One of the liver parameters of a biochemical blood test is listed as total bilirubin, which in turn is divided into two more types: direct and indirect. Many have encountered the problem of increased bilirubin and know that its levels increase with various problems in the liver. In addition, an increase in bilirubin is observed in many infants in the first week of life and is accompanied by slight jaundice. In most cases, an increased level of this indicator is accompanied by disturbances in the metabolic processes of the liver and is characterized by yellowness of the sclera or skin.

Bilirubin and its features

One of the components of liver bile is bilirubin, a dark substance yellow color, formed in liver cells at the time of breakdown of red blood cells, cytochromes and myoglobin.

The main breakdown of red blood cell molecules occurs in the liver, in the tissues of the spleen, and a little in bone marrow. During the day, more than 1% of all red blood cells in the body are destroyed, and the hemoglobin released from them forms approximately 300 mg of bilirubin. It is a pigment that, in certain quantities in the blood, is necessary for the normal functioning of the body as a whole. An increase in the molecules of this substance in the blood signals a problem.

The symptoms and manifestations of hyperbilirubinemia - jaundice of the skin and sclera, which occurs against the background of impaired bilirubin metabolic processes, are no secret to scientists today. Both the structure of molecules and all metabolic processes have been studied thoroughly. Therefore, making a diagnosis, as a rule, does not present any difficulty for the doctor.

Mechanism of bilirubin metabolism

After the destruction of red blood cells, the resulting bilirubin is a water-insoluble molecule with a high concentration of toxic substances. As it progresses, bilirubin goes through several stages of transformation:

• In the blood plasma, bilirubin molecules are tightly bound to albumin proteins, which act as a vehicle for its delivery to liver tissue. The protein-bilirubin complex cannot overcome the kidney filter, so these compounds do not enter the urine.
• In the liver, bilirubin is separated from albumin and penetrates into the liver cells, where it continues its further progress.
• Next, bilirubin molecules bind to glucuronic acid molecules and form bilirubin diglucuronides - water-soluble molecules direct bilirubin, which can overcome renal barriers and, accordingly, are excreted from the body by the urinary system.
• At the final stage of metabolic processes, excretion occurs, or removal of molecules with bile flow. Bilirubin enters the intestine in the form of urobilinogens - molecules of unbound bilirubin. A small amount of the substance is absorbed by the intestinal mucosa, and most of excreted in the stool as strecobilinogen.

Norm of bilirubin

So, in the process of metabolism, bilirubin molecules are converted into bound direct bilirubin and unbound, free bilirubin. The level of bilirubin of all three types of compounds in the blood serum is the starting point for determining the degree of damage.

For bilirubin levels, the norm is derived in mmol per liter, this is:

• Unconjugated bilirubin (indirect, unbound, free). These are toxic compounds formed during the process of hemolysis. In a healthy person, the level of unconjugated bilirubin should be 16.2 mmol/l.
• Direct bilirubin (conjugated, bound). It is formed in liver cells by binding to glucuronic acid molecules. These are non-toxic, water-soluble compounds that are ready to be excreted from the body. The normal level of direct bilirubin is 0 - 4.3 mmol/l.
• Total bilirubin levels usually range from 0.5 mmol/L to 20.5 mmol/L.

As the disease progresses, the level of one or another bilirubin indicator increases. The predominance of both direct and indirect connections depends on various pathological processes occurring in the body.

The main symptom of bilirubin levels exceeding their norm is the yellowness of the integumentary tissues, which is formed when the level increases above 34 µmol/l.

In severe pathologies, the levels of this substance may exceed permissible norm in tens. This condition is considered critical and requires emergency intervention, as it can lead to a tragic outcome.

Symptoms of high bilirubin

The main organ that plays a major role in the transformation of this substance is liver cells. appear in a person if the liver cannot cope with the processing of the emerging large quantity bilirubin. In addition, yellowness may appear due to a mechanical disruption of the outflow of bile, which creates an obstacle to the normal excretion of bound bilirubin molecules.

The severity of skin symptoms does not always correspond to the level of bilirubin in jaundice. So do fat people Those suffering from edema, the yellowness of the skin may be almost imperceptible, while persons with normal or low body weight are prone to more pronounced manifestations of jaundice, even with a slight increase in bilirubin.

Basically, the reasons for increased bilirubin levels are a consequence of its excessive formation or a violation at any stage of its transformation. Bilirubin levels that exceed normal levels affect the severity of jaundice in various tissues.

• The sclera of the eyes is most sensitive to increased bilirubin. They are usually the first to turn yellow, even with a slight increase in bilirubin.
• Next, the mucous membranes of the oral cavity react.
• And only then the yellowness becomes noticeable on the skin. In this case, first of all, a change in pigmentation is noted on the face, feet and palms, and then spreads throughout the skin.

Yellowness of the skin is not always associated with high serum bilirubin levels. Thus, carotene-containing foods, such as carrots or tomatoes, can affect the jaundiced skin tone. In addition, jaundice may accompany diabetes or hyperthyroidism. But with these diseases, the sclera of the eyes does not change their color.

Diseases indicated by elevated bilirubin levels

There is high bilirubin in the blood serum in diseases such as:

• acute form of foodborne hepatitis “A” and viral hepatitis “B” with the presence of infectious mononucleosis;
• chronic form of hepatitis C and autoimmune types of hepatitis;
• hepatitis bacterial etiology, such as brucellosis and leptospirosis;
• poisoning with various toxic substances - these can be mushrooms, hormonal contraception, antitumor or antituberculosis drugs;
• jaundice during pregnancy;
• biliary cirrhosis.

Diseases, causing an increase indirect bilirubin in the blood:

• Anemia of congenital origin, for example, thallasemia, non-spherocytic, spherocytic and sickle cell.
• Autoimmune disorders (acquired anemia) resulting from diseases such as:
  • rheumatoid arthritis,
  • systemic lupus,
  • lymphogranulomatosis,
  • lymphocytic leukemia
• Diseases of an infectious nature such as typhoid fever, malaria and sepsis.
• Hemolytic anemia caused by ingestion antibacterial drugs groups such as:
  • Penicillins,
  • Cephalosporins,
  • Levomycetin,
  • Levofloxacin,

as well as aspirin and insulin.

• Crigler-Najjar syndrome.
• Toxic conditions that develop after poisoning with poisons, salts of heavy metals, insect or reptile bites.
• Gilbert's syndrome.

