Icteric skin: causes and consequences of jaundice. Subicterity of the sclera is Bilirubin and its forms

Icterus is the medical term for a yellow staining of the skin and mucous membranes. Moreover, its intensity can vary from a light transparent to a rich green-yellow or yellow-orange hue.

In our review and video in this article, we will find out in which cases icteric skin occurs, and how such a condition can be dangerous.

Since most often icteric staining of the skin is a consequence of an excess of bilirubin in the blood, it is important to understand how this substance is metabolized in the body.

Bilirubin (BIL) is a bile pigment, one of the breakdown elements of hemoglobin, which is released from dying red blood cells. This process occurs constantly due to the natural aging of cells.

The transformation of BIL begins with its transport to the liver and conjugation (binding) with glucuronic acid. In this case, the bile pigment acquires a water-soluble form.

Note! Free bilirubin is toxic to many cells in the body, in particular the nervous system. After binding with glucuronic acid, the substance becomes safe.

At the next stage, BIL is excreted along with bile and enters the digestive tract. In the intestine, most of the substance is transformed into stercobilinogen and excreted along with the feces. A small amount of bilirubin is reabsorbed into the bloodstream, where it is converted into urobilinogen and excreted by the kidneys.

Causes of icterus

Icterus skin and sclera can accompany a wide variety of diseases. The sections below are the main causes of pathology.

Active breakdown of red blood cells

Hemolytic jaundice is caused by the massive breakdown of red blood cells with release a large number indirect (unconjugated) bilirubin into the blood. In fact, the liver is working normally, but it cannot bind this amount of pigment in the shortest possible time.

Icterus, provoked by massive hemolysis, develops when:

congenital / acquired hemolytic anemia;
hemolytic disease of the newborn;
poisoning with toxic substances (phosphorus, lead, nitrobenzene, etc.);
some infections (malaria, toxoplasmosis);
sepsis;
poisoning with snake venom;
window pathology, including leukemia;
radiation sickness;
lung infarction;
hemothorax;
transfusion of incompatible blood.

Liver dysfunction

Parenchymal jaundice is a consequence of damage to hepatocytes. The physiological seizure of bilirubin is not carried out, the substance is absorbed back into the blood and gives the skin its characteristic icterus.

Among the main causes of this pathology:

toxic damage to the liver by alcohol, some drugs, industrial and household poisons;

Problems with evacuating bile

Obstructive jaundice develops against the background of a violation of the normal outflow of bile.

What is false jaundice?

False, or carotene, jaundice is a special condition in which the skin (but not the mucous membranes) also acquire mild icterus. However, it is not associated with disturbances in the metabolism of bilirubin, but with excessive accumulation of provitamin A (carotene) in the body.

This can happen with excessive consumption of fresh carrots, beets, bell peppers, citrus fruits, as well as with long-term treatment with Picric acid and Achrinin.

It is interesting. Most often, carotene jaundice is diagnosed in infants under the age of 6 months, whose complementary foods are introduced incorrectly. This is due to the absence in the body of babies of the necessary bacteria that process fat-soluble vitamins.

Clinical symptoms and differential diagnosis

The main sign of icterus is very obvious - it is the staining of the skin and mucous membranes in yellow. In this case, the intensity of the shade will be influenced not only by the level of bilirubinemia, but also by the thickness of the skin and other individual characteristics of the patient.

Important! The sclera of the eyes are usually the first to turn yellow - they should be paid close attention to during examination.

In addition, depending on the disease that caused the icteric skin, the shade of jaundice may be different.

Table: Differential diagnosis of jaundice:

Parameters	Type of jaundice
Parameters	Hemolytic	Parenchymal	Mechanical
Clinical signs
Shade	Citric	Golden	Greenish, sometimes dark brown
Itchy skin	—	-/moderate	pronounced
Liver size	N
Laboratory signs
General BIL
Direct (linked) BIL	N
Indirect (unrelated) BIL			N
Hepatic transaminases (ALT, AST)	N		N /
Cholesterol	N	↓
ALF	N	N /
Urine color	dark	dark	dark
Feces color	Very dark	light	Completely discolored

Possible complications

If a disease accompanied by jaundice is diagnosed on time and the patient receives proper treatment, icteric skin coloration usually goes away quickly as the bilirubin level decreases. The most terrible complication of jaundice is the development of a severe fulminant form of pathology, which is accompanied by a toxic effect on the nervous system and may end in the death of the patient.

Treatment principles

As we have already found out, icterus is not a separate disease, but just a symptom that can accompany more than four hundred different ailments.

Therefore, when treating this pathology, the following principles should be adhered to:

All patients with jaundice are hospitalized.
Etiotropic therapy is the main one. It is important to act on the cause of the disease, and not on its manifestations. So, with viral hepatitis, antiviral agents are necessarily prescribed to patients, with obstruction of the bile ducts with a stone or tumor - surgery, etc.
All patients are recommended a diet with limited fat intake up to 40 g / day.
Most patients undergo detoxification therapy - infusion of saline solutions.
To facilitate the work of the liver, enzymes (Creon) and vitamins (A, E, D, K) are shown.

If you notice that your skin or the whites of your eyes have acquired a yellowish tint, do not delay your visit to the doctor. It is important to find out the cause of icterus as early as possible and start timely treatment.

Questions to the doctor

Jaundice of newborns

Hello! I gave birth to a son 5 days ago. He was examined by a pediatrician and said that everything was fine. Now I notice that it is kind of yellow. I am very worried, despite the fact that the doctor says that everything is in order and advises only to be in the fresh air more often, to sunbathe. Why do newborns develop jaundice, and is this condition dangerous?

Good day! First of all, don't worry: icteric skin coloration in newborns is quite common. It is called physiological jaundice and is associated with the replacement of fetal hemoglobin HbF with "adult" HbA. If your pediatrician says that everything is fine, you really should not worry: the unusual shade will pass without special treatment by about a month's age of the baby.

Causes of icterus

Hello! Recently, my grandfather (he is 78 years old) was taken by ambulance to the infectious diseases hospital on suspicion of hepatitis A. he lives far from us, and we do not see him often, for honey. the neighbors asked for help. According to them, he began to feel severe weakness, found himself from eating, vomiting a couple of times. Then the skin and eyes turned yellow.

Now the grandfather is being discharged from the hospital, although he remains yellow (but less so). The hospital conducted an examination: bilirubin just went off scale, the analysis for hepatitis was negative. Even on the ultrasound, the doctor found some kind of mass formation in the region of the pancreas head, and recommends doing an MRI. Is this a tumor?

Hello! Without seeing a complete medical report, it is difficult to draw any conclusions. Be sure to send your grandfather for an MRI to clarify what kind of education the doctor saw during an ultrasound examination. Probably, it was this that caused the disturbance of the outflow of bile and the development of jaundice. You may also need to consult an oncologist.

Influence of preanalytical factors on the outcome

Food intake. Eating food on the eve of taking blood for analysis can greatly distort its result, and in some cases lead to the impossibility of performing studies. This is due to the fact that after absorption of nutrients in the intestine, the concentration of proteins, fats, carbohydrates and other compounds in the blood increases sharply, enzyme systems are activated, blood viscosity may change, and the level of some hormones temporarily increases. All these factors can affect the concentration of the test substance directly, as well as due to changes physical properties the blood itself (its "transparency") lead to incorrect measurement of the analyte by the device.

Each of the tests has its own preparation features - they can always be found in the catalog, however, in all cases, it is recommended to adhere to several rules before donating blood:

do not eat fatty foods a few hours before the test, preferably not for 4 hours - a high concentration of fats in the blood can interfere with any research;
shortly before taking blood, drink 1-2 glasses of ordinary still water, this will reduce the viscosity of the blood, and it will be easier to take a volume of biomaterial sufficient for the study, in addition, this will reduce the likelihood of clots forming in the test tube.

Medications. Any medicine one way or another affects the body, sometimes on the metabolism. And although, in general, the effect of drugs on laboratory parameters is known, much is determined by the physiological characteristics of a particular person, as well as the presence of diseases in him. Therefore, it is almost impossible to accurately predict how the research results will change depending on any drug.

if possible, refuse to take medications at least one day before the tests;
when taking tests while taking medications, you must indicate this fact in the referral form.

Physical activity and emotional state. Any physical activity leads to the activation of a number of enzyme and hormonal systems. The concentration of many biologically active substances increases in the blood, and they begin to work more intensively internal organs, metabolism changes. Against the background of stress, the sympatho-adrenal system is activated, which, in turn, triggers mechanisms that lead to a change in the activity of many internal organs, to the activation of enzyme and hormonal systems. All this can affect the test results.

In order to exclude the influence of physical activity and psychoemotional factors on the day of testing, it is recommended:

do not play sports;
exclude increased emotional stress;
a few minutes before taking blood, take a comfortable position (sit down), relax, calm down.

Alcohol and smoking. Alcohol affects the human body in many ways. It affects the activity of the nervous system, which is known to regulate all physiological processes in the body. The products of alcohol metabolism are capable of affecting many enzyme systems, cellular respiration, and water-salt metabolism. All this can lead to changes in the concentration of most biochemical parameters, to changes in the general blood count of hormones, etc. Smoking, activating the nervous system, increases the concentration of some hormones, affects the tone of blood vessels.

To exclude the influence of alcohol and smoking on the test results, you should:

refrain from drinking alcohol for 72 hours before taking the test;
do not smoke for at least 30 minutes before taking blood.

The physiological state of a woman. The concentration of sex hormones and their metabolites in a woman's body changes significantly during the month. In this regard, tests for many hormonal indicators are recommended to be taken strictly on certain days of the menstrual cycle. The day of donating blood is determined based on which link of hormonal regulation needs to be assessed.

Pregnancy is another important physiological condition that influences research results. Depending on the week of pregnancy, the concentration in the blood of hormones and some specific proteins, the activity of enzyme systems, changes.

To obtain correct test results, it is recommended:

clarify the optimal days of the menstrual cycle (or gestational age) for donating blood for follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, androstenedione, 17-hydroxyprogesterone, prolactin, as well as for specific markers: inhibin B and anti-Müllerian hormone;
when filling out the referral form, it is necessary to indicate the phase of the menstrual cycle or the gestational age - this guarantees obtaining reliable research results with
correctly specified ranges of normal (reference) values.

