Total bilirubin: what does it mean?
Each of us, coming to the clinic, as a rule, undergoes tests. Most often doctors prescribe the General and biochemical blood analysis. They need to understand the various processes occurring in the body. One of the key values of biochemical blood test is bilirubin. What does this measure?
Digestion is a complex and multistage process. It begins in the mouth before getting into her food with saliva containing enzymes. The main organs of digestion are not only stomach and intestines but also the digestive gland, which help in this complex process is the pancreas and liver. Liver cells – hepatocytes – produce bilirubin, which is the main components of bile. Then formed the bile is transported via a system of ducts and into the gallbladder, where as required is injected into the duodenum.
Where is bilirubin and what it is?
Why is bilirubin formed? It is formed from hemoglobin, contained in erythrocytes, and myoglobin – muscle protein. Its formation occurs in the bone marrow, lymph nodes and spleen. This waste material is always a lot.
Each of us saw a bruise on the skin soon acquires a greenish tint. What does it mean? Erythrocytes are disintegrated and turned into bilirubin.
The bilirubin that has just formed in the body, is called indirect – it is toxic to the body. To neutralize it requires a liver function: it binds (conjugium), it becomes soluble and prepared to exit from the body through the intestines with the feces. This is a direct bilirubin. Dark brown color of feces normal due to the presence of bilirubin-derived – sterkobilina.
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In addition, there is another important way of circulation of bilirubin: once in the intestine in a bound form, it changes, and then re-absorbed into the bloodstream through the portal vein (portal) vein (as everything that came in the intestine) and is used for the synthesis of bile acids. This cycle is called the enterohepatic (intestinal-liver) circulation of bile acids.
Thus, in human blood are both newly formed indirect bilirubin, which goes to disposal, and its direct fraction. Combines the number of direct and indirect bilirubin is called total. The normal concentration of all fractions of the substance in the blood is micromol to 20.5 per liter. The increased levels of bilirubin in excess of this concentration in the blood is called hyperbilirubinemia. If the concentration exceeds 50 mmol / l, there is jaundice, which is noticeable. First turn the sclera of the eyes and the frenulum of the tongue. Then there is a darkening of the urine, which begins with the foam, and then becomes colorless feces.
Hyperbilirubinemia and its causes
Total bilirubin can be due to both direct and indirect fractions. Without going into details, let’s call the three most important causes of jaundice, each of which, in turn, is divided into many variants:
- Hemolytic jaundice. The second name her – «suprarenal» This speaks to the fact that all processes occur in the blood, and the liver can be healthy.
Arises from an increased breakdown of red blood cells in the blood. The cause may be a short period of their lives, the defects of membranes, genetic disease, some infections, e.g. malaria.
- Parenchymal, or hepatic jaundice. In this case, the increase in total bilirubin caused by various liver diseases.
The most common cause is an acute or chronic viral, toxic or alcoholic hepatitis. As a result of inflammatory processes occur cytolysis (destruction) of hepatocytes and their death, therefore there is access to the blood contained in them of bile, which «prepare» for disposal. The second reason this type of jaundice are cirrhosis of the liver and intrahepatic cholestasis – deep stagnation of bile at the level of the liver.
- Mechanical, obstructive or obstructive jaundice. In this type and the formation of bilirubin, and synthesis of the bile appears to be normal, but bring the bile to the intestinal lumen cannot, as there is a mechanical obstacle to the physiological flow of bile.
The most common cause of this type of jaundice – gallstone disease (GSD). In this case, the common bile duct blocked by stone. The second reason is the compression of the duct by tumor of pancreaticoduodenal zone, most often in the tumors of the pancreatic head. Unlike the first two types of jaundice, treatment of jaundice is often surgical.
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The increase of bilirubin in newborns
We should say a few words about the phenomenon as physiological jaundice of the newborn («normal jaundice»). During fetal life the baby had shared blood with the mother, he had a lot of hemoglobin. This is called fetal hemoglobin. After birth, the hemoglobin is simply unnecessary, and its level is reduced in connection with «modernization» and replace it with a new type of hemoglobin, which is more resistant (hemoglobin A).
The liver of the baby are not quite ready for «new conditions», just can’t cope with a sharply increased quantity of bilirubin. So may develop jaundice (every second child). Nothing wrong with that, this state soon passes, and the level of bilirubin in the baby’s blood to normal. In newborns there is another state in which they turn yellow. This hemolytic disease of the newborn, which develops as a result of RH-conflict pregnancy.