Types of jaundice and causes of increased bilirubin levels in the blood

If high levels of bilirubin are observed in the blood, this can be caused by three main reasons, such as:

• violation of the rate of destruction of red blood cells, both slowing and accelerating;
• obstructed bile flow;
• disruption of the process of bilirubin metabolism and its removal from the body.

Impaired breakdown of red blood cells

A significant increase in the level of unconjugated bilirubin in the blood serum during hemolytic jaundice is explained by the enhanced process of hemolysis that develops against the background of hereditary pathologies of erythrocytes or some external pathological factors:

• infectious diseases: malaria, typhoid fever, sepsis, mycoplasmosis;
• poisoning with toxic substances: toadstool poison, lead, reptile poison;
• transfusion of incompatible donated blood with the recipient’s blood: differences can be not only in group affiliation and Rh factor, but also in the characteristics of the formed elements;
• blood cancers (leukemia, myeloma) and liver tumors;
• massive internal hemorrhages, for example, pulmonary infarction or giant hematoma.

Any type of hemolytic jaundice is characterized by symptoms such as:

• bright lemon color of the sclera, mucous membranes and skin;
• general anemia caused by increased death of red blood cells, and against this background pallor of the skin;
• upon palpation, an enlargement of the spleen is noted, and the borders of the liver are palpated;
• significant darkening of feces and urine against the background of increased levels of urobilin and stercobilin;
• headache attacks, tachycardia and decreased performance due to oxygen starvation fabrics.

Difficulty in the flow of bile

When any obstruction occurs in the path of bile outflow, bound bilirubin begins to flow back into the blood, which provokes the development of subhepatic jaundice. This picture is typical for cholelithiasis, acute or chronic form of pancreatitis, malignant pancreatic tumor, hepatic aortic aneurysm, duodenal diverticulum or gallbladder tumor.

The penetration of conjugated bilirubin back into the blood is expressed in laboratory indicators as an increase in direct bilirubin, the rate of which depends on the free excretion of bound molecules. The causes of this picture most often are pathologies such as:

• formation of internal obstruction in the bile ducts, tumor, helminthic lump, stones;
• external compression of the biliary tract by tumor formations on the bladder itself, the head of the pancreas, or swelling of the lymph nodes;
• inflammation of the tissues of the bile ducts, complicated by sclerosis or narrowing of the internal lumen;
• anomalies intrauterine development, severe underdevelopment of the gallbladder and ducts.

Hyperbilirubinemia of conjugated bilirubin is characterized by symptoms such as:

• pronounced jaundice of the skin;
• severe subcutaneous itching and significant scratching against this background;
• a blood test shows high levels of bound bilirubin, since liver function is not impaired and the influx of bilirubin molecules into blood is flowing on both sides;
• absence of stercobyrine in stool completely deprives them of color, at the same time the urine becomes saturated dark color;
• periodic attacks of pain on the right side of the hypochondrium, a picture of hepatic colic;
• dyspeptic disorders such as:
  • nausea, vomiting,
  • bitter belching
  • loss of appetite,
  • constipation, diarrhea.

Violation of metabolic processes and excretion of bilirubin

Problems with the metabolism of bilirubin lead to its excessive accumulation in the blood, which causes jaundice. This situation develops as a hereditary disease or acquired, as a result of complications of other pathologies.

Hereditary jaundice

The main changes in the function of the hepatic stage of bilirubin conversion are disturbances in the binding, transport and excretion of molecules, which causes symptoms of hereditary jaundice, for example:

• Dubin-Johnson syndrome,
• Gilbert's syndrome,
• Crigler-Najjar syndrome.

Gilbert's syndrome is more common than other hereditary pathologies. This is not a disease in the full sense of the word, but a condition of the body in which there is a slight increase in bilirubin levels. The pathology does not require special treatment, as it is not life-threatening.

The causes of the pathology are hidden in the insufficient enzymatic activity of liver cells, whose responsibility is to bind bilirubin and glucuronic acid, which leads to the release of large amounts of unbound bilirubin.

Such a pathology occurs against the background of a defect in the development of genes on the second chromosome and is transmitted exclusively by inheritance. The frequency of this pathology is not the same in various countries. So in Europe, the syndrome is observed in approximately 5% of people, and in African countries this gene disorder is registered in 36% of the population.

Basically, Gilbert's syndrome does not bother the patient and proceeds without significant severe symptoms. Occasionally, exacerbations of the disease may occur due to severe stress, overwork or alcohol poisoning. Special treatment the disease does not require, and the exacerbation subsides on its own after eliminating the cause of its occurrence.

Acquired jaundice

The mechanism of development of this pathology lies in a huge number the formation of total bilirubin, which does not have time to bind liver cells even with increased albumin production. And, accordingly, incomplete removal of bilirubin from the body.

This type of jaundice is called parenchymal or hepatic jaundice. This is a common type of pathology, which is characterized by an increase in the level of direct conjugated bilirubin. A similar condition develops as a complication of certain diseases that negatively affect the parenchymal tissue of the liver, damaging it. As a result, the capture of bilirubin molecules by liver cells, its binding and removal from the body is disrupted. In addition, when the outflow is disrupted, some molecules penetrate back into the bloodstream, causing cholestasis or stagnation of bile. Most often, this picture is observed against the background of hepatitis or cirrhosis of the liver.

Hepatitis is a broad group of liver cell diseases of an inflammatory nature. Hepatitis is caused by viruses that infect liver cells (hepatitis A, B, C, D, E). Liver inflammation can also occur due to medications, alcohol, or autoimmune disorders. Acute form of acquired jaundice, developing as a complication viral infection, characterized by symptoms such as:

• general intoxication (nausea, fever, tachycardia);
• severe weakness throughout the body;
• pain in joints and muscles, often accompanied by muscle spasms;
• pain syndrome localized in the right hypochondrium;
• yellowing of the sclera, mucous membranes and skin;
• discoloration of stool and dark urine;
• significant increases in bilirubin levels compared to normal.

Such diseases have a very unfavorable prognosis. The development of pathology involves an increasing number of parenchyma cells in the process. At the same time, difficulty in the drainage of bile occurs, which provokes severe itching under the skin, bleeding of the pores, and the development of encephalopathy (damage to brain cells).

Against the background of these lesions, without providing immediate adequate assistance, renal and liver failure develops, often causing death (see).

The chronic form of hepatitis in most cases occurs as a consequence of acute viral, drug or alcohol intoxication liver cells. External symptoms chronic form There is only yellowing of the sclera and skin, as well as blood test results. During periods of exacerbation, joint pain, fever and skin rashes may appear.