Times of Day. The concentration of many substances in the human body changes cyclically during the day. This applies not only to hormones, but also to some biochemical parameters, and specific markers (for example, markers of metabolism in bone tissue). For this reason, it is recommended to take some tests strictly at a certain time of the day. In the case of monitoring a laboratory indicator, its re-delivery should occur at the same time. The table below provides guidelines for when to draw blood for the determination of various laboratory parameters.

In the Helix laboratory, before most of the tests, a study is carried out to determine the degree of lipemia, icterus and hemolysis of blood samples, in connection with which there are often questions from clients about what kind of blood conditions these are and why Helix cannot perform an analysis at certain values of the above indicators.

What is hemolysis? Hemolysis, as a laboratory concept, is the destruction of erythrocytes ("red blood cells") in a blood sample, with the release of various biologically active substances and, most importantly, hemoglobin into plasma.

Why does hemolysis occur? Hemolysis is most often caused by the physiological characteristics of the human body who donated blood, as well as a violation of the method of blood sampling.

Reasons associated with the technique of blood sampling leading to hemolysis:

applying a tourniquet for too long;
traces of a disinfectant solution (alcohol) remained on the skin surface at the site of venipuncture;
too vigorous mixing of the blood in the test tube;
centrifugation of blood not according to the established preanalytical rules (at too high speeds, longer than necessary);
taking blood with a syringe and then moving it into a vacuum tube;
violation of the technique for taking capillary blood (too intense pressure near the puncture site, collecting blood from the skin surface with the edge of a microtube, etc.);
storage of blood samples in violation of the temperature regime, freezing and subsequent thawing of blood samples before transportation to the laboratory;
Storing blood samples at room temperature for too long.

It should also be noted that hemolysis occurs twice as often in capillary blood samples. In this regard, Helix recommends using venous blood for all laboratory tests.

Why is it often impossible to perform an analysis on hemolyzed blood? The analysis is "hindered" by those substances that are released into the plasma from the erythrocytes. This is mainly hemoglobin. When performing many tests, the instruments used to carry them out can misinterpret the result and give an incorrect result.

How to detect hemolysis in a blood sample? The main sign of blood hemolysis is a change in its color ( see picture). The degree of color change directly corresponds to the degree of hemolysis. However, mild hemolysis may not always be visually noticeable. Therefore, in Helix, all blood samples suspected of hemolysis are subjected to a special study, which makes it possible to estimate the approximate amount of free hemoglobin in the blood, and, therefore, to accurately determine the degree of hemolysis.

The nurse should always pay attention to the color of the blood obtained after preanalytical measures. If a blood sample shows signs of hemolysis, it is better not to send it to the laboratory, as there is a possibility that it will not be possible to carry out tests on such blood. In this case, it is necessary to take blood for analysis again.

How to avoid hemolysis in blood samples? To do this, it is necessary to strictly follow the rules for taking blood and clearly and accurately perform all the necessary preanalytical actions with the obtained sample.

Here are the basic rules to follow during the blood collection process:

After treating the injection field with an antiseptic, be sure to wipe the area with a dry, lint-free cloth. This will prevent the antiseptic from getting into the test tube and destroying erythrocytes by it, as a result, hemolysis of the sample.
Use a tourniquet only if you are sure that venipuncture will not work without it (the patient has bad veins). Apply the tourniquet for a short time (a few seconds). The tourniquet should be removed immediately after entering the vein. This will avoid mechanical damage to the red blood cells.
Do not move the needle through the vein unnecessarily. Fix the holder with the needle firmly when attaching the tubes to it. This will also avoid mechanical damage to the red blood cells.
After obtaining a blood sample, stirring the blood should be carried out with smooth movements, in no case shake the tube. Also, do not drop the test tube, place it firmly in the tripod.
It is strictly forbidden to take blood with a syringe and then transfer it to a vacuum tube in any way (puncture, transfusion, etc.). This action in most cases makes the blood unsuitable for research.
The samples should be stored strictly at the required temperature. A change in temperature, long-term storage of blood at room temperature (especially in hot weather, in summer) often leads to hemolysis.
Blood samples that need to be frozen (stored at? 20 ° C) must not be thawed or re-frozen.
When taking capillary blood, you should not press hard near the puncture site to accelerate blood flow (it is better to refrain from mechanical action altogether). Collecting blood from the surface of the skin with the edge of the microtube is also unacceptable. The blood should drain independently from the wound into a special microtube for capillary blood. It should be noted that even strict adherence to all the rules for capillary blood collection cannot guarantee the absence of hemolysis in the sample obtained. This is due to physiological mechanisms that are triggered when tissue is damaged. Therefore, Helix recommends using only venous blood for all studies.

What is lipemia? Lipemia is a high concentration of lipids (fats) in a blood sample. Lipemic serum has a yellowish-white color ( see picture), the severity of which directly depends on the concentration of fats and, therefore, the degree of lipemia.

Why does lipemia occur? Most often, lipemia is caused by the ingestion of large amounts of fatty foods shortly before donating blood. Also, the presence of lipemia is possible with some diseases in which the metabolism and, in particular, the metabolism of fats are disturbed. The occurrence and degree of lipemia, as a rule, does not depend on the procedure for taking blood and subsequent preanalytical actions with the sample.

Why is it often impossible to analyze serum with lipemia? A high concentration of fats in the blood can distort the laboratory value. This is due to the peculiarities of research methods and equipment on which analyzes are performed.

How to avoid lipemia of blood samples? You should always ask the patient if he has taken food before donating blood for analysis. If the meal was later than required by the rules of preparation for the necessary tests, the patient should be advised to postpone blood donation and properly prepare for the tests.

Icterus

What is icterus? Icterus is a high concentration of bilirubin and its derivatives in a blood sample. Icterus is found in various liver diseases and some hereditary diseases. Icteric serum has a bright yellow color ( see picture), the shade of which directly depends on the concentration of bilirubin in it, and, therefore, on the degree of hemolysis.

Why is there serum icterus? Icterus is most often due to various liver diseases, in which the level of bilirubin in the blood rises sharply. Sometimes an increase in the level of bilirubin in the blood can be associated with prolonged starvation of the patient on the eve of the analysis, although even a very long absence of food intake in a perfectly healthy person rarely leads to icterus of the obtained blood serum.

Why is it often impossible for icteric serum to be analyzed? A high concentration of bilirubin in the blood can distort the laboratory value. This is due to the peculiarities of research methods and equipment on which analyzes are performed.

How to avoid icterus in blood samples? Before a blood sample is obtained, it is usually impossible to predict its icterus. If the sample obtained has signs of icterus, the patient should be warned about the likely need for repeated blood sampling for analysis. It should be borne in mind that it is not always possible to correct the increased level of bilirubin in the blood, in this case it is necessary to notify the laboratory about the peculiarities of the patient's state of health and this will be taken into account when performing research.

Test "LIH" (LIG)

As noted above, hemoglobin, bilirubin and some fractions of fats (triglycerides), at a certain concentration in the blood, can lead to distortion of the test results. This phenomenon is called interference, and manufacturers of laboratory diagnostic equipment must indicate at what concentrations of bilirubin, hemoglobin and triglycerides in blood plasma a particular study cannot be performed.

At Helix, preliminary testing of blood samples is carried out for the presence and degree of lipemia, icterus and hemolysis (LIG). After conducting the LIG study, the results are compared with the manufacturer's tolerances of the test system to perform the required analyzes and, if the allowable LIG values are exceeded, the tests are not performed.

What do the LEAG results mean? The research results are given in semi-quantitative terms in crosses from "+" (one cross) to "+++++" (five crosses). The more crosses, the higher the concentration of hemoglobin, bilirubin, or triglycerides in the blood to be tested, the higher the likelihood that the test cannot be performed.

Icterus is not a disease, but a symptom that can occur with the following pathologies:

Hemolytic yellowness. With an increased content of bile pigments in the blood, the decomposition of erythrocytes is observed, which leads to the formation of this disease. In this case, the icterus of the skin is not caused by liver diseases, but by anemia, hemolytic yellowness, and sometimes malaria.
Obstructive jaundice. This pathology can appear due to a narrowing of the biliary tract, for example, with blockage with stones. As a result, the outflow of bile worsens. The narrowing of the ducts can be caused by a tumor or enlarged lymph nodes. Sometimes such a pathology is caused by a malignant tumor of the pancreas.
Parenchymal icterus. It develops as a result of inflammatory processes occurring in the liver. Often, yellowing of the skin, the sclera of the eyes, and sometimes the tongue, is observed with hepatitis and cirrhosis. The intensity of pigmentation is influenced by the degree of damage to hepatocytes.

Causes

Bilirubin is a substance that is produced in the body due to the destruction of blood cells (hemolysis). In a normal person, the bilirubin produced must go to the liver, which neutralizes it and excretes it through the intestines along with bile.

If malfunctions occur in the body, then bilirubin begins to be absorbed into the blood, which leads to the staining of the mucous membranes and skin in yellow.

Jaundice appears when the accumulation of bilirubin in the blood serum is more than mmol / l. If the icterus index rises to the specified level, it can be judged that the disease has begun to progress.

Icterus can be accompanied by such diseases:

Chronic alcohol abuse or overdose of antibiotic drugs can also cause jaundice.

Icterus with helminthic invasion

If, against the background of helminthic invasion, the patient has a subicteric sclera, then you should visit a medical institution as soon as possible and undergo an examination.

In such cases, there is icterus of the skin and sclera of the eyes, painful sensations appear in the abdomen and right hypochondrium, appetite disappears, and nausea worries.

False icterus

Often, the use of carrots and beets leads to the appearance of yellowness of the whites of the eyes. As a result, the level of chinkarin and I-carotene rises in the body.

Sometimes antihelminthic drugs become a discoloration of the sclera. In the cases listed above, the change in eye color does not pose any threat to health and eventually disappears without any treatment.

