Skin and sclera yellowing

Introduction The yellowing of the skin mucous membrane is called yellow staining. More common in biliary obstruction, hepatocyte damage or hemolytic disease, due to elevated blood bilirubin, causing the skin mucosa to yellow, early or slightly seen in the sclera, more obvious when it is seen in the skin. Astragalus refers to hyperbilirubinemia, and the clinical manifestation is that blood bilirubin is increased to cause yellow staining of sclera, skin, mucous membranes and other tissues and body fluids. When the serum bilirubin concentration is 17.1 ~ 34.2umol / L (1 ~ 2mg / d1), but the naked eye can not see the jaundice called recessive jaundice.

Cause

1, the characteristics of jaundice initiator: A, jaundice first appeared in the sclera, hard palate posterior and soft palate mucosa, with the blood bilirubin concentration continues to increase, mucosal yellow staining is more obvious, will appear yellow skin. B, sclera yellow stained wet continuous, near the angle of the sclera, yellow staining light, yellow light, yellow staining at the far corner of the sclera, yellow deep.

2, carotene increased caused: A, yellow dye first appeared in the palms, soles, forehead and nose skin. B, generally does not appear sclera and oral mucosa yellow staining. C, blood bilirubin is not high. D, after stopping eating vegetables or juices containing carotene, the yellow pigmentation of the skin gradually subsides.

3, taking drugs: A, yellow dye first appeared in the skin, severe cases can also appear in the sclera. B, scleral yellow staining is characterized by yellow staining at the angle of the limbus, yellow deep, farther from the scleral margin, the lighter the yellow stain, the lighter the yellow.

an examination

Related inspection

Blood test serum iron serum cholangiography enzymology

1. Yellow staining of tissues such as skin and sclera. When jaundice is deepened, urine, sputum, tears and sweat are also yellow-stained, and saliva generally does not change color.

2. The color of urine and feces changes.

3, gastrointestinal symptoms, often abdominal distension, abdominal pain, loss of appetite, nausea, vomiting, diarrhea or constipation and other symptoms.

4, the performance of bile saltemia, the main symptoms are: skin itching, bradycardia, abdominal distension, fat leakage, night blindness, fatigue, listlessness and headache.

Differential diagnosis

In the presence of jaundice, serum total bilirubin and direct bilirubin should be examined to distinguish the type of elevated bilirubin, as well as urinary bilirubin, urobilinogen and liver function.

1. Indirect bilirubin is the main cause of jaundice. Mainly found in various types of hemolytic diseases, neonatal jaundice and other diseases. The ratio of direct bilirubin to total bilirubin is less than 35%.

In addition to the above tests, some auxiliary tests for hemolytic diseases, such as erythrocyte fragility test, acid hemolysis test, autologous hemolysis test, anti-human globulin test, blood routine, urinary occult blood, serum free hemoglobin, urine hemorrhage, should be performed. , serum lactate dehydrogenase, glucose-6-phosphate dehydrogenase, and the like.

2. The jaundice with a direct increase in bilirubin. Found in various types of intrahepatic, extrahepatic obstruction, poor bile excretion, direct bilirubin and total ratio greater than 55%.

In addition to performing some routine examinations, it is necessary to further examine alkaline phosphatase, -glutamyltranspeptidase, leucine aminopeptidase, 5-nucleotidase, total cholesterol, lipoprotein-X, and the like.

3, liver cell damage mixed jaundice. Found in various liver diseases, the performance of direct bilirubin, indirect bilirubin increased, direct bilirubin and total bilirubin ratio of 35% ~ 55%, check liver function can obtain abnormal results.

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