a cause of elevated bilirubin

Maternal milk contains substances that hinder the activity of hepatic fetal enzymes, therefore the jaggility of the skin in newborns on breastfeeding is observed much more often. Yellowing breastfeeding is a frequent cause of an elevated bilirubin in a child of the first months of life. This is not a reason to abandon breastfeeding if the rest of the child does not cause complaints and analyzes in dynamics show that the level of bilirubin falls. With a prolonged jaundice, it is important to eliminate diseases such as:

• anemia;
• atresia of biliary tract, cholestasis;
• galactosemia;
• hemolytic disease of newborns;
• hypoteriosis;
• sepsis;
• polycythemia is true or neonatal.

Nuclear jaundice as a cause of elevated bilirubin

This is a severe form of neonatal jaundice in which the body of the child affects the unconjugated bilirubin is elevated. Implications for CNS-born infant period causes bilirubin in an amount exceeding 324 mmol / L. For premature infants, this threshold yet below: 150-250 pmol / l.

Factors contributing to the development of kernicterus:

• prematurity;
• hemolytic disease of newborns;
• pathological hemolysis;
• hirschsprung's disease;
• hemolytic anemia, spherocytosis;
• pyloric stenosis;
• hemorrhage;
• fermentopathy;
• disorders of the endocrine system;
• intrauterine infection;
• sepsis.

Increased bilirubin - jaundice adolescent

After exclusion of diseases that cause hyperbilirubinemia, it is reasonable to assume that the bilirubin is elevated in a teenager due to congenital Gilbert's syndrome. The essence of the state is in violation of a transforming unbound bilirubin bound due to lack of the necessary enzyme. Manifested not before school age, most often first detected in adolescents. The risk to get Gilbert's syndrome, which increases the level of bilirubin in men increased by several times. Gilbert's syndrome is not curable, but with a healthy lifestyle, proper nutrition and moderate fiznagruzki does not cause harm.

Symptoms:

• slight yellowness of the skin that occurs after strenuous exercise, the use of "heavy" to digest food, alcohol, suffering stress;
• occasionally possible pain in the right upper quadrant aching, stomach cramps;
• metal taste;
• loss of appetite;
• dyspeptic disorders;
• possibly a slight increase in liver.

Increased bilirubin - jaundice in pregnancy

Elevated bilirubin in pregnancy can occur not only because of the available prior to conception or acquired during gestation health problems, but also to be directly related to the fact of pregnancy. A slight increase in bilirubin normally feel women that did not have at the time of conception of health problems and leading a healthy lifestyle, usually does not require treatment.

Causes of jaundice caused by pregnancy pathologies:

• early toxicosis, accompanied by severe vomiting;
• preeclampsia;
• intrahepatic cholestasis of pregnancy;
• sheehan's syndrome.

Increased bilirubin - what to do

• Causes of increased bilirubin set. First you need to determine at what stage of bilirubin metabolism fails and remove the cause / assign a maintenance therapy for the damaged organ.
• When obstructive jaundice diagnosed, provoking increased bilirubin, surgical treatment.
• Infusion therapy applies to remove intoxication.
• To remove intoxication in newborns with a high level of bilirubin in the blood, phototherapy is used - the effects on the skin of the visible light, under the influence of which is neutralized by indirect bilirubin.
• In developed countries, phenobarbital in the treatment of hyperbilirubinemia in children is not used: the damage to the drug for the central nervous system exceeds the benefit of the benefit.
• For children and adults who have increased bilirubins, the diet is extremely desirable. It is important to avoid very fatty, fried, spicy food, carbonated sugary beverages, limit your intake of fast carbohydrates. Vegan diet is also not suitable for people with hyperbilirubinemia. The diet must be present protein, slow carbohydrates. You need to eat small portions, and ideally 4-5 times a day.

Output

Yellowing of the skin when it is important to understand why elevated bilirubin: this determines treatment. Universal advice for people with jaundice is the observance of a healthy lifestyle, proper and split meals, to minimize stress.