Jaundice in infants

Icterus can also occur in newborn babies in the first day after birth. This condition is called physiological jaundice. It does not pose a danger to the health of the baby and goes away on its own after a few days.

A change in the color of the skin in babies occurs due to the active disintegration of red blood cells caused by the adaptation of the body to conditions unusual for it. The child's liver in the first days of life is not yet able to cope with large volumes of bilirubin, however, over time, it begins to fully perform its functions, and physiological jaundice disappears.

How to treat?

Icterus of the blood, skin or sclera of the eyes is not a separate disease, but signals about any pathology occurring in the body. Therefore, in order to eliminate such symptoms, it is important, first of all, to identify the cause of their occurrence. To do this, it is necessary to take blood and urine for analysis, as well as undergo other examination methods, which will be prescribed by the attending physician.

It should be noted that today special medications are used to lower bilirubin. However, they can only eliminate the external symptoms, while the cause of the disease remains.

Liver problems began about a year ago, then I was hospitalized for a long time for treatment. How.

I did not have any specific liver diagnosis, I just took a large count during pregnancy.

To cure the liver of any pills and injections that do not cure enough. You need it after treatment and.

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Icterus sclera of the eyes: causes and common diseases

The sclera is the white membrane of the eye, which consists of collagen fibers. In healthy people who do not have trouble sleeping, it should be white. In case of any violations, dilated vessels, redness, pigmentation (icterus) appear on the sclera. The last of the changes is a reason to urgently consult a doctor.

In fact, icterus is a yellowing of the skin and mucous membranes, due to the high concentration of bilirubin in the blood. This substance appears during the breakdown of red blood cells. Normally, the icterus index of the sclera and skin in adult women and men is 8.5-20.5 μmol / l. In newborns, these indicators are higher. If the test results indicate a significant excess of the norm of the icterus index, immediate diagnosis and treatment of diseases provoking jaundice is required.

It is worth remembering that it is impossible to eliminate this condition with any drops and homemade infusions for the eyes.

Bile duct stones

Skin problems (64)
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Face care (5)
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Preparation for analyzes

The rules for preparing for some laboratory tests include strictly specific recommendations for lifestyle, food intake, liquids and medications. The most complete recommendations for preparing for the research you need, can be obtained by placing a preliminary order.

General rules for preparing for blood tests

Food intake. Eating food on the eve of taking blood for analysis can greatly distort its result, and in some cases lead to the impossibility of performing studies. This is due to the fact that after absorption of nutrients in the intestine, the concentration of proteins, fats, carbohydrates and other compounds in the blood increases sharply, enzyme systems are activated, blood viscosity may change, and the level of some hormones temporarily increases. All these factors can directly affect the concentration of the investigated substance, as well as, due to changes in the physical properties of the blood itself (its "transparency"), lead to an incorrect measurement of the analyte by the device.

Each of the tests has its own preparation features - they can always be found in the Helix catalog or the medical knowledge base, however, in all cases, it is recommended to adhere to several rules before donating blood:

do not eat fatty foods a few hours before the test, preferably not for 4 hours - a high concentration of fats in the blood can interfere with any research;
shortly before taking blood, drink 1-2 glasses of ordinary still water, this will reduce the viscosity of the blood, and it will be easier to take a volume of biomaterial sufficient for the study, in addition, this will reduce the likelihood of clots forming in the test tube.

Medications. Any medicine one way or another affects the body, sometimes on the metabolism. And although, in general, the effect of drugs on laboratory parameters is known, much is determined by the physiological characteristics of a particular person, as well as the presence of diseases in him. Therefore, it is almost impossible to accurately predict how the research results will change depending on any drug.

if possible, refuse to take medications at least one day before the tests;
when taking tests while taking medications, you must indicate this fact in the referral form.

Physical activity and emotional state. Any physical activity leads to the activation of a number of enzyme and hormonal systems. The concentration of many biologically active substances in the blood increases, internal organs begin to work more intensively, and metabolism changes. Against the background of stress, the sympatho-adrenal system is activated, which, in turn, triggers mechanisms that lead to a change in the activity of many internal organs, to the activation of enzyme and hormonal systems. All this can affect the test results.

In order to exclude the influence of physical activity and psychoemotional factors on the day of testing, it is recommended:

do not play sports;
exclude increased emotional stress;
a few minutes before taking blood, take a comfortable position (sit down), relax, calm down.

Alcohol and smoking. Alcohol affects the human body in many ways. It affects the activity of the nervous system, which is known to regulate all physiological processes in the body. The products of alcohol metabolism are capable of affecting many enzyme systems, cellular respiration, and water-salt metabolism. All this can lead to changes in the concentration of most biochemical parameters, to changes in the general blood count of hormones, etc. Smoking, activating the nervous system, increases the concentration of some hormones, affects the tone of blood vessels.

To exclude the influence of alcohol and smoking on the test results, you should:

refrain from drinking alcohol for 72 hours before taking the test;
do not smoke for at least 30 minutes before taking blood.

The physiological state of a woman. The concentration of sex hormones and their metabolites in a woman's body changes significantly during the month. In this regard, tests for many hormonal indicators are recommended to be taken strictly on certain days of the menstrual cycle. The day of donating blood is determined based on which link of hormonal regulation needs to be assessed.

To obtain correct test results, it is recommended:

clarify the optimal days of the menstrual cycle (or gestational age) for donating blood for follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, androstenedione, 17-hydroxyprogesterone, prolactin, as well as for specific markers: inhibin B and anti-Müllerian hormone;
when filling out the referral form, it is necessary to indicate the phase of the menstrual cycle or the gestational age - this guarantees obtaining reliable research results with

correctly specified ranges of normal (reference) values.

Times of Day. The concentration of many substances in the human body changes cyclically during the day. This applies not only to hormones, but also to some biochemical parameters and specific markers (for example, markers of metabolism in bone tissue). For this reason, it is recommended to take some tests strictly at a certain time of the day. In the case of monitoring a laboratory indicator, its re-delivery should occur at the same time. The table below provides guidelines for when to draw blood for the determination of various laboratory parameters.

Hemolysis

What is hemolysis? Hemolysis, as a laboratory concept, is the destruction of erythrocytes ("red blood cells") in a blood sample, with the release of various biologically active substances and, most importantly, hemoglobin into plasma.

Why does hemolysis occur? Hemolysis is most often caused by the physiological characteristics of the human body who donated blood, as well as a violation of the method of blood sampling.

Reasons associated with the technique of blood sampling leading to hemolysis:

applying a tourniquet for too long;
traces of a disinfectant solution (alcohol) remained on the skin surface at the site of venipuncture;
too vigorous mixing of the blood in the test tube;
centrifugation of blood not according to the established preanalytical rules (at too high speeds, longer than necessary);
taking blood with a syringe and then moving it into a vacuum tube;
violation of the technique for taking capillary blood (too intense pressure near the puncture site, collecting blood from the skin surface with the edge of a microtube, etc.);
storage of blood samples in violation of the temperature regime, freezing and subsequent thawing of blood samples before transportation to the laboratory;
Storing blood samples at room temperature for too long.

It should also be noted that hemolysis occurs twice as often in capillary blood samples. In this regard, Helix recommends using venous blood for all laboratory tests.

Why is it often impossible to perform an analysis on hemolyzed blood? The analysis is "hindered" by those substances that are released into the plasma from the erythrocytes. This is mainly hemoglobin. When performing many tests, the instruments used to carry them out can misinterpret the result and give an incorrect result.

How to detect hemolysis in a blood sample? The main sign of blood hemolysis is a change in its color (see figure). The degree of color change directly corresponds to the degree of hemolysis. However, mild hemolysis may not always be visually noticeable. Therefore, in Helix, all blood samples suspected of hemolysis are subjected to a special study, which makes it possible to estimate the approximate amount of free hemoglobin in the blood, and, therefore, to accurately determine the degree of hemolysis.

How to avoid hemolysis in blood samples? To do this, it is necessary to strictly follow the rules for taking blood and clearly and accurately perform all the necessary preanalytical actions with the obtained sample.

Here are the basic rules to follow during the blood collection process:

After treating the injection field with an antiseptic, be sure to wipe the area with a dry, lint-free cloth. This will prevent the antiseptic from getting into the test tube and destroying erythrocytes by it, as a result, hemolysis of the sample.
Use a tourniquet only if you are sure that venipuncture will not work without it (the patient has bad veins). Apply the tourniquet for a short time (a few seconds). The tourniquet should be removed immediately after entering the vein. This will avoid mechanical damage to the red blood cells.
Do not move the needle through the vein unnecessarily. Fix the holder with the needle firmly when attaching the tubes to it. This will also avoid mechanical damage to the red blood cells.
After obtaining a blood sample, stirring the blood should be carried out with smooth movements, in no case shake the tube. Also, do not drop the test tube, place it firmly in the tripod.
It is strictly forbidden to take blood with a syringe and then transfer it to a vacuum tube in any way (puncture, transfusion, etc.). This action in most cases makes the blood unsuitable for research.
The samples should be stored strictly at the required temperature. A change in temperature, long-term storage of blood at room temperature (especially in hot weather, in summer) often leads to hemolysis.
Blood samples that need to be frozen (stored at? 20 ° C) must not be thawed or re-frozen.
When taking capillary blood, you should not press hard near the puncture site to accelerate blood flow (it is better to refrain from mechanical action altogether). Collecting blood from the surface of the skin with the edge of the microtube is also unacceptable. The blood should drain independently from the wound into a special microtube for capillary blood. It should be noted that even strict adherence to all the rules for capillary blood collection cannot guarantee the absence of hemolysis in the sample obtained. This is due to physiological mechanisms that are triggered when tissue is damaged. Therefore, Helix recommends using only venous blood for all studies.

Lipemia

What is lipemia? Lipemia is a high concentration of lipids (fats) in a blood sample. Lipemic serum has a yellowish-white color (see figure), the severity of which directly depends on the concentration of fats and, therefore, the degree of lipemia.

