What is jaundice ?
Jaundice is the symptom that the patient sees yellow. This is usually best seen on the eyeballs. This phenomenon may have many causes; a classification of possible causes short discussion follows below.
The yellow dye that causes the color is typically bilirubin, a breakdown product of the heme group in hemoglobin. If hemoglobin is degraded (as a red blood cell has reached the end of its useful life), the dye is first converted to an insoluble form of bilirubin, which is transported to the liver through the blood by special proteins, where the substance by coupling to glucuronic acid , a well-soluble group, is made water-soluble. The now-soluble dye is excreted in the bile into the intestine and is the cause of the brown color of stool. A small portion of the dye is also in the bloodstream, partly as a result of re-uptake of the substance itself from the intestinal contents, but also of reaction products thereof which have been converted by bacteria in the gut. If the bile ducts are blocked (eg by a gallstone), the stool can be almost white (putty color). Galkleurstoffen are also responsible for the yellow color in urine, which in the absence (see Acholurie) refers to a particular form of jaundice.
Categories causes of jaundice
- Prehepatisch: ('for the liver): the liver is nothing wrong but there is an increased breakdown of hemoglobin in such a way that there is much supply so that the patient (usually not very) looks yellow. For certain types of anemia by increased hemolysis, in a number of hereditary conditions in which the processing capacity of the liver is reduced (Gilbert syndrome, Crigler-Najjar syndrome)
- Hepatic ('through the liver): the liver itself is compromised by disease (e.g., hepatitis, cirrhosis) and may be less selection of and / or processed products allows leak-back to the blood instead of going to the bile.
- Posthepatisch (after the liver): the gall-access roads (including the common bile duct) in or after the liver blocked, usually by a gallstone, sometimes a tumor, causing a lot of soluble bilirubin finds its way back to the blood. The stool will be light to white, urine just very dark brown.
- Other causes: for example, eating by the patient of an unusual amount of yellow dyes for example, carotene in carrots or tanning tablets.
Jaundice in newborns / in babies
In newborns play two, sometimes three factors involved:
- The liver is still immature and does not have very high throughput for bilirubin, and
- After the birth, the fetal hemoglobin, which is of a different composition than the hemoglobin which is created after the birth, first broken down. Because in the uterus, the oxygen tension is much lower, fetal hemoglobin has a higher affinity for oxygen. There is more 'offer'.
- Under pathological conditions finally find the baby a rapid breakdown of red blood cells because the mother has antibodies against the fetal blood (Rh disease). The breakdown of red blood cells leads to an increase of the hemoglobin in the blood that is broken down, and there exists bilirubin. This bilirubin is very toxic to the baby's brains. Before birth the mother takes care for the discharge of the bilirubin from the baby's blood. At the moment that the baby is born There is a build-up place of the bilirubin in the blood. This increased bilirubin content in the blood can lead to motor disorders, or in severe cases, death. As with babies on the first day of life jaundice is observed it is always pathological.