Cirrhosis of the liver- This serious disease, in which liver cells die, and in their place is formed connective tissue, unable to perform necessary functions. In other words, lobules of hepatocytes disappear on the liver, the vascular and capillary network is destroyed, and extensive foci of connective tissue are formed.

As a result, the liver becomes unable to bind or remove from the body not only bilirubin, but also other compounds that need to be removed. Cirrhosis occurs mainly as a consequence of severe inflammatory lesion liver cells.

Symptoms are characterized by the following:

• a significant increase in the volume of the liver and spleen;
• skin itching,
• ascites – accumulation of fluid in the abdominal cavity;
• varicose veins of such organs as the esophagus, rectum, anterior abdominal wall;
• severe jaundice of the whole body.

Further symptoms of cirrhosis are expressed in the following changes:

• insufficient liver function;
• pronounced signs of brain dysfunction;
• a sharp decrease in blood clotting properties, which leads not only to blood sweating on the skin, but to the development of extensive internal hemorrhages in all organs (intestinal, gastric, uterine, pulmonary).

The prognosis of liver cirrhosis is unfavorable, leading to death in 70% of cases.

Reasons for increased bilirubin in newborns

In the first days of life, the body of a newborn suffers a physiologically prescribed slight jaundice; during this period, the rate of bilirubin in newborns increases slightly.

The mechanism of this process is determined by the baby’s transition to independent existence. In the very first minutes, a child finds himself in an environment that is hostile to him and tries to adapt to life in it. In this case, fetal hemoglobin is replaced by adult-type hemoglobin, which, naturally, is accompanied by the death of some of the red blood cells. After a week, bilirubin in children returns to normal and its indicators do not differ from generally accepted values.

Babies born prematurely or with maternal blood may experience a significant increase in the level of unbound hemoglobin in the blood. As a result, signs of kernicterus appear with brain damage, which is a severe pathology that threatens life.

Before taking any action to help the newborn, pediatricians determine the cause of the increase in bilirubin. This is necessary to resuscitation measures didn't make the situation worse. These may be pathologies such as:

• breakdown of red blood cells as a physiological process;
• damage to liver tissue;
• abnormalities in the development of the biliary tract;
• blood incompatibility.

Methods for reducing bilirubin

There are no specific treatments for jaundice, since it is not a disease, but a symptom of other pathologies. Therefore, before taking any action, it is necessary to establish this reason. In any case, you should not take any medications on your own.

Emergency measures to reduce bilirubin in a clinical setting include: intravenous administration solutions of glucose, albumin, drugs that enhance the production of liver enzymes. As well as performing plasmaphoresis. Newborns are prescribed ultraviolet treatment and phototherapy.

It is important to remember that jaundice is a symptom of severe and dangerous diseases, therefore, to avoid a fatal outcome, you must immediately consult a doctor.

Not every person thoroughly knows the anatomy of his body and the substances and elements that comprise it. For this reason, after receiving test results, we sometimes feel increased anxiety. After all, we cannot explain or understand some meanings, which means that it is not in our competence to correctly assess our condition. One of these little-known meanings is increased bilirubin in the blood. We will consider the causes and methods of treatment, as well as the symptoms of this condition below.

Bilirubin is a substance in the human body

This organic matter, formed during the natural breakdown of hemoglobin due to the destruction of red blood elements - erythrocytes. This process occurs continuously as the red blood cells reach the end of their lifespan. Bilirubin can be seen in blood plasma or bile. Deviations from the norm in the presence of bilirubin in these fluids most often indicate the presence of pathological conditions of the blood (increased destruction of red blood cells), liver or biliary tract.

The difference between direct bilirubin and other types

IN medical science There are two types of bilirubin - direct and indirect. The second of them, also called unbound, is formed in liver cells (about 80%), and the rest - in the spleen and bone marrow cells.

Called bound, it is formed in the liver by adding glucuronic acid to indirect bilirubin. This is required in order to convert a toxic and insoluble substance into soluble form and successfully excreted from the body with bile.

However, non-toxic and easily soluble direct bilirubin can also have harmful effects on the body. At increased concentration of this substance in bile, it is prone to precipitation and crystallization, this can ultimately lead to the formation of solid deposits in structural elements gallbladder and its ducts.

In the results laboratory examinations Total bilirubin is often mentioned, but this is a clinical name; there is no such substance in the body. This concept refers to the total amount of direct and indirect bilirubin.

Why is a blood test for direct bilirubin prescribed?

This study is very important because it allows us to answer the question of whether an increase in bilirubin is associated with liver problems or not. An increase in total bilirubin due to high levels of only indirect bilirubin is possible with an increase in the breakdown of hemoglobin. And an increase in only a readily soluble substance most often occurs when there is difficulty in the outflow of already formed bile, for example, with mechanical blockage bile ducts.

The reasons for increased bilirubin in the blood are different. Serious diffuse liver pathology - hepatitis - is common. The disease is characterized by the fact that the cells of this organ are not able to excrete pigment in the required amount. gallbladder and its ducts. A timely blood test for direct bilirubin will identify this disease and prevent its further progression.

What is the normal level of blood bilirubin?

In order to clearly define the pathological condition, experts have established the concept of normal bilirubin in the blood. It can individually fluctuate within wide limits, but exceeding these values ​​can indicate serious health problems.

In the table below, we see that the level of bilirubin in the blood differs in different age categories. Increased bilirubin, the symptoms of which can only be determined by a specialist, can occur in the first days after birth. Therefore, it is important to monitor its level in the blood so as not to miss serious pathology internal organs.

What pathologies cause an increase in direct bilirubin?

An increased concentration of pigment is possible when too much of it is formed, or there are obstacles to its removal from the body.

Most often, excessive formation of bilirubin is observed in various hereditary diseases, and not only the liver, but also the hematopoietic organs. This can be caused by various anemias, primarily associated with increased fragility of red blood cells, as well as pathology of the spleen, which excessively destroys red blood cells, including healthy ones.

Difficulties in converting and excreting bilirubin are most often associated with liver diseases caused by damage from toxins or inflammation. Often this picture is given by cholelithiasis and oncological changes.

The reasons that led to an increase in bilirubin levels in tests are divided into two large groups: hepatic and extrahepatic. The former are more often caused by diffuse processes in the liver tissue, and the latter - with scarring or other mechanical disturbances in the process of bile outflow.

Hepatic causes:

• Acute viral hepatitis A, B, C.
• Chronic and bacterial hepatitis (with brucellosis, leptospirosis).
• caused by the action of drugs, including.
• Intrahepatic cholestasis.
• Oncological diseases of the liver.