Why does lipemia occur? Most often, lipemia is caused by the ingestion of large amounts of fatty foods shortly before donating blood. Also, the presence of lipemia is possible with some diseases in which the metabolism and, in particular, the metabolism of fats are disturbed. The occurrence and degree of lipemia, as a rule, does not depend on the procedure for taking blood and subsequent preanalytical actions with the sample.

Why is it often impossible to analyze serum with lipemia? A high concentration of fats in the blood can distort the laboratory value. This is due to the peculiarities of research methods and equipment on which analyzes are performed.

How to avoid lipemia of blood samples? You should always ask the patient if he has taken food before donating blood for analysis. If the meal was later than required by the rules of preparation for the necessary tests, the patient should be advised to postpone blood donation and properly prepare for the tests.

Icterus

What is icterus? Icterus is a high concentration of bilirubin and its derivatives in a blood sample. Icterus is found in various liver diseases and some hereditary diseases. Icteric serum has a bright yellow color (see figure), the shade of which directly depends on the concentration of bilirubin in it, and, therefore, on the degree of hemolysis.

Why is there serum icterus? Icterus is most often due to various liver diseases, in which the level of bilirubin in the blood rises sharply. Sometimes an increase in the level of bilirubin in the blood can be associated with prolonged starvation of the patient on the eve of the analysis, although even a very long absence of food intake in a perfectly healthy person rarely leads to icterus of the obtained blood serum.

Why is it often impossible for icteric serum to be analyzed? A high concentration of bilirubin in the blood can distort the laboratory value. This is due to the peculiarities of research methods and equipment on which analyzes are performed.

How to avoid icterus in blood samples? Before a blood sample is obtained, it is usually impossible to predict its icterus. If the sample obtained has signs of icterus, the patient should be warned about the likely need for repeated blood sampling for analysis. It should be borne in mind that it is not always possible to correct the increased level of bilirubin in the blood, in this case it is necessary to notify the laboratory about the peculiarities of the patient's state of health and this will be taken into account when performing research.

Test "LIH" (LIG)

At Helix, preliminary testing of blood samples is carried out for the presence and degree of lipemia, icterus and hemolysis (LIG). After the LIG study, the results are compared with the tolerances of the manufacturer of the test system for performing the required analyzes, and if the allowable LIG values are exceeded, the tests are not performed.

What do the LEAG results mean? The research results are given in semi-quantitative terms in crosses from "+" (one cross) to "+++++" (five crosses). The more crosses, the higher the concentration of hemoglobin, bilirubin, or triglycerides in the blood to be tested, the higher the likelihood that the test cannot be performed.

General rules for preparing for urine tests

Depending on the necessary laboratory tests, the first, middle, third (usually morning) or "one-time" (not depending on the collection sequence) portion of urine can be used for analysis. Regardless of the preanalytical procedures, urine for examination is collected by the patient in a sterile plastic container. Then, for storage and transportation, a sample of a single portion of urine is transferred into an appropriate vacuum tube, depending on the study.

women are recommended to conduct a study before menstruation or 2 days after its end;
The PCR method for diagnosing urogenital infections by urine is suitable exclusively for men; in women, this diagnostic method is much inferior in terms of its information content to the study of a urogenital smear and is not used.

Daily urine tests

Daily urine is all urine collected within 24 hours.

Daily urine is most often collected by the patient independently at home using a special kit for collecting and transporting a daily urine sample. Before the collection begins, the patient is given the necessary instructions on the collection procedure and the necessary measures to prepare for the test. The 24-hour urine samples are then transferred to the appropriate shipping container for storage and transportation, depending on the study.

it is not recommended to consume on the eve of the study (10–12 hours in advance): alcohol, spicy, salty foods, foods that change the color of urine (for example, beets, carrots);
as far as possible, exclude the use of diuretics;
before taking the analysis, make a thorough toilet of the external genital organs;
women are not recommended to perform research during menstruation.

General rules for preparing for fecal analyzes

To collect and transport feces, the patient is given a sterile plastic container with a spoon. The container may contain culture medium (peptone) or a preservative, depending on the type of test.

The material obtained after an enema, after taking radiopaque substances (barium in an X-ray examination), is unsuitable for research.

General clinical and antigenic research

Eliminate the intake of laxatives, the introduction of rectal suppositories, oils, limit the intake of medications that affect intestinal motility (belladonna, pilocarpine, etc.), and drugs that affect the color of feces (iron, bismuth, barium sulfate) for 72 hours before collecting feces ...
The study should be carried out before performing sigmoidoscopy and other diagnostic procedures in the intestine and stomach.
To study feces for occult blood, exclude meat, fish, green vegetables, tomatoes from the diet for 72 hours before the study.

General rules for preparing for analyzes of urogenital smears

For 2 weeks before the study, exclude the local use of antiseptics and / or antibacterial and antifungal drugs.
For 3 hours before the study, refrain from urinating, do not toilet the external genitalia.
It is recommended to analyze a urogenital smear in a man no earlier than 2 weeks after taking antibacterial drugs.
In men, in the presence of urethral discharge, the surface of the head and the area of the external opening of the urethra should be cleaned with a gauze swab and the foreskin pulled back to prevent contamination.

Urogenital swab in women

The study should be carried out before menstruation or 1-2 days after its end.
On the eve of the examination, douching, toilet of the external genital organs with the use of intimate hygiene products should not be carried out.
The material is taken before manual research.
Biomaterial sampling from virgins, pregnant women and patients under 18 years of age should preferably be carried out by a doctor.

General rules for preparing for the analysis for enterobiasis

For the study, a smear-print from the perianal region is used. Taking biomaterial for research is carried out by a nurse.
The collection of biomaterials is carried out only in the morning, until 10:00.
In the morning on the eve of biomaterial sampling, do not toilet the skin in the anus and buttocks.

General rules for preparing for ejaculate analyzes

The ejaculate is collected by the patient independently by masturbation.

To obtain the true parameters of the reproductive capacity of sperm, the analysis of the semen analysis should be carried out twice with an interval of at least 7 days and no more than 3 weeks.

Microbiological studies and PCR studies

The study is recommended to be carried out before the start of taking antibiotics and other antibacterial chemotherapy drugs (if this is not possible, then not earlier than 12 hours after the drug is discontinued).

Spermogram

Completely exclude taking medications within 24 hours before the study (in agreement with the doctor).
For 72 hours before the examination, exclude sexual intercourse, alcohol intake, hot baths, sauna visits, physiotherapy and X-ray examination.

General rules for preparing for sputum tests

The sputum is collected by the patient independently through deep coughing.
It is recommended to collect sputum in the morning.
Before collecting sputum, it is recommended to brush your teeth, rinse your mouth and throat with boiled water.

General rules for preparing for analyzes of the buccal (buccal) epithelium

If the patient has eaten less than 2 hours before taking the biological material, it is necessary to rinse the mouth with water.
For infants - exclude breastfeeding 2 hours before taking biological material.

General rules for preparing for the delivery of biomaterial for cytological studies

It is advisable to take smears no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the expected start of menstruation.
You can not get smears within 24 hours after sexual intercourse, using lubricants, vinegar or Lugol solution, tampons or spermicides, douching, introducing medications, suppositories, creams, including gels for performing ultrasound into the vagina.
In acute infection, it is desirable to obtain material for the purpose of examination and identification of the etiological agent; after treatment, but not earlier than 2 months later, cytological control is required.

Aspirate from the uterine cavity

It is advisable to receive the material no earlier than on the 6-9th day of the menstrual cycle and no later than on the 5th day before the expected start of menstruation.
Douching should not be performed within 24 hours before the study, and the use of intravaginal therapy should also be excluded.
Before taking smears from the uterine cavity, you must make sure that there is no pregnancy, vaginitis or cervicitis.
All manipulations in the uterine cavity can be carried out only if infectious diseases of the vaginal mucosa and cervix are completely cured.

General rules for preparing for hair analyzes

Special conditions for patient preparation are not required.

Trace element studies

Hair from the head is the preferred biomaterial for research. Hair from other parts of the body should only be used if there is no hair on the head.
Stop using medicated hair products 2 weeks before submitting your hair for analysis.

Dyed, bleached, permed hair is not suitable for examination. Wait until the hair grows back in an amount sufficient to collect the hair sample.

Hair should be clean and dry (it is advisable to wash your hair no later than 24 hours before collecting hair). Before the examination, it is not allowed to apply any cosmetic or medical products (creams, oils, gels, etc.) to the hair.

Avoid professional contact of hair with external contamination (welding, mining) between shampooing and hair collection.

Before collecting hair, thoroughly wash and dry hands and scissors.

What is icterus and how can it be caused?

Icterus is pigmentation, the acquisition of a yellow color of the mucous membranes and skin, which occurs with an increase in the level of bilirubin in the blood serum. Best of all, the manifestation of this pathology is noticeable on the sclera. Depending on a number of reasons and factors, the patient's skin can acquire not only yellow color, but in rare cases, green and olive shades.

Icterus is not an independent disease, but only a symptom that accompanies a number of diseases such as:

Mechanical or subhepatic jaundice. This pathology is the cause of narrowing of the bile ducts (most often this occurs due to blockage of the pathways by stones), as a result of which the level of bile outflow decreases. Also, various neoplasms of a benign or malignant nature, tumors, hematomas, and enlarged lymph nodes can also compress the channels and restrict the outflow. In some cases, pancreatic cancer can cause subhepatic jaundice.
Hemolytic yellowness. It occurs during the breakdown of red blood cells due to an overabundance of bile pigments. This icterus is in no way associated with diseases of the liver and bile ducts, and mainly it can be observed with pernicious anemia, hereditary hemolytic jaundice or malaria.
Parenchymal icterus. It is no longer observed with blockage of the channels, but with a disease of the liver itself. There are two main factors in its occurrence - cirrhosis and hepatitis. The intensity of jaundice directly depends on the degree of damage to the cells of the organ.

Bilirubin is a toxic substance that is a breakdown product of aging red blood cells. At the biochemical level, the cause of the disease is an increase in the saturation of the patient's blood with bilirubin - hyperbilirubinemia. But at the same time, external manifestations are regulated not only by the content of bilirubin in the plasma, but also by the thickness of the subcutaneous fat layer in each individual patient.

