As a result of the breakdown of red blood cellsthere is a special substance - bilirubin. It is also called yellow-red pigment, it is one of the main components of bile. In serum, it occurs in two forms: direct (connected) or indirect (free).
Find out what straight bilirubin means,impossible if you do not know why this study is necessary. It is necessary to assess the performance of the liver and the diagnosis of a number of diseases of the gastrointestinal tract. Any deviation of this indicator from the norm indicates that the body has failed.
In most cases, it is important to reliablydetermine what led to a deterioration of the liver. For this, it is important to understand that direct bilirubin can not be increased just like that. Therefore, without determining the disease that led to this condition, and the appointment of adequate treatment, it will not decrease.
Changes in the level of bilirubin can be caused by several reasons. It:
Also problems can be caused by hemolytic anemia. Malaria, vitamin B12 deficiency and other equally serious problems can be another reason.
Ситуация, при которой билирубин прямой повышен, there is also due to the fact that it is produced as a result of enhanced hemolysis. At the same time, abnormalities in the work of the liver lead to the fact that it is unable to cope and form an increased number of glucuronides, which are so necessary for the body.
So, its level will be increased when:
- Hepatitis (both viral and toxic etiology);
- Cytomegalovirus, which led to an infectious liver disease;
- secondary or tertiary syphilis;
- cholecystitis;
- hypothyroidism of newborns;
- jaundice of pregnant women.
If the total bilirubin and direct increased, then the doctormay suspect both hepatitis and a number of other diseases. The patient may have liver cancer, primary cirrhosis, cholelithiasis. Also, the deviation of indicators from the norm can be in the case of toxic, drug or alcohol poisoning of the body.
Some future moms in the last trimestermay find out that they have not very good test results. After all, some can have direct bilirubin increased during pregnancy. This condition requires mandatory follow-up. After all, an increase in this indicator indicates violations in the process of outflow of bile in the liver. This condition is called "intrahepatic cholestasis of pregnant women."
It is also impossible to exclude a number of diseases, such as viral hepatitis, cholecystitis, hemolytic anemia. It is important to diagnose them in time to prevent possible complications.
It is important to understand:if direct bilirubin is elevated, treatment must be prescribed necessarily. After all, this condition can threaten both the normal course of the pregnancy itself and the life of the unborn baby. It can lead to an edematous form of hemolytic disease of the fetus, and there is a high probability of premature birth and death of the baby inside the womb or in the first hours after birth.
- yellowness of the sclera of the eyes, mucous membranes, skin;
- temperature increase;
- an enlarged spleen, which may indicate discomfort in the left hypochondrium;
- dark urine, it may become dark brown or even black;
- lethargy, fatigue, palpitations, headaches - these signs indicate that oxygen has become worse to the tissues.
Such symptoms occur with hemolytic anemia.It should be noted that the change in the color of urine is not always found. It can be in the destruction of red blood cells still inside the vessels, and this happens only in certain diseases, for example, in Markiafav-Micheli syndrome.
But hemolytic anemia is not the onlyfactor that leads to the fact that bilirubin direct increased. The reasons also lie in the disruption of the liver. It is possible to talk about such problems if the patient has:
- nausea, discomfort after eating, bitter belching;
- a feeling of heaviness in the right hypochondrium, it occurs due to an enlarged liver;
- decrease in working capacity, weakness.
Sometimes there may be a darkening of the urine to the color of beer or strong tea. When viral hepatitis also often increases in temperature.
Try to figure out for yourself whattherapy should be carried out, even if direct bilirubin is slightly elevated, it is impossible. After all, it is impossible to get rid of a problem until its cause is determined.
It is also important to carry out detoxification activities.They include a special diet aimed at reducing the load on hepatocytes and enzymes responsible for the elimination of toxins. In a hospital, often carry out infusion-transfusion therapy. It is designed to change the composition and volume of blood, intracellular and extracellular fluid. Only a doctor can choose a solution that will be injected intravenously. In some cases, a glucose solution, a mixture of amino acids, saline and other drugs may be prescribed.
Sometimes it is recommended to carry out phototherapy, whichcontributes to the destruction of toxic bilirubin. To reduce toxicity, doctors often prescribe activated carbon and gels designed to remove toxins, for example, Enterosgel.
So, if as a result of intense destructionblood cells turned out that direct bilirubin was elevated, the causes of such hemolysis must be established without fail. First of all, it is necessary to figure out what exactly led to this. After all, it will be necessary to treat not the consequences, but the cause of hemolysis. To do this, use glucocorticoid hormones, for example, the drug "Prednisolone". After eliminating the cause, the level of bilirubin will decrease by itself.