Extrahepatic causes:

• Compression of the bile ducts.
• Diseases of these passages.

Thus, an increased level of direct bilirubin may indicate various violations in the body and cannot be the basis for setting accurate diagnosis. But knowing this indicator, it is possible to conduct further targeted examination of the patient.

Increased unconjugated bilirubin in the blood

If test results indicate elevated level indirect pigment, then you should pay attention to, namely, the amount of red blood elements and hemoglobin. Since indirect bilirubin changes due to increased breakdown of hemoglobin, the person will have obvious signs of anemia. Due to the accumulation of excess unbound pigment in the blood, signs appear and intensify. hemolytic anemia(through jaundice).

Causes of low bilirubin

One of the leading causes of decreased direct bilirubin is coronary heart disease. This phenomenon also occurs after taking alcohol, caffeine (including energy drinks) and a number of medications (penicillin, prednisolone and others).

How does increased bilirubin in the blood manifest externally?

If so what does this mean? With a high concentration of direct bilirubin in the blood, patients experience yellowing of the sclera, and in more severe conditions, yellowing of the skin. Urine acquires a rich yellow color, and feces, on the contrary, become discolored due to impaired excretion of pigment through the intestines. Upon examination, the doctor may detect compaction or an increase in the size of the liver, and there may be pain in the area where the gallbladder is projected.

If direct bilirubin is increased, what does this mean for a patient who has suffered an acute In this case, a person may complain of decreased appetite, nausea, heaviness and pain in the right hypochondrium.

When the flow of bile is obstructed, a change in skin color occurs. This is due to the fact that bilirubin is not evacuated through the intestines, but returns to the bloodstream and is filtered in the kidneys. In addition to the symptoms of “obstructive jaundice,” signs of a disease that has caused a violation of the outflow of bile may clearly appear. These are symptoms of acute chronic pancreatitis, etc. Most effective methods Diagnosis of diseases in such cases is ultrasound or tomography. They help identify inflammatory edema of the walls bile ducts, as well as their overlap with various neoplasms.

Bilirubin in children in the first days of life

The metabolism of newborns is somewhat different from that of adults. At birth, the blood contains a high content of fetal hemoglobin, which is subject to rapid breakdown and excretion from the body. Therefore, physiological, natural jaundice is very often observed in the first days of life. But as the liver enzyme system, which converts indirect bilirubin into direct bilirubin, develops, these symptoms quickly disappear.

However, there is a possibility of pathological occurrence. It can be caused by processes such as:

• incompatibility by blood type or Rh factor of mother and child;
• hereditary fragility of red blood cells, which causes increased formation of indirect bilirubin;
• infectious hepatitis;
• disturbances in the outflow of bile from the liver of a mechanical nature and others.

Treatment for elevated bilirubin in the blood

It is impossible to say for sure what to do if bilirubin is elevated. Actions depend on several factors. First you need to identify the nature of the disease, why it arose. The reasons for increased bilirubin in the blood are varied; when making a diagnosis and prescribing treatment, a doctor cannot rely on data from only one or two studies. Additional studies may be prescribed: ultrasound diagnostics, computed tomography, which can reveal the presence of solid deposits or other obstructions to the outflow of bile, due to which increased bilirubin appears in the blood. Causes and treatment for this pathological process can be determined in some cases by a hematologist (a specialist in blood diseases), in others - by an infectious disease specialist. If there are difficulties in the outflow of bile, therapy is prescribed aimed at relieving spasms of the bile ducts and gallbladder.

However, like many substances in the body, bilirubin should not be perceived as a completely useless waste. As studies have shown in recent years, bilirubin is very good antioxidant, superior in its effectiveness to vitamin E. It is able to inactivate peroxide compounds, preventing the development of many pathological conditions and diseases. Thus, in people with a high level of bilirubin in the blood, the risk of atherosclerotic vascular lesions and associated heart diseases is significantly reduced. Bilirubin is able to fight aggressive free radicals, significantly reducing the risk of cancer.

Features of bilirubin in pregnant women

Sometimes it happens that pregnant women have increased direct bilirubin. What does this mean for them? The state of pregnancy cannot in any way provoke a decrease or increase in this substance. Most often, expectant mothers note that in the analysis results the reference indicator of the substance corresponds to the column “Bilirubin direct norm”. It may be increased or decreased not because of pregnancy, but during an exacerbation chronic diseases or the emergence of new pathologies. Increased content pigment in the blood can be caused by diseases such as cholestasis, hemolytic anemia, viral hepatitis, cholecystitis. Such conditions require immediate and full examination women, after which the doctor prescribes adequate and effective treatment.

Ways to lower bilirubin

If you find yourself with symptoms of increased direct bilirubin, then you need to get rid of them, since this condition can affect the condition of the internal organs. To lower the level of this pigment, you first need to study your diet. Good results can be achieved by changing your diet. To do this you need:

• stop eating fried and spicy foods;
• completely eliminate alcoholic beverages from the diet;
• do not consume drinks with gases;
• Newborn babies need to drink more fluids to quickly remove toxins from the body.

It is necessary to pay maximum attention to the condition of the liver. By applying these simple nutritional rules, you enable this organ to cleanse and recover. Healthy liver actively gets rid of large amounts of bilirubin in bile and blood. In addition, it is necessary to monitor the healthy functioning of the intestines. Boiled and baked foods promote good intestinal function. You cannot exhaust yourself with endless diets or hunger, this leads to a malfunction of the digestive organs.

Thus, only a symptom is a condition in which direct bilirubin is elevated. What does it mean? This suggests that it is important not only to reduce the amount of pigment in the blood, but also to treat the cause.

Pathological processes in the liver will manifest themselves through nausea, painful sensations in the area of ​​this organ, a feeling of heaviness, increased temperature, bitter taste in the mouth. If increased bilirubin is due to anemia, it will manifest itself through yellow tint mucous membranes, chronic fatigue, frequent heart contractions, pain in the left side of the chest. Increased bilirubin caused by diseases of the biliary tract will manifest itself through dark urine, loss of appetite, severe itching and nausea.

In such conditions, it is necessary to take a blood test for direct bilirubin. The doctor will tell you what the results and recommendations for reducing it mean.

The yellow-green pigment bilirubin is a breakdown product of hemoglobin in the blood. This element is found both in the blood serum and bile of every person. The liver plays a very important role in the metabolic process of this substance, so it immediately responds to its increase. For example, with increased bilirubin, a person experiences signs of jaundice (yellowing of the skin, as well as the sclera of the eyes and mucous membranes).