The ingestion of bilirubin into the blood occurs as a result of absorption from the blocked bile ducts. Bilirubin bypasses bile and is absorbed directly into the bloodstream, which causes pathology.

Until the content of serum bilirubin in the blood exceeds the norm by two times

(approximately domkmol / l), pigmentation should not appear. If jaundice manifests itself, then we can talk about a significant progression of pathology.

Quite often, jaundice can manifest itself in newborns in the first week of their life. But there is no cause for panic here. This is completely natural and goes away in a few days. The reason is the process of adaptation of the newborn to new conditions, as a result of which a dynamic breakdown of red blood cells occurs and the liver cannot cope with the amount of bilirubin produced.

In medicine, there is also such a thing as "false icterus". It arises as a result of an increase in the concentration of I-carotene and chinkarin. However, it has a significant difference - with "false jaundice" pigmentation does not affect the mucous membranes.

Pathology has very obvious and simple symptoms. As already described above, it is visually manifested by yellow staining of the sclera of the eyes, skin and other mucous membranes. Jaundice may be accompanied by symptoms such as vomiting, nausea, itching, fever, and abdominal pain.

In case of exacerbation of subhepatic jaundice, golden pigmentation appears, and in the future it can acquire a green tint. This happens as a result of the oxidation of bilirubin. If the treatment is ineffective or not at all, the color may turn dark green, sometimes very close to black.

Hemolytic icterus has a mild character, the skin becomes pale with a yellowish tinge.

If you find the slightest signs of a disease, you should immediately consult a doctor.

Since icterus is only a symptom, treatment is directly related to the treatment of those ailments that caused it. There are many drugs that artificially lower the amount of bilirubin in the blood. These are Silibinin, Silibor, Silymarin-Geksar, Darsil, Geparsil, Siromin and others. However, taking them will not give the desired result and will only relieve external symptoms. To make an accurate diagnosis, the patient is prescribed general analysis blood and urine.

And a little about secrets.

A healthy liver is the key to your longevity. This organ performs a huge number of vital functions. If the first symptoms of a disease of the gastrointestinal tract or liver were noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stools, you simply have to take action.

All information on the site is provided for informational purposes only. Always consult your doctor before applying any recommendations.

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Icterus sclera - causes and treatment

Skin pigmentation caused by an increase in serum bilirubin levels is called icterus. This is a peculiar yellow coloration of the epidermis and mucous membranes, which is best seen on the sclera. Icterus sclera is not an independent disease, it is only a symptom indicating a pathological increase in blood bilirubin.

Jaundice with icterus of the sclera becomes noticeable with an increase in the level of serum bilirubin domcmol / l, which is approximately two times higher than the norm (20-25 mg / l). True, a yellow color of the skin can also be noted with an increase in the serum carotene content (false icterus), however, in this case, it is not accompanied by pigmentation of the eye sclera.

Bilirubin metabolism

Bilirubin in blood is the main element of the breakdown of hemoglobin, which is released from aging red blood cells. Its transformation begins with binding to albumin, then it enters the liver, where it is conjugated via glucuronyl transferase and converted into a water-soluble form (glucuronide). At the next stage, bilirubin is excreted by bile, and at the last stage, it is transformed in the intestine into urobilinogen. The main part of urobilinogen is excreted in the feces, the remainder is reabsorbed and excreted through the kidneys.

At the level of biochemistry, icterus is explained by a significant increase in the level of bilirubin in the blood - hyperbilirubinemia.

Bilirubin enters the bloodstream through absorption from blocked bile ducts (in the case of obstructive jaundice) or dysfunction of liver cells when the substance is excreted into bile. That is, bypassing bile, the compound is absorbed immediately into the bloodstream, which explains the appearance of icterus.

At the same time, the external manifestations of jaundice are regulated not only by the level of bilirubin in the blood, but also by the thickness of the layer of human subcutaneous fat. That is, the greater the thickness of the fatty deposits, the lower the visual intensity of icterus. In this regard, scleral icterus is a more reliable factor in the progression of the disease that caused it.

Diseases accompanied by icterus sclera

It is worth noting that the icterus of the skin and sclera of the eyes can accompany a number of diseases. It is they who determine the external manifestations of this symptom:

Obstructive jaundice. It occurs due to the narrowing of the biliary tract, which becomes the cause, the deterioration of the outflow of bile. As a rule, the narrowing of the biliary tract is caused by blockage of the canals with stones in gallstone disease. At the same time, mechanical restriction of bile outflow can be triggered by compression of the pathways by tumors, enlargement of lymph nodes, and trauma. Often, obstructive jaundice is caused by pancreatic cancer.
Parenchymal icterus. A condition that results from damage to liver cells. As a rule, this occurs with acute hepatitis and cirrhosis. In this case, the yellowness of the integument can vary significantly in intensity, which depends on the degree of organ damage.
Hemolytic yellowness. It is usually caused by an excess of bile pigments, which is the result of the destruction of red blood cells. This condition has nothing to do with liver disease or obstruction of bile outflow. Most often, such a violation is observed in the case of hereditary hemolytic jaundice, malaria, pernicious anemia. The yellowness in this case is usually less pronounced than in the others.

Signs of icterus

The external manifestations of icterus are well visualized, because the skin, the sclera of the eyes, and the rest of the mucous membranes are colored yellow (with variations in intensity).

At the same time, exacerbation of obstructive jaundice, gives a golden color of pigmentation, which eventually acquires a greenish tint. The reason for this is the oxidation of bilirubin. In the absence or ineffectiveness of treatment and further progression of the disease, the color may gradually change to brown-green and even close to black.

Parenchymal jaundice is characterized by a bright yellow color of the skin, which is accompanied by severe itching, pain in the right hypochondrium, symptoms of hepatocellular insufficiency.

Hemolytic icterus is poorly expressed. As a rule, it is manifested only by the pallor of the skin, which has a not pronounced yellowish tint.

Treatment

As mentioned above, scleral icterus is not a disease, but becomes only a symptom of it. Therefore, treating it, without treating the underlying disease, simply does not make sense.

True, today there are drugs that artificially reduce the level of bilirubin in the blood, which leads to the disappearance of external symptoms. However, when using them without proper treatment, it is worth remembering that this is only a temporary measure and the yellowness of the skin will return again very soon.

At the Moscow Eye Clinic medical center, everyone can be examined using the most modern diagnostic equipment, and based on the results, they can get advice from a highly qualified specialist. The clinic consults children from 4 years old. We are open seven days a week and work every day from 9 am to 9 pm. Our specialists will help to identify the cause of decreased vision, and will carry out competent treatment of the identified pathologies.

You can clarify the cost of a particular procedure, make an appointment at the Moscow Eye Clinic by phone (daily from 9:00 to 21:00, free of charge for mobile phones and regions of the Russian Federation) or using the online registration form.

Icterus sclera

Bilirubin is a pigment produced by hemolysis (destruction) of red blood cells. An increase in the level of bilirubin is accompanied by characteristic symptoms: icterus of the sclera, skin, discoloration of feces. An increase in the amount of bilirubin can be physiological (for example, physiological jaundice of newborns), as well as pathological (diseases of the liver, as well as of the gallbladder, etc.).

Where does bilirubin come from?

Erythrocytes are involved in the formation of bilirubin, i.e. red blood cells. Each red blood cell contains a hemoglobin molecule. Red cells have a specific life cycle. Destruction of old red blood cells occurs in the spleen as well bone marrow, liver. During this, the release and breakdown of hemoglobin, myoglobin, cytochromes occurs. Bilirubin is formed from the decay products. In the future, it is excreted in the bile by the liver.

Bilirubin and its forms

Bilirubin is divided into direct and indirect. The latter is the so-called "fresh" bilirubin, formed recently. It has toxic properties. Direct bilirubin is bound and rendered harmless in the liver.

Indicators of bilirubin in blood biochemistry

To determine the level of bilirubin, it is necessary to donate blood for biochemistry. There are certain rules for preparing for this study in order to exclude false results:

blood is donated on an empty stomach;
a light dinner the night before;
refrain from drinking alcohol, fatty foods.

The laboratory standards for bilirubin are as follows (measurements are presented in μmol / l):

general (direct + indirect) - 8.5–20.5;
straight (connected) - up to 4.3
indirect (unrelated) - up to 17.1;

Causes of hyperbilirubinemia

There are three main reasons here:

Violation of the processing of bilirubin by the liver

With various pathologies of the liver, there is a violation of the formation of direct bilirubin. These diseases include: hepatitis (viral, medicinal, toxic), liver cancer, Gilbert's syndrome, liver cirrhosis. Patients with hepatitis may experience the following symptoms:

yellowness;
darkening of urine;
discoloration of feces;
discomfort or pain in the right hypochondrium;
belching, nausea;
fatigue.

In Gilbert's syndrome, the formation of the liver enzyme UDFGT is reduced and bilirubin transport is impaired. This is a hereditary disease, manifested by icterus of the sclera, skin.

The main pathology in which increased destruction of red blood cells occurs is hemolytic anemia... It can be congenital (for example, thalassemia) and acquired (for example, as a result of malaria). In laboratory parameters, indirect bilirubin will be increased.

yellowness;
enlargement of the spleen and discomfort as a result;
fever;
darkening of urine.

Violation of the outflow of bile.

This includes diseases of the gallbladder (cholestasis, gallstone disease, cancer, etc.). With these pathologies, an increase in direct bilirubin will be observed in blood tests. The leading symptoms here will be:

Bilirubin levels in pregnant women

In expectant mothers, the so-called cholestasis - stagnation of bile, can be observed. In this case, there will be an increase in bilirubin, and the woman may feel discomfort or pain under the costal arch on the right, itching of the skin. This condition requires correction of diet or drug therapy, depending on the level of increased bilirubin.

Newborns and their features of the level of bilirubin

Among the borderline conditions of newborns, "physiological jaundice" is noted. It is associated with the breakdown of erythrocytes containing fetal hemoglobin, as well as the fact that immature liver enzymes do not have time to bind excess bilirubin. The norms for total bilirubin are:

in premature babies - up to 171 μmol / l;
in full-term newborns at 3-5 days of life - up to 205 µmol / l;

But sometimes, as a result of the Rh-conflict, hemolytic disease occurs in newborns. This disease requires urgent medical attention.

