Jaundice

Jaundice is a common symptom and sign, and its occurrence is caused by increased serum bilirubin concentration due to bilirubin metabolism disorder. Clinically, the sclera, mucous membrane, skin and other tissues are stained yellow. Because the sclera contains more elastin and has a strong affinity with bilirubin, yellowing of the sclera in patients with jaundice is often first noticed before the mucous membranes and skin. When the total serum bilirubin is 17.1～34.2μmol/L and the jaundice is not visible to the naked eye, it is called recessive jaundice or subclinical jaundice; when the total blood bilirubin concentration exceeds 34.2μmol/L, it can be found clinically Jaundice, also known as dominant jaundice.

Jaundice is caused by many factors, and its mechanism can be divided into five categories:
1. Excessive production of bilirubin
This is because the formation of unbound bilirubin increases after the destruction of a large number of red blood cells (hemolysis). A large number of unbound bilirubin is transported to the liver, which will inevitably increase the burden of the liver (liver cells). When the uptake and binding capacity of the liver to unbound bilirubin is exceeded, the concentration of unbound bilirubin in the blood will increase. In addition, anemia caused by a large number of hemolysis causes liver cells to be in a state of hypoxia and ischemia, and their ability to absorb and combine unbound bilirubin will inevitably be further reduced, resulting in higher concentration of unbound bilirubin in the blood and jaundice.

2. Hypofunction of liver cells or decrease in the amount of functional liver cells
Hypofunction of liver cells or decrease in the amount of functional liver cells
This is due to the low liver enzyme function of the liver, or due to advanced liver cirrhosis, or fulminant hepatitis, liver failure, the amount of functional liver cells remaining in the liver is small, and the unconjugated bilirubin in the blood cannot be taken up, resulting in non-combined bilirubin. The concentration of conjugated bilirubin in the blood increases and jaundice occurs. Neonatal physiological jaundice is also due to this reason.

3. Hepatocyte destruction combined with bilirubin spillover
In patients with hepatitis, due to extensive damage (degeneration, necrosis) of liver cells, the hepatocytes' uptake and binding of unconjugated bilirubin are hindered, so the concentration of unconjugated bilirubin in the serum increases, but some are not affected. Damaged hepatocytes can still continue to take up and combine with unbound bilirubin, turning it into bound bilirubin, but some of the bound bilirubin cannot be excreted in the capillary ducts, but through the interstitial reaction of necrotic hepatocytes. Inflow into the liver lymph fluid and blood, resulting in increased serum bilirubin concentration and jaundice. At this time, the patient's transaminase will increase.

4. Intrahepatic cholestatic jaundice
Some patients, hepatitis is caused by hepatocyte degeneration, swelling, inflammatory lesions in the portal area and bile thrombus inside capillary bile duct, small bile duct form, make combine bilirubin excretion is blocked, the result causes to combine bilirubin to overflow via small bile duct (the pressure inside small bile duct increases and produce rupture) and flow liver lymphatic instead and blood. Still a few patients are as a result of the pathological changes of capillary bile duct, small bile duct itself, bile thrombus is formed inside small bile duct, or the structure of capillary bile duct is abnormal, make the excretion of union bilirubin is blocked, the result causes union bilirubin to overflow via small bile duct (or the pressure inside small bile duct is increased and produce rupture) and flow into liver lymph instead and blood. Also some patients are not completely caused by mechanical factors such as bile duct rupture (such as cholestasis caused by drugs), but also due to the secretion of bile is reduced (secretion dysfunction), capillary bile duct permeability increases, bile concentration, stagnation and flow reduction, eventually lead to bile duct salt deposition and the formation of bile thrombus.

5. Jaundice caused by obstruction of the bold tube
Intrahepatic, extrahepatic hepatic duct, total hepatic duct, common bile duct and lack of ampullary obstruction or any part of the place such as cholestasis, blocking or stasis increasing pressure in the top of the bile duct, bile duct expands, will eventually lead to small intrahepatic bile ducts or subtle bile duct, capillary bile duct rupture, the combination of bilirubin from the broken bile duct overflow, reverse flow in the blood and jaundice.

Diet and life recommendations:

1. Food diversification to ensure the full intake of nutrients

2. Light diet, eat slowly, eat small and frequent meals to reduce the metabolic burden on the liver

3. Coarse grains are rich in vitamin B group, which is helpful for liver metabolism and can replace some staple foods.

4. Fish/shrimp/meat and other foods are indispensable, 1 palm-sized amount a day; 1 egg a day; soy products 3 times a week; however, it is necessary to avoid eating raw or undercooked fish and meat Or poultry, there may be a risk of parasite infection

5. Adequate intake of fresh vegetables and fruits

6. Drink plenty of water, more than 1800ml per day (lemonade is recommended)

7. Quit alcohol and avoid any alcoholic foods to reduce the metabolic pressure of the liver

8. Live a regular life without staying up late, rest before 23 o'clock every day, and ensure 8 hours of sleep a day

9. Avoid overeating and avoid eating 2 hours before bedtime