In addition, increased bilirubin usually accompanies known disease liver - hepatitis. Also, exceeding its norm can be a symptom of a blood disease (hemolytic anemia).

What needs to be done, what measures to take if bilirubin is elevated, causes, treatment, what kind of health condition is this? These questions concern many people whose blood test showed an excess of this substance. Therefore, today we will talk about this in more detail:

Bilirubin norm - what is it?

You need to know that blood serum contains this substance in direct form (bound) and indirect form (free). Total bilirubin is determined by adding the amount of direct and indirect. It should be taken into account that the norm of direct bilirubin is 75% of the total.

To find out the concentration of this substance (all three of its fractions), venous blood is examined. Depending on the results of the study, a conclusion is drawn about the presence or absence of certain pathologies in the body.

Norm:

Indirect bilirubin - no more than 17.1 µmol/l,
- direct - no more than 4.3 µmol/l,
- total - should be from 8.5 to 20.5 µmol/l.

Why is bilirubin increased? Causes of the condition

What are the most common causes of increased bilirubin? common reasons include the presence of diseases such as:

Blood diseases (anemia), when the number of non-viable red blood cells sharply increases.

Immune disorders, when the immune system mistakenly attacks normal red blood cells ( hemolytic disease newborns, as well as Rhesus - a conflict between the child’s body and the mother’s body).

The cause may be the destructive effect of toxic or chemical substances on normal blood cells.

Liver diseases: all types of hepatitis that destroy liver cells, as well as jaundice.

Violation of the outflow of bile, when it cannot move freely along the bile ducts. This is observed when cholelithiasis, with dyskinesia of the gallbladder. The disorder can be caused by paccreatitis, various tumors, and scars. The movement of bile is hampered by enlarged lymph nodes located close to the bile ducts.

Alcohol, chemical and drug poisoning, vitamin B12 deficiency. The cause of increased bilirubin can be Gilbert's syndrome (hereditary liver enzyme deficiency), as well as the quite common physiological jaundice of newborns.

What to do if bilirubin is elevated? Treatment of the condition

In order for the treatment of elevated bilirubin to make sense, the first step is to establish the cause of its increase, to find out what it is? Once a diagnosis has been made, it is necessary to take measures to treat the underlying disease.

For example, if bilirubin is elevated due to obstruction of bile flow, the obstruction will need to be removed. The doctor will prescribe medications that improve bile secretion. It may be necessary to remove the gallstone.

If the cause is hepatitis, antiviral treatment is prescribed; if the liver is damaged by toxins, adsorbents and hetaprotector drugs are prescribed.

In addition, to bring this enzyme back to normal, you will need to change your diet. Spicy, salty, smoked foods and alcohol are excluded from it. Fried, fatty foods, strong tea, sweet soda, and any sweets are contraindicated.

To relieve the liver, gall bladder, and cleanse the intestines, eat vegetables, fruits (fresh, boiled and baked), and include fermented milk products in the menu. Eat little, but more often. You can't overeat, just like you can't starve. For cholelithiasis, a special therapeutic diet is prescribed.

When treating elevated bilirubin, use remedies from the arsenal of traditional medicine. For example, it is useful to take motherwort tincture, infusions, and decoctions of chamomile and St. John's wort. These remedies will help cleanse and heal the liver.

It should be noted that detection of this enzyme below its norm should also alert. Of course, more often patients suffer from increased bilirubin rather than decreased bilirubin. However, based on the studies conducted, a connection was established between the development of coronary heart disease and a significantly reduced bilirubin enzyme. That is, the risk of a heart attack (stroke) is much higher when its level is reduced rather than increased.

If the bilirubin level deviates significantly in one direction or another, be sure to consult a doctor. It is likely that this deviation is a sign of some disease that requires medical intervention. Be healthy!

It is a yellow-green pigment formed after the breakdown of hemoglobin. Bilirubin is found in both bile and blood serum. An organ such as the liver plays a significant role in the metabolic processes of bilirubin. When the bilirubin pigment in the blood increases, jaundice may begin, accompanied by yellowing of the sclera of the eyes and skin of the body, as well as mucous membranes. Liver diseases, in particular hepatitis, as well as various types of anemia, can also be triggered by an increase in the level of bilirubin.

How does bilirubin form?

Red blood cells, called erythrocytes, contain hemoglobin, which carries oxygen directly to the tissues from the lungs. Damaged red blood cells, just like old ones, decompose in the liver and spleen cells intended for this purpose, as well as in the bone marrow. In the process of destruction of the erythrocyte substance, hemoglobin is released, which, after some time and a stage of chemical reactions, turns into the substance bilirubin. The bilirubin that was just formed from hemoglobin (indirect bilirubin) is extremely harmful to the body, in particular to the central nervous system. Therefore, right in the liver, some substances seem to bind bilirubin, thereby neutralizing it. This bilirubin is called direct bilirubin. It is secreted into bile by the liver and exits human body along with feces through the intestines. If the stool is dark, then we can say that it contains bilirubin (altered). There are diseases with the biliary tract and liver, when the process of releasing bilirubin directly into the intestines is hampered, disrupted, and feces become colorless, like clay.

Characteristics of direct (connected) and indirect bilirubin

As mentioned above, direct and indirect bilirubin are the two main fractions of this substance. It all depends on how the laboratory reaction with the diazo reagent goes.

Indirect bilirubin is poisonous and toxic bilirubin that has recently formed from hemoglobin and has failed to reach the liver.

Direct or bound bilirubin is a substance that has been neutralized in the liver. Here, bilirubin is prepared for removal from the body, therefore there is no toxicity in it.

What indicators are considered normal?

A bilirubin test is taken in the morning on an empty stomach.

Bilirubin levels are determined through blood tests. IN in this case it is necessary to take a biochemical analysis. In order for its results to be reliable, the analysis must be carried out only in the morning, and, of course, on an empty stomach. It is very important not to eat anything for about eight hours before the test itself. Biochemical analysis carried out from a vein.

So, the norm for bilirubin (both direct and indirect) is its level in the blood serum from 8.5 to 20.5 µmol per liter. Thus, the norm for bilirubin in the indirect fraction is 17.1 micromol per liter, while for direct bilirubin, up to 4.3 micromol per liter is considered normal.

