General Practice 2022

Icterícia in adults: what é, causes and treatment

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Icterícia in adults: what é, causes and treatment
Icterícia in adults: what é, causes and treatment
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Jaundice is characterized by the yellowing of the skin, mucous membranes and whites of the eyes, called sclera, due to the increase in bilirubin in the bloodstream, a yellow pigment that results from the destruction of red blood cells in the blood

Jaundice in adults is usually caused by diseases that affect the liver, such as hepatitis, obstruction of the bile ducts, such as a stone, or diseases that cause red blood cell destruction, such as sickle cell anemia or spherocytosis, for example. In newborns, the most common cause is physiological jaundice, caused by the immaturity of the liver. Check out what causes and how to treat neonatal jaundice.

Treatment is based on the cause, and may include treating infections with antibiotics, surgical removal of gallstones, or measures to combat hepatitis, for example.

What are the causes

Bilirubin is a yellowish pigment that arises as a result of the degradation of red blood cells, being metabolized and eliminated by the liver, together with bile, through the intestine, in feces and urine. Jaundice can arise when there are changes at any stage of this production process until elimination.

Thus, excess bilirubin in the blood can happen for 4 main reasons:

  • Increased destruction of red blood cells, which occurs due to blood disorders such as sickle cell anemia, spherocytosis or other hemolytic anemias, or from infections such as malaria;
  • Changes in the liver that impair the ability to capture bilirubin from the blood or to metabolize this pigment, due to hepatitis, side effects of certain medications such as Rifampicin, prolonged fasting, alcoholism, intense exercise, or genetic disorders such as Gilbert syndrome or Crigler-Najjar syndrome;
  • Changes in the bile ducts inside or outside the liver, called cholestatic or obstructive jaundice, which prevents the elimination of bilirubin along with bile, due to stones, strictures, or tumors in the bile ducts, autoimmune diseases such as primary biliary cholangitis, or hereditary syndromes such as Dubin-Johnson syndrome;
  • Other conditions that interfere with more than one phase of bilirubin metabolism, such as generalized infection, liver cirrhosis, hepatitis, or neonatal jaundice.

Increased bilirubin can be of 2 types, called indirect bilirubin, which is free bilirubin, or direct bilirubin, when it has already undergone an alteration in the liver, called conjugation, so that it can be eliminated along with bile by the liver. intestine.

How to identify

The yellowish coloration of the skin and mucous membranes in jaundice usually appears when blood bilirubin levels exceed 3 mg/dL. Understand how to identify high bilirubin in the blood test.

It can be accompanied by other signs and symptoms, such as dark urine, called choluria, or whitish stools, called acholic stools, which arise especially when there is an increase in direct bilirubin. High levels of this pigment in the blood can be irritating to the skin, which causes intense itching.

In addition, symptoms that indicate the cause of jaundice may also be present, such as abdominal pain and vomiting in hepatitis, pallor and tiredness in diseases that cause destruction of red blood cells or fever and chills in case of infections, for example.

How the treatment is done

To treat jaundice, it is necessary to treat the disease that led to it. Treatment is usually guided by the gastroenterologist, hepatologist or hematologist, and may include measures to unclog the bile ducts, use of drugs to fight infections, discontinuation of drugs toxic to the liver or immunosuppressants to control diseases that cause hemolysis, for example.

The doctor may also recommend protective measures, such as drinking plenty of water and reducing the consumption of fatty foods to avoid abdominal discomfort. To control the itching caused by excess bilirubin, medications such as antihistamines or cholestyramine may be indicated.

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