Differential diagnosis of jaundice
Page 1 of 8
According to the book of VINOGRADOV A. B. Differential diagnosis of internal diseases. Moscow: Medicine, 1980.
Jaundice is called the syndrome developing owing to accumulation in blood of excess amount of bilirubin. In clinic it is diagnosed on coloring of covers of a body in various shades of yellow color.
Jaundice can be the earliest, and sometimes and the only visible symptom of many internal diseases. At an acute hepatitis and obstruction of bilious channels yellow coloring of scleras is found in the beginning. A little later it is possible to note yellow coloring mucous covers, and then and skin of proximal departments of extremities. The last palms and soles turn yellow.
Intensity of jaundice depends on blood supply of body or fabric. It is especially well visible on the example of skin hems which are always represented by less yellow, than the normal skin surrounding them. Collecting in skin, bilirubin in combination with other pigments paints over it in light yellow color with a reddish shade. Further there is an oxidation of the bilirubin which is in skin in biliverdin, and jaundice gets a greenish shade. At long existence of jaundice integuments get a black shade. Thus, survey of the patient allows to resolve an issue of jaundice duration that has great differential and diagnostic value.
Coloring of skin bilirubin and products of its transformation sometimes it is necessary to distinguish from a prokrashivaniye it other pigments. Yellow coloring of skin meets at reception of a large number of the vegetables containing carotene. The orange shade of skin often develops after the use of a large number of oranges, tangerines, pumpkin. Well-known prokrashivany skin in yellow color after reception of some chemicals from which the greatest distribution was gained by quinacrine. Carotene pigments it is easy to distinguish a temporary prokrashivaniye of skin from the real jaundice, and mentioning of it has rather traditional character, than reflects requirements of the differential diagnosis.
A large number of classifications of jaundices specifies that any of them is not ideal. Long-term experience in the conditions of a big municipal hospital with its standard biochemical service showed advantage of division of all jaundices into two types: with accumulation in blood of the conjugated and not conjugated bilirubin. Research of urine allows to distinguish by the maintenance of bilious pigments easily these jaundices from each other. Each of these main types is divided in turn into two forms — hepatic and not hepatic (appendix).