Elevated bilirubin

Introduction Bilirubin is a pigment produced by hemoglobin in red blood cells. Red blood cells have a fixed life span and are destroyed every day. At this time, hemoglobin is decomposed into heme and heme. Then the action of the heme-enzyme will turn into bilirubin, and the heme will be reconstituted into tissue proteins. Normal value: total bilirubin: 1.7 to 17.1 mol/L, direct bilirubin: 0 to 3.42 mol/L, indirect bilirubin: 1.7 to 13.68 mol/L.

Cause

The life span of human red blood cells is generally 120 days. After erythrocyte death, it becomes indirect bilirubin (I-Bil), which is converted into direct bilirubin (D-Bil) by the liver, forms bile, is discharged into the biliary tract, and is discharged through the stool. The sum of indirect bilirubin and direct bilirubin is total bilirubin (T-Bil). Any obstacles in any of the above-mentioned links can cause jaundice. If the red blood cells are destroyed too much, the indirect bilirubin produced is too much, and the liver cannot completely convert it into direct bilirubin, which can cause hemolytic jaundice, when the liver cells are damaged, or because bilirubin cannot be converted normally. Bile, or swelling of the liver cells, the bile duct in the liver is compressed, the bile is excreted, and the bilirubin in the blood is raised. At this time, hepatic jaundice occurs, and once the extrahepatic biliary system develops a tumor or appears Stones, the biliary tract is blocked, the bile can not be drained smoothly, and obstructive jaundice occurs.

an examination

Related inspection

Indirect bilirubin direct bilirubin/indirect bilirubin ratio

Most of the bilirubin in the body comes from hemoglobin released by lysis of aging red blood cells, including indirect bilirubin and direct bilirubin. Indirect bilirubin is transported to the liver through the blood, and direct bilirubin is produced by the action of liver cells. Increased bilirubin is found in:

(1) Liver disease: acute jaundice hepatitis, acute yellow liver necrosis, chronic active hepatitis, cirrhosis, etc.

(2) Extrahepatic diseases: hemolytic jaundice, blood transfusion reaction, cholecystitis, cholelithiasis, etc.

It can be judged whether there is jaundice, jaundice and evolution. When total bilirubin is >17.1mol/L, but <34.2mol/L is recessive jaundice or subclinical or subclinical jaundice, 3.42~171mol/L is mild jaundice, and 171~342mol/L is moderate jaundice. >342mol/L is severe jaundice.

According to the degree of jaundice, the cause of jaundice can be inferred: hemolytic jaundice is usually <85.5mol/L, hepatic jaundice is 17.1~171mol/L, incomplete obstruction jaundice is 171~265mol/L, and complete obstructive jaundice is usually >342mol/L. .

At the same time, the type of jaundice can be judged according to the degree of increase of total bilirubin, direct bilirubin and indirect bilirubin: if the total bilirubin is increased with the increase of indirect bilirubin, it is hemolytic jaundice, and the total bilirubin is increased. Direct bilirubin was significantly elevated to cholestatic jaundice, and all three increased to hepatic jaundice.

Differential diagnosis

The jaundice of hepatitis patients is generally hepatic jaundice, which means that both direct bilirubin and indirect bilirubin are elevated, while patients with cholestatic hepatitis are mainly elevated by direct bilirubin.

1, total bilirubin, direct bilirubin increased: intrahepatic and extrahepatic obstructive jaundice, pancreatic head cancer, capillary bile duct hepatitis and other bile stasis syndrome.

2, total bilirubin, indirect bilirubin increased: hemolytic anemia, blood type is not transfusion, malignant disease, neonatal jaundice.

3, total bilirubin, direct bilirubin, indirect bilirubin increased: acute jaundice hepatitis, chronic active hepatitis, cirrhosis, toxic hepatitis. Most of the bilirubin in the body comes from hemoglobin released by lysis of aging red blood cells, including indirect bilirubin and direct bilirubin. Indirect bilirubin is transported to the liver through the blood, and direct bilirubin is produced by the action of liver cells.

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