Signs of increased bilirubin in the blood

Considering the fact that the liver plays the main role in bilirubin levels, it becomes clear that the main symptom of an increase in the level will be jaundice. This symptom occurs both when there is a violation of the binding of excess substances, and when there are difficulties with the excretion of bile.

Important: the severity of jaundice may be less in people who are overweight and have edema.

Jaundice has its own characteristics. First of all, changes in the sclera are noted. Further, yellowness appears on the oral mucosa and on the skin of the palms. Only then, in the absence of treatment, does jaundice spread to the entire body. Concomitant symptoms will depend on the root cause of the change in bilirubin levels, that is, on the underlying disease.

What diseases cause bilirubin levels to increase?

A presumptive diagnosis can be determined by which bilirubin is elevated. Thus, direct bilirubin increases more often in the following diseases:

• Hepatitis of viral and bacterial nature, including chronic.
• Food poisoning (usually mushrooms).
• Intoxication due to improper use of medications ( hormonal contraceptives, NSAIDs, antitumor drugs).
• Tumors of liver tissue.
• Cirrhosis.
• Hereditary pathologies - Rotor, Dabin-Jackson syndrome.

Indirect bilirubin is more often observed in pathologies such as:

• Congenital hemolytic anemia.
• Hemolytic anemia caused by SLE, lymphocytic leukemia, lymphogranulomatosis.
• Sepsis, .
• Long course of cephalosporins, penicillins, insulin and NSAIDs.
• Toxic anemia due to poisoning with metals, arsenic, salts, as well as after snake bites.
• Gilbert's syndrome, Lucy-Driscoll.

What can cause an increase

Here we can highlight three main reasons that can provoke an increase in bilirubin levels.

1. Accelerated rate of destruction of red blood cells
2. Disturbances in the process of processing bilirubin directly in the liver
3. Disturbances in bile flow

If there is increased speed erythrocyte destruction, then, accordingly, hemoglobin and bilirubin increase sharply. main reason Such accelerated destruction of red blood cells is hemolytic anemia, which is the destruction of blood. Hemolytic anemias can be either congenital or acquired. If anemia is congenital, it can develop due to certain defects in the erythrocyte structure or hemoglobin disorders. This may be hereditary microspherocytosis and thalassemia, as well as sickle cell anemia. Acquired anemia results from autoimmune processes. Here the immune system begins to fight with its own red blood cells. Acquired anemia can also be caused by malaria and the use of certain medications.

In general, indirect bilirubin may increase in the presence of hemolytic anemia. With such anemia, discomfort may be felt under the left rib caused by an enlarged spleen. With hemolytic anemia, body temperature rises and the urine darkens. Thus, shades of urine can range up to dark brown and black, which will indicate that red blood cells are being destroyed inside the vessels. Such destruction of red blood cells can be found with a defect in cell membranes in the blood - Marchiafava-Miceli disease. Thus, the membranes become unstable and lead to the destruction of red blood cells.

During such anemia, a person may feel severe fatigue and frequent heart pain.

As mentioned, the liver plays an important role in the metabolic processes of the substance bilirubin. Thus, in case of liver diseases, indirect bilirubin cannot be neutralized in liver cells. Diseases may occur: viral hepatitis A,B,C,D and E types, drug-induced hepatitis and alcoholic hepatitis. Liver cirrhosis develops, and subsequently liver cancer. Yes, you can observe sharp jumps degree of bilirubin, which may manifest itself in jaundice and other symptoms. Such symptoms include “bitter” belching and nausea; discomfort may occur after eating food, in particular fatty foods. Performance decreases, as does appetite, which is accompanied by a sharp increase in overall body temperature.

There are other causes of increased bilirubin. So, it may be heredity, when the body lacks a liver enzyme. This process is called glucuronyl transferase. The missing enzyme is involved in the metabolic processes of bilirubin. This syndrome is called Gilbert's syndrome. Here an increased, and significantly, level of bilirubin appears. This can manifest itself in yellowing of the skin and eye sclera, as well as mucous membranes of the body.

Increased bilirubin can be detected if bile outflows from the liver or from the gallbladder are disrupted. This can occur with cholelithiasis and pancreatic or gallbladder cancer. If bile flow is impaired, then direct bilirubin may be elevated in the blood. What could such an increase lead to? First of all, this development in acute form jaundice. However, other symptoms may also occur, such as hepatic colic, which usually precedes the development of jaundice in gallstone disease. Hepatic colic is accompanied by an attack acute pain under the right rib.

Bilirubin irritates the nerve endings of the skin and can cause itching of the skin, which can be quite pronounced.

Bloating or constipation and frequent diarrhea may occur.

Disturbances also occur in the stool - it takes on a white clay shade, almost discolored. This indicates disturbances in the bile outflows.

Urine can change its consistency and shades, including dark, brown and black.

Elevated bilirubin is normal for a newborn

An increase in bilirubin levels in newborns requires special attention. In general, elevated bilirubin is normal for infants. The fact is that immediately after birth, the child begins to rapidly destroy red blood cells. During the development of the baby inside the womb, he has fetal hemoglobin in his red blood cells, which, of course, differs from ordinary hemoglobin. Red blood cells, which contain such hemoglobin, are easily destroyed.

Accordingly, the rapid destruction of most red blood cells can lead to a jump in bilirubin upward, after which the newborn may develop normal jaundice. For a newborn, the norm of bilirubin four days after birth is 256 µmol per liter in children who are considered full-term. If the baby is premature, the figure for him will be 171 micromol per liter.

At strong increase the child's hemoglobin level may begin to develop pathological jaundice, indicating hemolytic disease of the newborn.

Diagnostics

First of all, it is determined by how much the indicator has changed. For this purpose, Harrison's test is prescribed. The technique is based on the ability of bilirubin to be oxidized under the influence of reagents to biliverdin. Additional tests are performed based on the preliminary diagnosis. More often a biochemical blood test is prescribed.

Features in women and men

It should be noted right away that normal indicators for men and women do not differ. The same applies to the reasons for the increase in the indicator - they will be similar. But there is one difference. According to statistics, men are 10 times more likely to experience Gilbert's syndrome.

Separately, the increase in bilirubin during pregnancy should be considered. In addition to the above reasons for changes in the level of the indicator, when carrying a child, the following conditions can provoke the symptom:

• Acute fatty liver degeneration.
• Formation of gallstones.
• Severe toxicosis of the early period.
• Intrahepatic cholestasis of pregnancy.
• Eclampsia and preeclampsia.

In addition to the above, the indicator may change during pregnancy if the woman is a carrier of the Epstein-Barr virus, cytomegalovirus, or an exacerbation is observed chronic pathologies liver.