What it is?

As already mentioned, bilirubin is a breakdown product of hemoglobin. Red blood cells, or red blood cells, are natural oxygen carriers. The hemoglobin contained within red blood cells captures an oxygen molecule and transports it to other cells in the body. When red cells become old, they are destroyed in the organs of the reticuloendothelial system:

Here hemoglobin is released and broken down into globin chains and a non-protein component - heme. Under the influence of enzymatic activity, heme is converted into indirect bilirubin. What is indirect bilirubin? This pigment is not detectable with Ehrlich's reagent until additional treatment with alcohol is carried out. After that, blood proteins will fall into a sediment, and bilirubin will acquire a characteristic color. This reaction was named indirect, and the bilirubin fraction was named after it. The pigment does not dissolve in water, however, it perfectly passes through cell membranes. This property causes increased cytotoxicity in hyperbilirubinemia. Subsequently, indirect bilirubin binds to albumin and is delivered to the liver.

Once in the liver, indirect bilirubin reacts with glucuronyltransferase and combines with glucuronic acid, after which it turns into direct bilirubin. This means that additional treatment with alcohol is not required to carry out the Ehrlich reaction, and bilirubin will be stained immediately. In the future, straight bilirubin is part of the bile and secreted into the intestine. In the intestine, glucuronic acid is cleaved from it and bilirubin is converted into urobilinogen. Part of it is absorbed through the mucous membrane and goes back to the blood and liver. The other part enters the large intestine, where stercobilinogen is converted after interaction with microflora. In more distal parts the colon, stercobilinogen comes into contact with oxygen and is converted to stercobilin. This pigment gives the feces its specific color. With the development of obstructive jaundice, bile cannot enter the digestive tract, as a result of which discoloration of excrement occurs.

Diagnostics

To detect bilirubin in the blood, it is necessary to use the Van den Berg reaction, during which the aforementioned Ehrlich reagent is used. Bilirubin, interacting with this reagent, begins to stain in a specific pink color. Further assessment of the concentration of bilirubin in the blood plasma is carried out colorimetrically.

To detect bilirubin in urine, the Harrison test is used. As the concentration of pigment increases, the urine will turn blue or green. This test is considered highly specific, and the appearance of a positive result immediately indicates disturbances in bilirubin metabolism.

Norm

To assess the general state of the liver and the hematopoietic system, it is necessary to know the normal levels of bilirubin. Performance can vary greatly depending on the laboratory and the reagents used. It is very important that the specialist who performed the analysis should indicate normal values next to the result. In most laboratories, the physiological indicator of total bilirubin is considered to be a result from 0.5 to 20.5 μmol / L. Indirect and direct up to 16.2 and up to 5.1, respectively. The ratio of the total amount of indirect bilirubin to direct bilirubin should be at least 3: 1.

Depending on the developed pathological process, these indicators can vary greatly. The condition caused by an increase in the level of bilirubin in the blood is called hyperbilirubinemia. The change in the ratio of fractions depends on the level of disturbance of bilirubin metabolism.

Diseases

There are several diseases in which an increased concentration of bilirubin will be found in the blood. A specific symptom of bilirubinemia is the appearance of jaundice. Depending on the level of disturbance of bilirubin metabolism, it can take on different shades:

Suprahepatic (lemon yellow);
Hepatic (saffron yellow);
Subhepatic (yellow-green).

Suprahepatic jaundice

A number of pathological conditions can occur in the human body, in which there is an increased breakdown of red blood cells. Due to the large release of hemoglobin, it must be rapidly metabolized. An increase in the level of indirect bilirubin is due to the need to convert free bilirubin for further utilization. The breakdown of red blood cells can occur in many diseases:

Malaria;
Typhoid fever;
Poisoning with toxins and heavy metals;
Blood transfusion of incompatible blood group;
Acute blood loss.

Symptoms characteristic of adhepatic jaundice:

Decreased hemoglobin levels;
Increased weakness;
Pallor of the skin in combination with jaundice gives a specific lemon-yellow color;
Enlargement of the spleen;
Cardiopalmus;
Headache.

Subhepatic jaundice

The reason for the development of subhepatic jaundice is a mechanical violation of the outflow of bile into the intestine. The condition can be associated with several pathologies.

Calculous cholecystitis. The gallbladder is the organ in which bile accumulates. When food enters the gastrointestinal tract, bile secretion is stimulated. With pathological activity of microorganisms, as well as with damage to the wall of the gallbladder, disorders of bile metabolism may occur. A change in the ratio of bile components leads to the formation of stones. It is not uncommon for people to live with calculous cholecystitis for many years and are unaware of their condition. However, other patients on this background develop a serious illness called obstructive jaundice.

Under certain circumstances, the stone begins to leave the gallbladder and go along the bile ducts. If the stone is small, then it easily comes out into the lumen of the duodenum. If the size is large, then the stone gets stuck in the bile duct or at the exit from the gallbladder. In this case, further accumulation of bile occurs, which cannot find a way out. Gradually, the gallbladder becomes inflamed and increases in size, and bile begins to enter the bloodstream. Direct bilirubin spreads through the circulatory system and begins to stain almost all organs and tissues.

On examination, in such patients, sclera icterus, yellowness of the skin and visible mucous areas are observed. Itching is a specific symptom. In all forms of subhepatic jaundice, the value of direct bilirubin in the blood will be increased.

Another pathological condition leading to subhepatic jaundice is cancer of the head of the pancreas. This part of the organ is located adjacent to the gallbladder and liver. If cancer begins to grow in the head of the pancreas, then there is an increased risk of blocking the gallbladder duct. Unlike calculous cholecystitis, jaundice will be painless and slowly increasing. On palpation of the liver, an enlarged, painless gallbladder is felt under its lower edge. This feature called Courvoisier's symptom.

Hepatic jaundice

Hepatic jaundice develops as a result of damage to the liver parenchyma and an inability to carry out normal bilirubin metabolism. Typically, the main cause of this condition is hepatitis. Inflammatory processes in the liver, depending on the etiology, can be classified in different ways:

The most common is viral hepatitis. Today, five main viral hepatitis are known: A, B, C, D, E. The first and the last are transmitted by the fecal-oral route, their course is not so pronounced for the patient. Typical clinical picture for hepatitis:

General weakness and increased fatigue;
Increased body temperature;
Myalgia;
Arthralgia;
Soreness in the right hypochondrium;
Yellowness of the skin and visible mucous membranes;
Changes in the color of feces and urine due to a violation of bilirubin metabolism.

The progressive suppression of liver function leads to digestive problems, decreased blood protein levels, swelling, itching, and increased bleeding. Since one of the main functions of the liver is the metabolism of toxic compounds, then from time to time the amount of these substances in the blood will increase. A condition called hepatic coma is due to this effect. Liver failure is life-threatening and requires immediate detoxification measures. In hepatitis, the total bilirubin level will be increased by two fractions.

Cirrhosis

This condition is a severe pathological change in the liver parenchyma, manifested by the replacement of healthy areas with connective tissue. Massive death of liver cells leads to a decrease in the functional activity of the liver. Due to various histological abnormalities, the normal exchange of bilirubin becomes impossible. The liver cannot capture indirect bilirubin and metabolize it to direct bilirubin. In addition, other functions are suppressed. Protein synthesis falls, toxins are not removed from the body, the blood coagulation system suffers.

A number of characteristic signs are observed in patients with cirrhosis. Due to the increase in pressure in the portal vein system, the size of the liver and spleen increases. Typical manifestations of portal hypertension are:

Ascites;
Hypoproteinemia;
Varicose veins of the esophagus and anterior abdominal wall;
Esophageal-gastric bleeding;
Haemorrhoids.

If timely treatment is not started, then patients develop hepatic encephalopathy, which can easily turn into a coma. As a result of blood clotting disorders in patients, hemorrhagic skin rashes, as well as hemorrhages in internal organs, are noted. Liver cirrhosis is a condition with a poor prognosis that reduces the patient's quality of life.

Congenital disorders of bilirubin metabolism

Due to certain genetic changes transport, metabolism or utilization of bilirubin from the body may be impaired. These conditions are called hereditary jaundice.

The most common disorder of bilirubin metabolism is Gilbert's syndrome. In this pathology, bilirubin is not transported to the point of connection with glucuronic acid, therefore it does not turn into its direct fraction. Laboratory Gilbert's syndrome is manifested by an increase in the concentration of indirect bilirubin in the blood. The course of the pathology is benign, and the prognosis of such patients is favorable. Gilbert's syndrome is a hereditary disorder and is most common in Africans. As a rule, the course of the syndrome is asymptomatic, it can manifest itself as episodic jaundice, which occurs against the background of psycho-emotional experiences, excessive physical exertion, or when drinking a lot of alcohol. Since the pathology has a favorable prognosis and does not manifest itself clinically, no specific treatment is required.

Jaundice of newborns

In many babies, in the first days of life, an increase in the level of bilirubin is observed, however, this condition is completely physiological and does not pose a danger to the child. Such a reaction is part of the adaptive mechanisms associated with the replacement of fetal hemoglobin by an adult. The replacement process is accompanied by increased destruction of red blood cells. Physiological jaundice is most pronounced on the 3-5th day of birth. Over time, it goes away on its own and is harmless to the child.

Another situation is observed when the baby is premature or when there is a Rh-conflict between him and the mother. This condition is pathological and may be accompanied by nuclear jaundice. In this case, the penetration of the breakdown products of hemoglobin through the blood-brain barrier occurs, which leads to a powerful intoxication of the body.

For any form of jaundice, it is necessary to prescribe appropriate tests to make sure that it is physiological and to exclude pathology.

Treatment

Elimination of disorders in the exchange of bilirubin should be complex. It must be remembered that the main problem is not hyperbilirubinemia, but the cause that caused it. The appropriate treatment is selected depending on the pathological process.

The information provided in the text is not a guide to action. To obtain reliable information about your own disease, you must consult a doctor.

