Bilirubin common is elevated. The causes of increased bilirubin in the blood. Diet with elevated bilirubin

For normal metabolism and energy in the body, he needs constant supply of substrates from the outside, that is, with food, water and air. Their most important constituents are organic compounds, vitamins and mineral components - potassium, magnesium, sodium, copper, iron and many others. The last of these is included in the red blood cells, the only cells-carriers of oxygen in our blood, and therefore the exchange of iron is so important for the body. And with its violations one way or another develops icteric syndrome, characterized by the fact that bilirubin is common. Now let's look at all the important points.

Exchange of iron

A person gets iron solely with food. Its highest concentration is observed in the liver of animals, some nuts (pistachios, peanuts, cedar, cashew), beans (lentils, peas), cereals (buckwheat, wheat, oats, barley), spinach, corn. At the same time, its necessary amount is first replenished for the heme, which forms the basis of the erythrocyte, and then the deposit of iron in its depot in our organism occurs, which is about 3-4 grams, it is ions, mainly connected by plasma proteins and enzymes (ferritin, Transferrin, xanthine oxidase, ferroflavoproteins, succinate- and NADH-dehydrogenase and others). But this is normal, now let's consider its losses and some pathological conditions.

Causes of loss of important minerals

One of the physiological processes in which iron loss occurs is menstruation and pregnancy in women. However, perhaps the most significant situations are blood loss, intoxication, anemia of various genesis, severe diseases of internal organs, malignant neoplasms. If the loss was insignificant, then it can replenish in a short time, and the patient does not have symptoms of its deficiency (sideropenic syndrome). However, there are also those diseases in which the volume of iron remains, but its exchange is sharply disrupted. To such cases the icteric syndrome of any genesis concerns, as at it the increase in the basic metabolite - bilirubin is revealed. To begin with, we will try to disassemble its metabolism in the body and the causes of increased bilirubin in the blood: this is important for understanding the pathogenesis of these diseases.

Hemoglobin exchange: first phase

Bilirubin refers to the most important pigments, which are part of the bile and excreted from the body precisely at its expense. It goes a long way along the vessels in the form of hemoglobin, performs important transformations in hepatocytes and, finally, is secreted into the intestine for isolation into the environment with feces. So, this substance is formed during the decay of erythrocytes and is immediately captured by carrier proteins for transport to the main laboratory - the liver. This fraction is called indirect or unrelated, because bilirubin in it is in unchanged form. This happens because in its free form it easily penetrates the membranes of any cells and exerts a pronounced toxic effect primarily on neurons. Thus, its capture is a normal protective reaction.

The phases of neutralization and excretion of bilirubin

However, these proteins can not accompany it to the intestine, because they are still needed by the body for many other functions, and therefore bilirubin should be subjected to such transformations that it lost its property of passage into the cells. To do this, in hepatocytes (structural cells of the liver parenchyma), its conjugation occurs, that is, binding by glucuronic acid, which, to put it simply, makes it heavier. So, under the action of the enzyme UDF-glucuronyltransferase, bilirubin-diglucuronide is formed. Further from hepatocytes, it enters bile and in its composition is released into the intestines during digestion. Now, passing the path together with the food lump first into the thin and then into the large intestine, under the influence of the bacterial flora it is again released and transformed into urobilinogen, then into urobilin and sterocilin, which are directly excreted with feces. However, always an extremely small amount of bilirubin returns to the portal vein and is carried to the kidneys, where it is removed from the urine.

Limits of the norm

Disturbance of the metabolism of this important pigment can occur at three main stages: circulation in the blood during the decay of erythrocytes, capture in the liver and excretion with bile. However, for all these variants, it will be detected in the blood: bilirubin will be generally elevated, mainly by either a direct or indirect fraction. So, its normal concentration in the plasma is about 8.5-20 micromolar per liter. If this number increases to 85, then there is a state of mild hyperbilirubinemia, from 86 to 169 - the average and, finally, more than 170 μmol / l - severe. This is the case, if it is simply revealed that the total bilirubin is elevated. However, the norm exists separately for fractions: direct - up to 5.1, unbound - up to 16.5 micromol / l.

Superhepatic type of jaundice

So, if there is a violation at the first stage, bilirubin is generally increased in the blood mainly due to the indirect fraction. This is explained by the etiology of the condition, namely, the increased disintegration of red blood cells in the vascular bed. This can occur with congenital forms of hemolytic anemia (defects at the genetic level of the red blood cells themselves, their enzymes, hemoglobin) or acquired (immunological diseases with the attack of their own red blood cells, the effects of toxins and poisons, viruses, bacteria and other microorganisms). Thus, the basis of pathogenesis is the increased formation of bilirubin, which is why the liver cells simply do not have time to capture such a huge amount of it, and it accumulates in the skin and mucous membranes, and then in the internal organs, causing their severe damage. This is how the superhepatic form of jaundice is formed.