Important: slight increase bilirubin against the background of normal general well-being may be the result of stress of the expectant mother.

A growing fetus can also cause an increase in bilirubin. This is explained by the fact that it displaces and compresses organs, in particular the gallbladder ducts, which causes stagnation of bile.

How can you reduce bilirubin?

Before treating elevated bilirubin levels in the blood, you need to make sure that the reasons for its increase are correctly established. Initially, you need to determine the cause of the destruction of red blood cells and build on it.

If elevated bilirubin is caused liver diseases, then the phenomenon of increased bilirubin here is only a symptom. It may disappear immediately after the patient recovers. If the reason is stagnation of bile, then it is important to remove all obstacles that interfere with the quality outflow of bile. So, bilirubin will decrease.

To reduce bilirubin in a newborn, you need to use special activators - inducer drugs for liver enzymes.

Any increase in bilirubin requires nutritional correction. This will help reduce the load on the liver. First of all, you should reduce your salt intake as much as possible. It's better to cook without it. The daily norm will be 10 g. Naturally, marinades, pickles, smoked meats and canned food are excluded. Baked goods, especially those containing soda, are also prohibited. Mushrooms, fatty broths, sour fruits and berries, spices, seafood and alcohol.

Water-based porridge should definitely be on your menu if bilirubin levels are high.

The menu is compiled using the following products:

• Porridge cooked in water.
• Lean meat.
• Low fat dairy products.
• Vegetable oils.
• Juices, just not sour ones.
• Honey and sugar.

All products must undergo heat treatment, preferably boiled or baked. It is especially important to maintain a drinking regime that involves drinking two or more liters of water. Herbal decoctions, compotes, and still mineral waters are acceptable.

You will need

• - Aralia tincture;
• - tincture of ginseng;
• - lemongrass tincture;
• - Leuzea extract;
• - decoction of rose hips;
• - decoction of corn silk.

Instructions

The level of bilirubin in the blood, which exceeds 17.1 µmol/l, is considered pathological and has a negative effect on well-being. The first sign of this is yellowing of the sclera of the eyes and skin, darkening of the urine. Other symptoms include nausea, headache, dizziness, fatigue, itching, pain in the right hypochondrium after exercise or eating, and abdominal pain. If you notice such signs, immediately contact your doctor, who will prescribe tests to determine the exact condition and correctly draw up a treatment regimen.

Eliminate the main cause of the increase in bilirubin levels, without which it will be impossible to reduce it. Most often, this pigment increases in the blood and urine when there is a violation of the outflow of bile into the intestines, jaundice, liver damage of various types, including congenital or acquired anemia, Gilbert's syndrome and hereditary deficiency of liver enzymes. Some drugs also help increase bilirubin levels, for example, certain types of antibiotics, Fluraschepam, Deazelam, Phenytoin, etc.

Take the medications prescribed by your doctor based on your test results. Thus, to maintain liver function, hepatoprotectors are usually prescribed first of all: Karsil, LIV52, Essentiale Forte, milk thistle extract. To reduce bilirubin, doctors recommend taking from 0.05 to 0.2 grams of Phenobarbetal and Zixorin per day. The duration of taking these drugs is 14-28 days. To improve digestion and gastric motility, enzyme preparations are prescribed: Festal, Mezim, Pancreatin. They are drunk 1-2 minutes before meals, during meals or after meals three times a day. If high bilirubin levels are associated with immune disorders or infections, the patient is also prescribed a course of antiviral, anti-inflammatory or immunomodulatory drugs. In case of intoxication, it is necessary to take sorbents and antioxidants. To cleanse the body of large amounts of pigment and its breakdown products, especially in severe cases, shows the intravenous effects of glucose.

Follow a strict diet, as a comprehensive approach is important to successfully reduce bilirubin. Drink more plain water, forgetting about juices and sweet soda. Avoid everything fatty, spicy and fried. Strictly prohibited. In no case should you eat marinades or pickles if you have elevated bilirubin, so as not to injure your kidneys and digestive system. Limit your salt intake. Eat often, but in small portions. Replace brown bread with gray bread made from wholemeal flour; eat porridge: buckwheat, oatmeal, rice, but not wheat. You can't fill them with anything. Drink any compotes and fruit drinks, except cranberry. Strictly coffee, also limit the consumption of black tea, giving preference to herbal tea. At the same time, do not starve yourself or adhere to any other diets.

After consulting with your doctor, take herbal decoctions several times a day: St. John's wort, mint, oak bark, rose hips. Also, when diagnosing problems with the outflow of bile, drugs such as tincture of aralia, ginseng, lemongrass, Leuzea extract, and motherwort are prescribed. Just brew a couple of teaspoons of crushed herbs with a glass of boiling water, cover with a lid, let it brew, then strain and take half an hour before meals and between meals.

Patients suffering from biliary dyskinesia with the formation of stones are recommended to take the drug Ursosan, which has the property of removing small stones from the bile ducts. Before purchasing a medicine, consult your doctor, who will determine whether there are any contraindications for taking it, calculate the right dosage.

Watch your lifestyle. In addition to medication and a strict diet, it is recommended to limit excessive physical exercise, but do not forget about light daily gymnastics and walks on fresh air. Support your immunity to prevent the development of viral and infectious diseases. Avoid stressful situations whenever possible and nervous breakdowns, which also have Negative influence on the functioning of internal organs.

Forget about drinking any alcoholic beverages, which are not only strictly contraindicated when taking medications, but also destroy the already damaged liver, which has long been a proven fact. Quit smoking and other bad habits.

Reducing the level of bilirubin in the body should only be carried out under the strict supervision of a doctor. In case of prolonged absence of effect from the treatment listed above and with acute currents illness shown surgical intervention. However, even if your condition improves and stabilizes, do not forget to monitor your diet and tests.

note

Elevated bilirubin often occurs in newborns. This may be due to the appearance of some pathology, for example, underdevelopment of the bile ducts. However, usually a slight jaundice - normal condition in infants and goes away during the first two weeks of the baby’s life. Nevertheless, this cannot be ignored.

Related article

Biliary dyskinesia ways(JVP) is an incomplete, untimely or excessive contraction of the muscles of the biliary sphincters ways or gallbladder, which in turn leads to disruption of the outflow of bile. The following variants (types) of JVP are distinguished: hypertonic and hypotonic; hyperkinetic and hypokinetic.

