Increased bilirubin: causes and treatment in adults
Jaundice is a staining of the skin and mucous membranes a yellow color in connection with increase of level of bilirubin. Traditionally yellow is associated with liver disease, but this is not always the case.
What is the bilirubin?
Bilirubin is a substance formed during decomposition of hemoglobin from worn-down red blood cells. Spleen selects from the blood stream of old red blood cells and disposes of them hemoglobin — iron is stored for reuse, and the protein portion is destroyed.
First a so-called indirect (unbound, free) bilirubin. It is toxic, literally toxic to the brain when the threshold is exceeded about 200 µmol/L. It is not soluble in water, so cannot be filtered by the kidneys and removed in the urine. In blood it circulates in a complex with albumin — they do not allow the bilirubin to penetrate into the nervous tissue and damage it.
Liver cells «catch» from the blood of this compound, bilirubin is separated from albumin and bound to glucuronic acid. This substance is called direct or conjugated bilirubin. With bile it enters the intestine. One part of it after some transformations is displayed together with a chair, and the other is absorbed through the intestinal wall back into the bloodstream, where is filtered out by the kidneys and into the urine. The normal amount of indirect fraction in the blood — to 17.1 µmol/l, direct — to 4.3 mmol/l. Indicators included in the biochemical analysis of venous blood.
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Causes of bilirubin in adults
If the path transformations pigment having difficulty, number of a particular faction increases. Due to these characteristics there are 3 types of jaundice:
- hemolytic (hemolysis — gemos — blood, «lysis» — destruction);
Hemolytic jaundice occurs when, because of an illness destroys too many red blood cells and the liver doesn’t manage to dispose of all vacant indirect bilirubin. The level of indirect fraction is elevated, but direct is fine.
Hepatic jaundice — a consequence of liver disease (all types of hepatitis — infectious, toxic, autoimmune). The hepatocytes are not able to associate indirect bilirubin in the necessary volume. In this case, in the analysis increased as the fraction of indirect and direct (due to back diffusion of bilirubin from the bile capillaries into the blood).
Obstructive jaundice caused by the appearance of obstructions in the biliary tract — gall stone, tumour, tangle of worms etc. Indirect bilirubin remains in the normal range. Straight increases, as the pressure of bile in the ducts increases, and there is reverse diffusion from the bile capillaries into the blood vessels.
All cases require a detailed examination and a completely different treatment. If the colouring of the skin in yellow color, you need to first consult a therapist or General practitioner. After an initial examination and initial tests it can be referred to a specialist — hematologist, infectious disease, hepatologist, gastroenterologist or other. The first essential tests are:
- a General analysis of capillary blood (of finger);
- a General analysis of the middle portion of the urine;
- a detailed biochemical analysis venous blood (vein);
- the analysis on antibodies to viral hepatitis (drawing blood from the veins);
- Abdominal ultrasound;
- Fegds (fibroesophagogastroduodenoscopy).
These studies will help to clarify the type of jaundice and to determine the direction of the diagnostic search.
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By itself, elevated bilirubin should not be treated. It is only a symptom of one of the many States. Requires an accurate diagnosis and treatment of the underlying disease. No medicines and folk remedies should not be used until inspection of the therapist and without preliminary diagnosis — they can hurt and worsen the disease!
In any case, you want diet — the rejection of oily and fried foods, spicy sauces and marinades, pickles and smoked. This food increases the production of bile and may cause severe complications in obstructive jaundice. Give preference to low-fat dishes, boiled, baked or steamed.