Gastroenterology / / April 27, 2016
Bilirubin - it is yellow-green pigment, which is a product of the breakdown of hemoglobin.The collapse of hemoglobin for the most part (approximately 80%) occur in the spleen and bone marrow.
Bilirubin is divided into three types: direct (conjugated bilirubin), indirect (unbound bilirubin) and total.Total bilirubin indicates the total amount of direct and indirect bilirubin.
Indirect bilirubin - a toxic bilirubin, which recently formed in the body of hemoglobin and is not processed by the liver.Indirect bilirubin is insoluble in water, but at the same time, readily soluble in fats (lipids).Easily penetrates the healthy cells and disrupts their functioning.
direct bilirubin - is processed by the liver indirect bilirubin, which is then excreted from the body with the help of bile.Direct bilirubin is less toxic and is soluble in water.
Education of direct and indirect bilirubin is due to various factors, so for correct installation of the diagnosis is necessary to kn
As bilirubin is produced?
Bilirubin is formed from the decay of red blood cells, namely hemoglobin, a component of red blood cells.With the destruction of red blood cells, hemoglobin is released and processed spleen and bone marrow.After this treatment becomes indirect bilirubin.In the future, indirect bilirubin is processed by the liver where it is converted into direct and excreted with the feces and urine.
Causes of increased direct bilirubin
Increased direct bilirubin in the blood occurs as a result of violations of the outflow of bile from the gallbladder.As a result, there is no bile into the stomach and into the blood.The reasons most often is: gallstone disease, cancer of the gallbladder or pancreas.
Symptoms of increased direct bilirubin
following symptoms have been reported with increasing direct bilirubin: dark urine, pain in the right upper quadrant, loss of appetite, itching, belching, hepatic colic.
Causes of increased indirect bilirubin
There are two main reasons for the increased indirect bilirubin, it accelerated destruction of red blood cells (anemia), and violation processing indirect bilirubin in the investigation of any liver disease (hepatitis, cirrhosis, liver cancer, ciderGilbert's, Rotor syndrome,)
Increased bilirubin levels in anemia
anemia can be two types of acquired or congenital.The cause of acquired anemia often is that the body begins to perceive the red blood cells as a foreign body and starts to fight against them.often in turn congenital anemia develops due to congenital defects in the structure of hemoglobin and red blood cells.
Increased bilirubin in liver disease
is no processing of indirect bilirubin in liver disease in a straight line, and so it comes out of the liver in its raw form.Due to the fact that the indirect bilirubin is toxic in patients with nausea, bitter belching, pain in the right upper quadrant, dark urine, reduced working capacity, as well as jaundice appears.
cider Zhilberna occurs due to lack of liver enzymes responsible for the processing of indirect bilirubin in a straight line.To reduce the amount of indirect bilirubin used drugs phenobarbital and ziksorin.
Norma bilirubin in a healthy person
bilirubin The rate for women and men
very often faced with the fact that people believe that bilirubin rate is different in men and women, butthis is not true.The rate of bilirubin is the same in men and women.
For a healthy person the rate of bilirubin:
direct bilirubin: up to 4.6 mmol / l.
indirect bilirubin: to 15.4 mmol / l
total bilirubin: 3,4 - 9,1 mmol / l
total bilirubin rate for newborns
0-1 days - 24149 umol / l
1-3 days - 58-197 mmol / l
3-5 days - 26-105 mmol / l
14 days of 3.4-20 mmol / l
note that the exact upper limit depends on the reagents used for determination of bilirubin (from different manufacturers, they are different), while accuracy is not great and does not exceed 10-15%.
Bilirubin in pregnant
problems in pregnant women with bilirubin sometimes occur in the last trimester of pregnancy.This is due to intrahepatic cholestasis of pregnancy.A key role in the emergence of this disease plays a genetic predisposition and hormonal factors.It is also noted that intrahepatic cholestasis in pregnancy is more common in the winter.After delivery, within 2-3 days bilirubin rate returns to normal.
bilirubin in newborns
Before the birth of a child in the body contains a special (fetal) hemoglobin.After birth, the hemoglobin is no longer involved in the transport of oxygen and excreted from the body.As a result, some infants in the first few days there may be jaundice, it is not only a large number of output bilirubin from the body, but also to the fact that the child's enzyme system responsible for the processing of bilirubin, mature in just a few days after birth.
Status elevated bilirubin in the newborn is removed using phototherapy.Suitable irradiation of blue-violet radiation.
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How to lower bilirubin?
panacea for reducing bilirubin does not exist.Reduce the level of bilirubin, it is possible only after the establishment of the reasons for his elevation.So if increased direct bilirubin, there is reason lies in the violation of the outflow of bile.If elevated indirect bilirubin, the more often it is only an indicator of the diseased liver or Gilbert's syndrome.After effective treatment of the underlying disease bilirubin indicators significantly reduced.