Treatment of obstructive jaundice is usually surgical. Laparoscopic surgery is by far the most convenient way to remove gallstones. With calculous cholecystitis, the gallbladder is removed along with the stones.

Treatment for cancer of the head of the pancreas is more complex and depends on the stage. When neoplasms grow into neighboring organs and with metastasis, preference is given to radiation and chemotherapy. Hepatitis B and C are treated with specific antiviral drugs and human interferon.

With hemolysis of erythrocytes, a massive infusion of a solution of glucose, albumin and erythrocyte mass is prescribed. If hemolysis is of autoimmune origin, then glucocorticoid administration is required. For jaundice of newborns, phototherapy is indicated. Under the influence of ultraviolet radiation, the exchange of indirect bilirubin improves, which has a beneficial effect on the condition of the child.

But perhaps it is more correct to treat not the effect, but the cause? We recommend reading the story of Olga Kirovtseva, how she cured her stomach ... Read the article >>

Causes of icterus of the sclera and skin

As mentioned above, the reason is the same - a high concentration of bilirubin in the blood. But the following diseases can cause the breakdown of red blood cells:

A severe genetic disorder that prevents the normal development of the bile ducts. Icterus of the skin and sclera is one of the symptoms of this disease. Patients can be easily distinguished from healthy people by facial features such as a small chin, a high forehead, and an elongated bridge of the nose. Sufferers of this disease often have problems with the heart, kidneys, and stomach.

Inflammatory disease gallbladder... Yellowing of the sclera does not necessarily become a symptom of it, but it does occasionally appear in some people. In addition, the ailment is accompanied by pain in the upper abdomen, nausea, vomiting and, as a result, loss of appetite and weight loss.

Although the symptoms are different for each type of disease, icteric skin tone and yellowness of the sclera are their main signs. In addition to them, there is also nausea, vomiting, pain in the right hypochondrium, itching of the skin. All hepatitis differ from each other by the rate of flow, by infection, by the duration of treatment. With hepatitis A and B, symptoms appear within two weeks. But you may not know about hepatitis C for a long time.

As a rule, it is lamblia or liver fluke. They enter the human liver along with food that has not been subjected to high-quality heat treatment. When there are a lot of them, symptoms similar to liver diseases appear, namely: yellow skin and sclera of the eyes, pain in the upper abdomen and in the right hypochondrium, nausea, loss of appetite. The analysis of feces and blood (liver function tests) will help to distinguish worms from liver diseases.

A very serious illness leading to disability. The liver degenerates into scar tissue and ceases to perform its functions. Symptoms of the disease are yellow sclera of the eyes, icterus and dry skin, swelling of the abdomen, nausea, vomiting. There are plenty of reasons for cirrhosis of the liver; neglected diseases or congenital defects of this organ, or alcoholism, drug addiction and even unhealthy diet lead to it.

Tumors of the liver and pancreas

Neoplasms can be cancerous or benign. Depending on their size and location, they interfere with the normal functioning of the liver, and therefore people develop the symptoms of the diseases described above. Causes of the disease: heredity, smoking, diabetes, obesity.

Bile duct stones

Often appear in overweight people, although there are exceptions. The reason is an excess of cholesterol in the body, caused by poor diet or diabetes. The stones interfere with the normal outflow of bile, thus provoking various diseases of the liver and pancreas.

Infection. It is transmitted from one person to another by airborne droplets and is accompanied by a slight yellowing of the mucous membranes and skin, enlarged lymph nodes, plaque on the tonsils. During the diagnosis, an enlarged liver and spleen of the patient can be seen.

Yellowing of the sclera is not a cosmetic defect, such as yellowing of the skin. The icterus of the ocular membrane is the cause of very serious diseases. Their treatment almost always takes place within the walls of the hospital. Some diseases are very contagious, some require surgical intervention, others are fraught with death, others are not cured completely and the patient needs to constantly keep his condition normal, taking the prescribed drugs.

If you find this symptom in yourself, you should immediately consult a doctor. The diagnosis of the above diseases is carried out by a gastroenterologist and a therapist.

Causes of yellowing of proteins

Yellow staining of the sclera occurs as a result of pathological disorders. The albuminous coat takes on various shades: from light lemon to bright brown. Yellow sclera of the eyes occurs at any age, both in newborns and in adult patients. The most common conditions associated with scleral icterus are jaundice, which are:

False - yellowing of the sclera is caused by the consumption of a large amount of carrots, beets, and is also noted after therapy with antihelminthic drugs. In this case, the yellow whites of the eyes do not pose a threat to health, and the color normalizes on its own.
Mechanical - the cause of development is the narrowing of the bile ducts and the obstruction of the outflow of bile into the duodenal cavity. As a result of blockage, bilirubin enters the bloodstream and spreads through the vascular system to tissues and organs. The disturbed outflow of bile leads first to pigmentation of the skin, and then a yellow sclera of the eyes is noted.
Parenchymal - result from liver damage. This form develops in acute hepatitis and cirrhosis.
Hemolytic - caused by an excessive amount of bile pigments and increased destruction of red blood cells. The yellow whites of the eyes in this form are not associated with pathology of the liver or bile ducts.

Regardless of the form of pathology, yellow whites of the eyes are a sign of an increased concentration of bilirubin in the blood. The reasons and treatment are determined by the doctor after examining the patient. If it became visually noticeable that the sclera began to acquire a yellow tint, then you need to immediately go to the hospital.

Acquired scleral anomalies

Yellowness of the skin and sclera occurs as a result of an increase in the concentration of bilirubin in the blood. If stagnation has formed in the biliary system, then bile enters the plasma. Blockage of the ducts is possible with: gallstone disease, spasmodic contraction of the biliary tract, tumor formations. Also, a change in the color of the sclera occurs with pathological disorders in the functioning of the liver and other body systems:

Yellowing with pathological abnormalities is caused by the fact that the process of removing the decomposition products of hemoglobin from the body is disrupted. Bilirubin is present in plasma in free form and, having reached excessively high concentrations, poisons the body. The white membrane of the eyes is supplied with blood and through the capillary network the pigment penetrates into the organs of the visual system, causing a color change. Pathologies of the hematopoietic system also provoke the appearance of yellowness of the sclera. The symptom occurs as a result of increased breakdown of red blood cells.

In the practice of ophthalmologists, there are often patients who complain of red eyes. In medicine, such a disorder is called scleral injection or scleral vascular injection. The protein membrane can acquire a red color as a result of eye fatigue or lack of sleep, but after rest, the hyperemia disappears. If the injection persists after the normalization of the regimen, then you need to contact an ophthalmologist and undergo an examination. Hyperemia of the membrane is caused by many pathologies of the organs of the visual system, including those leading to serious complications.

Congenital malformations of the sclera

In life, you can meet people not only with a yellow albuminous membrane of the eye, but also of other shades. Normally, a person has white sclera, and as a result of congenital and acquired changes, they acquire different colors. There are the following types of abnormalities resulting from a genetic defect or pathological disorders in newborns:

Blue sclera is a sign of pathologies that cause thinning of the albuminous membrane of the eyes. As a result of the violation, the vessels shine through it. Blue sclera is most often found in newborns with Lobstein-van der Heve syndrome, the development of which is triggered by genetic damage. The disease is rare. About one in 50,000 babies are born with this syndrome. Also, patients often have brittle bones and hearing loss.

Scleral melanosis is expressed in the form of colored spots on the albuminous membrane of the eye. The anomaly is both congenital and acquired.

The reason for the change in the color of the protein membrane is the excessive accumulation of melanin in the body, due to metabolic disorders. Ochronosis is a hereditary disease caused by an increased deposition of homogentisic acid in tissues. It is possible to detect pathology in newborns in the first days of life. Ochronosis is characterized by: darkening of urine on contact with air, pigmentation and modification of the auricles, as well as almost black sclera.

Staphiloma is a destructive change in the shape and size of the albuminous membrane of the eye. Pathology, as a rule, is a consequence of the inflammatory process during intrauterine development. Keratoconus (a degenerative, non-inflammatory eye disease) can cause staphyloma. In this case, treatment with scleral lenses or partial keratoplasty is indicated. Staphyloma is characterized by local or limited stretching of the albuminous membrane of the eye. An increase in intraocular pressure is also possible.

With the development of sclera icterus, there is no special treatment aimed at eliminating the symptom. The yellowing of the protein coat is a consequence of a pathological disorder, which means that you need to get rid of the cause first of all. There are special medications, the action of which is aimed at reducing the concentration of bilirubin in the blood. As a result of therapy, jaundice decreases, but this is a temporary improvement. Only curing the underlying pathology will help to completely get rid of pigmentation.

What is bilirubin

Human blood contains cells called red blood cells. They are responsible for providing oxygen to all body tissues. With the decay of aged erythrocytes, bilirubin is released. It is a yellow-green pigment. It is very toxic to the body, capable of penetrating cells and impairing their normal functioning.

Therefore, nature has thought out a mechanism for neutralizing bilirubin: it combines with blood albumin and is transported to the liver, where it is neutralized and excreted with bile through the intestines. If this mechanism is disturbed, bilirubin is absorbed directly into the bloodstream, and icterus of the sclera appears.

With increased bilirubin, not only the whites of the eyes can become yellow, but also the skin and mucous membranes. This is a very alarming symptom with which you should immediately consult a doctor.

Possible causes of scleral icterus

Yellowness of the whites of the eyes can manifest itself in various diseases. This is a very indicative symptom of many ailments:

cholecystitis;
hepatitis A;
obstructive jaundice;
cirrhosis of the liver;
tumors of the liver and pancreas;
disorders of bilirubin metabolism, inherited;
icterus sclera is possible when taking certain medications;
this violation occurs in mononucleosis.

With obstructive jaundice, the mechanism of bile outflow is disrupted due to narrowing of the bile ducts. The ducts are often blocked by a gallstone, but swelling can also cause the ducts to be blocked. The exit of bile becomes impossible, yellowing of the skin and sclera appears. With cirrhosis of the liver and hepatitis, the normal functioning of the liver is impaired, it is unable to neutralize bilirubin.