Если к проблемам привело нарушение процесса outflow of bile, it is impossible to do without medicamental intervention. Doctors in such cases prescribe a treatment regimen, which may include such means as Ursosan, Febihol, Ceruglun, Hermital, Papazol, Gepabene, Analgin. Therapy is aimed at stimulating the outflow of bile, anesthesia. But to use drugs without the consent of the doctor is not worth it. Indeed, in some cases antibacterial or antiparasitic therapy is necessary.
Often the cause of icterus is hepatitis. In such a situation, it is necessary to treat the liver. The following drugs may be prescribed for this: Essentiale, Methionine, Heptral.
Вне зависимости от возраста пациента (за except for newborns), the indicators should be within limits. So, for total bilirubin, the norms range from 3.4 to 17.1 μmol / l, while the direct bilirubin in the blood should be no more than 4.3 μmol / l. These norms do not change, they are valid both for adults at any age, and for children. The level of the indirect fraction is not determined separately, it is calculated as the difference in the results of the analysis between the amount of total and direct bilirubin. It should not exceed 13.7 µmol / L. Indirect bilirubin increases with jaundice of newborns, hemolytic and pernicious anemia, Rotor, Gilbert, Crigler-Nayar syndromes.
The situation is somewhat different with babies inage up to 1 month. On the first day of life, bilirubin in the crumbs can be in the range from 24 to 149 μmol / l. On the second day of life, the rate is within 58-197. For 3-5 days bilirubin can be from 26 to 205 µmol / l. In full-term infants, this indicator is usually normalized to a two-week (sometimes to a month) age.
Do not panic, it is quite normalsituation, if, of course, the indicators do not exceed the norm established for kids of this age. Usually, the liver is rebuilt and begins to function normally by the second week of life, and the level of bilirubin is normalized independently.
When the doctor suspects that problems are possible, hemay conduct a special study. If direct bilirubin is elevated in newborns above the established rate, it is often recommended to carry out treatment in a hospital. It is undesirable to refuse the recommended therapy, because the jaundice of newborns is not as safe as many parents think.
В связи с тем, что печень новорожденных does not function in the same way as in adults, they can have direct and indirect bilirubin. This may be due to the following reasons. In the process of the breakdown of blood cells, toxic hemoglobin is formed - heme, which begins to be fermented by the body and turns into bilirubin. At the same time, its indirect fraction does not dissolve in the liquid, and therefore cannot be excreted in the urine. After combining it with various substances, it is transported to the liver, where it is converted into direct bilirubin and moved to the gallbladder. In babies, this process is getting better only a few weeks after birth. Therefore, physiological jaundice is quite normal.
Но бывают ситуации, когда уровень билирубина rolls over. This is a rather dangerous situation, because a chronic increase in it can be a hindrance to the normal development of the brain, lead to various mental disorders, cause hearing loss, vision or even mental retardation. This is due to the fact that excessively overestimated bilirubin prevents albumin from blocking its toxic effects. And this leads to the fact that the nervous system suffers.
Excessively elevated direct bilirubin in the bloodOften becomes the reason that the baby begins to be treated in the maternity hospital or transferred to the children's hospital. The main method is phototherapy. This is the lighting of the baby with a special light that is able to convert toxic bilirubin into safe forms. They are eliminated from the body within 12 hours with feces and urine. This method has its side effects, but they pass as soon as the treatment is completed. So, the baby can start a slight peeling of the skin, loose stools and become more sleepy.
But in some cases the body to speed up the outputbilirubin requires extra help. In this case, in the hospital are prescribed droppers with glucose, choleretic drugs are used, ascorbic acid.
Главным методом профилактики желтушки newborns are called breastfeeding. It is colostrum that has a mild laxative effect on the newborn and contributes to the fact that elevated direct bilirubin in the blood gradually normalizes. But there are situations when the problems lie in breast milk. In this case, it is recommended to replace the breast feeding mixture for a few days. If the level of bilirubin starts to decrease, then the jaundice was caused by breast milk. But this is not a reason for refusing to breastfeed. Usually, 3 days of feeding the mixture is enough to normalize the condition of the baby, after which you can put the baby on the breast again.
But an increase in the amount of yellow-red pigmentblood is not only in newborns. True, if elevated direct bilirubin in a child, then it is imperative to carefully examine it. If the baby has already left the age of the newborn, then the causes of jaundice are no different from those that cause problems in adults.