Liver type of jaundice

If the disorder occurs in the second main stage, the hepatocytes do not have time to capture and process even the normal amount of hemoglobin metabolite entering them, and as a result, the total bilirubin is increased due to both fractions. The causes of this are severe destructive changes in the liver. These include hepatitis of the most diverse genesis (toxic, alcoholic, viral) and cirrhosis. Thus, the causes of increased bilirubin in the blood lie in the fact that hepatocytes can not work adequately, either due to inflammation in them, or due to their insufficient quantity. The most common cause, of course, is viral hepatitis A-type, B, C, delta, E or PP. This is how the hepatic (parenchymal) type of icteric syndrome develops, which is accompanied by vivid symptoms of mesenchymal inflammation and hepatociliary insufficiency.

Subhepatic type of jaundice

And, of course, a violation of bilirubin metabolism can occur at the third main stage, that is, in the excretion of bile. One way or another with this option, there is a blockage of its exit along paths either from the liver, or already from vesicafellea. As a result of such changes, bile accumulates in the pathways and the bladder, its pressure gradually builds up, and eventually it returns (this phenomenon is called regurgitation) into the intrahepatic ducts and further into the blood vessels, which is why the total bilirubin is elevated. In this case, of course, there are other changes in biochemical analyzes. So, in the blood there is a cholemia, that is, bile acids and enzymes enter it, and cholestasis is formed in the ducts, that is, stasis of secretion. Clinically, this will be expressed by jaundice of sclera, mucous membranes and skin (yellowish color with a green tinge), and in the analyzes it will be not only bilirubin common and direct increased, but also bile acids, cholesterol, alkaline phosphatase level , triglycerides, activity of gamma-glutamyl transferase .

Causes of development

The etiology of the obturation or, as it is called, subhepatic, jaundice, is quite extensive. The most common cause is a blockage of the biliary tract by calculus in calculous cholecystitis or cholelithiasis, as well as helminthic invasion, when a lump of worms is localized within ducts or expressed cholangitis, when they are inflamed and the lumen is obturating either due to swelling of the walls or due to infiltration from them. And, of course, this explains the fact that direct and total bilirubin is elevated. The causes of other pathologies in any case are determined by compression from the outside. Most often this is observed because of the growing tumor process, which usually affects the head of the pancreas. But such a situation can also occur with biliary cirrhosis, when the ducts are squeezed by growing areas and connective tissue strands.

Physiological jaundice of newborns

However, not all jaundices are pathological conditions of the body. So, if bilirubin is generally elevated in a child immediately at birth or several hours after it, and the skin and mucous membranes have a bright icteric tinge, then do not immediately sound an alarm. After all, in newborns this is a physiological condition, called transient, because it is transient. Of course, the question arises for his troubled mother, who learns that her child has bilirubin increased: "What should I do?" The answer is simple: wait. In this case, only wait-and-see tactics are really shown, since for a few days (usually up to three to five) the icteric yellowing gradually disappears. And only if it is delayed, the condition of the baby worsens, and the bilirubin remains elevated, the treatment is done urgently, namely detoxification therapy and ultraviolet irradiation. Now let's look at the pathogenesis of this condition.

Features of the blood circulation of newborns

The fact is that the blood circulation of the fetus in the womb is significantly different from that observed in already-born children. During pregnancy, the baby is immersed in a bladder with an amniotic fluid, and therefore his lungs are not yet familiar with the air and are in a shrunken state, that is, non-working. But in fact the child is vital to the constant supply of oxygen to his tissues for their formation, growth and differentiation. So his blood is so closely communicated with the mother. To put it in more detail, the baby's erythrocytes simply take oxygen from the erythrocytes of a woman, and for that they need a stronger ability that captures it. Therefore, its hemoglobin is represented by F-type, which means fetal. He easily receives oxygen and carries it to the cells of the fetus.

Results

However, after birth, such a super-force is unnecessary, because from this time his lungs open, he breathes himself, and he himself extracts oxygen. And if his hemoglobin remains the same, he will not be able to give it to the cells. Therefore, after the first sigh, the active replacement of this main protein of erythrocytes from fetal to adult type A begins. This causes increased hemolysis of red blood cells and the urgent development of new, regular, from the bone marrow. Thus, jaundice is observed in the first, superhepatic type, which stops as soon as all old red blood cells are destroyed, and new ones fill the bloodstream.

Therapy

The most important stage in the treatment of elevated bilirubin is, of course, the therapy of the underlying disease that caused such metabolic disorders, that is, antibiotics for viral hepatitis, detoxification with poisons, blood transfusions and erythrocytic masses in hemolysis, or liver transplantation in severe cirrhosis. However, physiotherapy, hepatoprotectors, a correct lifestyle without risk factors and a special diet with increased bilirubin should support this. For this, first, you need to give up smoking and alcohol, excess fat, cholesterol, spicy and fried foods. It is strictly forbidden to eat pickles and pickled products. You should limit the consumption of salt and tea, and you should not drink coffee at all. On the contrary, a diet with increased bilirubin includes frequent fractional meals with an increase in the number of lenten porridges, compotes, and the replacement of white bread with gray bread. After all, thanks to the medicines prescribed by the doctor, the positive dynamics will start and, eventually, the illness will leave you.