Often, doctors judge the degree of damage to this organ by the intensity of staining of the sclera. Icterus can also develop with intoxication, for example, with arsenic or phosphorus. Mononucleosis - acute infection, which, among other symptoms, is characterized by fever, lesion lymphatic system, liver and spleen. It is with the pathological processes occurring in the liver that the yellowing of the eye proteins in the patient is associated.

When to see a doctor

A doctor should be consulted immediately if yellowing of the sclera appears. In medicine, it is generally accepted that if icterus has become distinguishable with the naked eye under normal lighting, then the bilirubin content in the blood is approximately 2 times higher than normal. It is possible that a patient with icteric sclera of the eyes will be diagnosed with false icterus.

In this case, the cause of the disease will not be bilirubin, but completely different substances. Then, in addition to yellowed eyes, the patient will not have other pronounced symptoms. In a patient with true icterus of the eyes, other accompanying symptoms: itching, bleeding, bone pain, chills, pain in the pancreas, nausea, vomiting. You should definitely inform the doctor about these symptoms.

Some doctors consider icterus of the sclera a very subjective symptom: supposedly, with good lighting, yellowness of the eyes can be detected in everyone. Therefore, on the basis of this symptom alone, the doctor does not make a diagnosis. Urine and blood tests are prescribed.

The treatment regimen for a patient with scleral icterus is almost always the same: the disease that caused the jaundice is treated, and drugs are prescribed that artificially reduce the level of bilirubin in the blood. These medicines help relieve the external manifestations of the disease. As a rule, a patient with a similar symptom is hospitalized in order to find out the causes of jaundice as soon as possible, as they can be very serious.

Do not be afraid of such a symptom as sclera icterus. But you should not treat the disease yourself either.

What is scleral icterus? You will find the answer to this question in the article in question. You will also learn about what diseases this phenomenon is characteristic of and how it should be properly treated.

General information

Icterus of the skin and sclera is a kind of pigmentation of the epidermis and mucous membranes, which take on a yellow color.

Depending on the reasons for the occurrence of such a pathological process, the shades of yellow in which the sclera or skin are painted can be lemon, pale yellow, and these can be mixed with dark green and olive colors.

What diseases is it observed?

What diseases are sclera icterus typical for? This unpleasant symptom manifests itself in the following conditions:

The development of jaundice

Why do some people develop scleral icterus? The reasons for the occurrence of such a state may be associated with the belonging of people to the groups that we described above.

According to experts, at the biochemical level, this phenomenon is explained by an increase in the concentration of bilirubin in the blood. However, jaundice can be regulated not only by the content of this substance in the plasma, but also by the thickness of the patient's subcutaneous fat layer. For example, a large thickness of deposits significantly reduces the visual intensity of the disease, and a small one, on the contrary, increases it.

As you know, bilirubin enters the blood after its absorption from blocked bile ducts or dysfunction of liver cells. Thus, without entering bile, this substance is absorbed directly into the plasma, resulting in icterus.

Many experts believe that such pigmentation does not appear until the moment it exceeds the norm by two times. In other words, the appearance of jaundice indicates a significant progress of the disease.

It should also be noted that there is such a thing as “false icterus”. Such jaundice develops not due to an increased content of bilirubin in the blood, but due to increased concentrations of chinkarin and I-carotene. However, this case is attributed to a completely different group of the disease.

Clinical manifestations

How is such a pathological condition manifested as icterus of the sclera? You can find a photo of this in the materials of the article in question.

The external manifestations and symptoms of icterus of the skin and mucous membranes are very obvious and simple. With the aforementioned diseases, the sclera and epidermis are colored yellow.

It should also be said that with mechanical jaundice of the aggravated type, this phenomenon is characterized as golden pigmentation. By the way, it subsequently takes on a greenish tint. What is the reason for this? This condition occurs due to the oxidation of bilirubin.

In the event that the existing disease is not treated or is treated ineffectively, then the color of the sclera and skin gradually changes to brown-green or even close to black.

As for hemolytic icterus, it, on the contrary, is rather weakly expressed. Most often, such a pathology is manifested by integuments, which border on a yellowish tint.

The icterus treatment process

Surely there is no need to explain that complex therapy jaundice is closely related to the treatment of diseases that cause the development of icterus of the skin and sclera.

It should be especially noted that there are such medications, which are able to artificially reduce the level of bilirubin in the blood plasma, and, as a result, eliminate the external symptoms of jaundice. But at the same time, it must be remembered that such a kind of struggle with icterus does not represent a cardinal solution to the problem. Taking such medications is only a temporary measure.

Icterus sclera is the yellowness of the white membrane of the eye. A pathological change is easily diagnosed by visual examination and indicates an increase in the level of bilirubin. Sclera staining is accompanied by darkening of urine.

And what exactly is bilirubin, the increase of which causes pathology? In the human body, red blood cells are responsible for providing oxygen to all tissues. Aged cells disintegrate, resulting in the release of bilirubin. It is a toxic pigment that can penetrate cells and cause them to malfunction.

To avoid this, the body provides defense mechanism, during which this substance binds to albumin, enters the liver, where it is neutralized and excreted through the intestines along with bile secretion. When this natural mechanism is disturbed, the pigment is absorbed into circulatory system, which causes icterus of the sclera, skin and mucous membranes.

External manifestations of jaundice are regulated not only by the concentration of bilirubin in the blood. The thickness of the subcutaneous fat layer also plays an important role. In obese people, icterus is usually less pronounced than in thin people.

The pathological process can be the result of congenital and acquired anomalies. Yellowness of the eyes is one of the first signals of the body about the development of metabolic disorders or even serious diseases. What are the causes of scleral icterus?

Common Causes

The yellowness of the protein coat is observed in the following cases:

melanoma;
cancerous tumors;
wen;
enlargement of the conjunctiva;
cholecystitis;
cirrhosis of the liver;
improper nutrition;
overwork;
obstructive jaundice;
hereditary diseases;
mononucleosis;
leptospirosis;
intoxication;
intoxication;
tuberculosis;
anemia;
pancreatitis;
receiving some medications(antibiotics, cytostatics);
helminthic invasions;
hepatitis A.

Subicteric sclera appear with elevated bilirubin levels

Obstructive jaundice occurs against the background of blockage of the bile ducts and difficulty in the outflow of bile secretion into duodenum... As a result, bilirubin penetrates to all tissues and organs through vascular system... Mechanical obstruction of the biliary tract is most often associated with gallstone disease and malignant tumors.

The parenchymal type appears when the liver is damaged. Such jaundice manifests itself in acute hepatitis and cirrhosis of the liver. The hemolytic form develops against the background of the destruction of erythrocytes. Icteric sclera are not associated with liver and bile duct disease.

False yellowness is also distinguished. In this case, the subicteric sclera appears as a result of eating a large amount of carrots and beets, as well as after anthelmintic therapy. False jaundice does not require treatment, the color of the white of the eyes returns to normal on its own.

Diseases accompanied by icterus sclera

First, let's talk about eye pathologies that can cause a change in the color of the protein coat.

The essence of the pathological process is the proliferation of the conjunctiva onto the cornea. Pterygium is considered a benign neoplasm.

The following reasons can cause diseases:

aggressive solar radiation. Residents of countries with hot climates are most susceptible to the disease. Wearing sunglasses will help reduce the likelihood of an illness;
wind, smoke;
hereditary predisposition;
negative influence of the computer;
frequent inflammatory processes organs of vision.

Pterygium can cause scleral icterus

The disease manifests itself in the form of the following symptoms:

discomfort in the eye;
foreign body sensation;
stinging, itching, burning and dryness;
painful sensations during the lowering of the upper eyelid;
hyperemia of the conjunctiva;
lacrimation;
deterioration of vision;
constant irritation.

The pinguecula is a yellow conjunctival mass that most often appears in the inner corner of the eye. The disease affects elderly people.

Pinguecula is an indicator of the aging of the conjunctiva

People who often spend time outdoors without the use of sunglasses can be exposed to the disease. In fifty percent of cases, the disease affects both eyes. The pathological process progresses slowly, which is why people rarely seek medical help... As the progression progresses, the following symptoms appear:

against the background of the white conjunctiva, a small yellow island of tissue is visible;
dryness and discomfort in the eyes;
a feeling of the presence of a foreign body;
redness, inflammation, and swelling.

In the absence of patient complaints, no special treatment is prescribed. An operation can be performed to eliminate the aesthetic defect, but it does not give a 100% guarantee, after a while the pinguecula may reappear.

The tumor is usually detected in people after fifty years. Possibly asymptomatic course of the disease. If the appearance of melanoma is accompanied by symptoms, then patients present with the following complaints:

deterioration of vision;
loss of visual fields;
formation on the conjunctiva orange or brown;
fog and veil in the eyes.

Choroidal melanoma can cause discoloration of the sclera

Hepatitis

You can get hepatitis A through unwashed hands, shared utensils, or poorly processed food. The disease manifests itself in the form of fever, weakness, loss of appetite, vomiting, abdominal pain, and jaundice. Vaccination is the most effective way disease prevention.

Hepatitis B develops gradually, the initial period can last more than one month. You can get infected through sexual contact, blood transfusion, injury, insect bite. The disease manifests itself in the form of the following symptoms:

nausea, vomiting;
constipation;
headache;
itchy skin;
icterus of the skin and sclera;
aversion to food;
dull pain in the right hypochondrium;
temperature increase.

Liver disease can also cause scleral icterus.

You can catch hepatitis C by the fecal-oral or parenteral route. The disease is asymptomatic for a long time. In the early stages of the process, hepatitis C proceeds as a respiratory infection. Among other symptoms, there are such: an increase in the size of the abdomen, pain in the joints and abdomen, nausea, weakness, weight loss.

Cholecystitis

Cirrhosis

With cirrhosis, the skin, mucous membranes, and sclera of the eyes turn yellow. Patients are worried about severe itching, spider veins. Due to cirrhosis, weakness appears, performance decreases.

Early diagnosis can help prevent serious complications from developing. Do not delay the visit to the doctor, do not start solving the problem on your own. This can make the situation worse.