Instructions

Treatment of ADHD must begin with normalization of nutrition, rest and work schedule. In case of hypertonic variant, it is recommended with the exception of spicy, fried foods, various seasonings, smoked foods, etc. Food intake is carried out in small portions, often. With the hypokinetic type of JVP, the diet is somewhat different.

From the first days, correction is carried out from the vegetative side nervous system sick. In case of hypertensive type, intravenous injections must be prescribed sedatives: infusion of valerian, motherwort, bromides. For hypotonic type of JVP, it is recommended to take tonic drugs: ginseng tincture, Eleutherococcus extract, Leuzea, Schisandra, Aralia.

For pain syndrome, antispasmodics are prescribed, and medicinal herbs that have a sedative effect can also be used. In case of severe pain syndrome, it is necessary to spend in a hospital for two weeks, and then in a specialized local sanatorium. To relieve bile, duodenal intubation is performed. In the presence of intrahepatic cholestasis, tubing is recommended up to 2 times a week. At the same time, tonics, cholekinetics and choleretics are used. Choleretics are not prescribed for elevated ALT or liver enzyme.

For the hypertensive type of DVT, nicodine, oxafenamide, and low-mineralization mineral waters (Smirnovskaya, Slavyanovskaya, Narzan, Essentuki 20.4 heated or hot 5 times a day) are prescribed. For herbal medicine, peppermint, chamomile flowers, licorice root, motherwort herb, rose hips, valerian root are used. For the hypotonic type, magnesium sulfate, flamin, pancreozymin, cholecystokinin, highly mineralized mineral waters (Arzni, Essentuki 17, etc., slightly heated) are used or room temperature 30 minutes before meals). Herbal medicine used: immortelle flowers, chamomile, corn silk, nettle leaves, St. John's wort, rose hips.

In the case of the hyperkinetic type of JVP, short-course antispasmodics, magnesium and potassium preparations, and warm mineral waters of low mineralization are prescribed 5 times a day. Medicinal herbs: licorice root, peppermint, chamomile flowers, valerian root, dill fruits. For the hypokinetic type, it is recommended to take sorbitol, xylitol, cholecystokinin, magnesium sulfate, as well as take highly mineralized mineral waters slightly warmed or at room temperature 30 minutes before meals. Herbal medicine as for hypotonic type.
When identifying helminthic infestation, giardiasis must be carried out anthelmintic therapy(pyrantel, vermox and other drugs).

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• biliary dyskinesia how to treat in 2019

Bilirubin is a red-yellow bile pigment that is a product of the breakdown of hemoglobin. The breakdown process is carried out by reticuloendothelial cells located in the liver, spleen and bone marrow. Bound and thereby neutralized by other substances, it is excreted by the liver as part of bile and leaves the body with feces, and its presence explains its dark color.

Instructions

In blood serum, bilirubin is presented in two fractions: direct and indirect, bound and unbound. Together they make up the total bilirubin. Immediately after the breakdown of hemoglobin, indirect, free bilirubin is formed, which is very toxic to the body (and especially to the central nervous system). Next, it binds in the liver and into direct, conjugated bilirubin, which is less toxic and ready for excretion from the body.

The blood normally contains a small amount of bilirubin, reflecting the processes of formation and excretion of this substance. The concentration should be in the range of 5.1-17.0 µmol/liter, direct - no more than 1.0-5.1 µmol/liter. Indicators normal values may vary between laboratories.

A pathological increase in bilirubin levels leads to the development of jaundice, which is characterized by yellowing of the skin, sclera and mucous membranes. In this case, an increase to 85 µmol/liter indicates a mild form of jaundice, 86-169 – moderate, over 170 – severe.

An increase in bilirubin levels is caused by three main reasons: increased or accelerated destruction of red blood cells, impaired processing of bilirubin in the liver, and bile disorders. Hemolytic, which can be congenital or acquired, most often leads to increased destruction of red blood cells. At the same time, indirect bilirubin increases.

In case of liver - hepatitis, cancer and others - indirect bilirubin cannot be neutralized by liver cells. Bilirubin metabolism is also impaired due to a hereditary deficiency of glucuronyl transferase, a liver enzyme. If there is a violation of the outflow of bile from the liver or bladder, possibly due to cholelithiasis, pancreatic or gall bladder cancer, increased bilirubin is also detected.

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note

In the first week of life, newborns often experience physiological jaundice, since at this time fetal hemoglobin is actively destroyed, and the conjugating system is not yet fully formed.

Tip 4: How to eat with biliary dyskinesia

Biliary dyskinesia is a disorder of the gallbladder function associated with disturbances in the constant outflow of secretions. It can manifest itself as stagnation of bile, slow or accelerated excretion. To normalize the function of this internal organ, you need to follow a special diet.

What foods should you not eat if you have biliary dyskinesia?

Biliary dyskinesia does not pose a threat to, but significantly reduces its quality and creates conditions for the appearance of more serious disorders. The reasons for this may be nutritional disorders, excess weight resulting from the consumption of large quantities of simple refined carbohydrates and animal fats.

Dyskinetic disorders are aggravated by coffee, strong tea, alcoholic and carbonated drinks, so you should exclude them from the diet or sharply reduce consumption.

Therefore, with dyskinesia, it is recommended to exclude or sharply limit the consumption of the following foods: sugar, confectionery, fatty meats, pork, beef, lamb fat, goose, duck, oily fish, sour cream, butter. Hot spices (horseradish, pepper, mustard), fast food, ice cream, chocolate, nuts, mushrooms, legumes, all broths, pickles and smoked meats (since its dense shells are digested) should be excluded from the diet. The consumption of semolina and rice cereals should be limited. You cannot eat fried foods; foods must be boiled, steamed or baked. Dishes should not be too cold or too hot.

What to include in the diet for biliary dyskinesia

Patients with biliary dyskinesia will benefit from porridge (buckwheat, pearl barley, oatmeal) - they contain complex carbohydrates and dietary fiber. It is necessary to include any fruits in the diet (except radishes, radishes, onions, garlic), it is advisable to consume dishes from them during the day. With accelerated excretion of bile to reduce smooth muscle tone, you need to eat foods rich in magnesium (buckwheat and wheat cereal, bran or grain bread, vegetables).

Sweets allowed include honey, marshmallows, marmalade, marshmallows, caramel, and jam.

You should definitely eat beets, carrots, zucchini, pumpkin, cucumbers, tomatoes, cauliflower and Brussels sprouts. Some patients do not tolerate rough food well, so they are not recommended to use white cabbage a lot. The menu should include vegetarian soups, milk cereal soups, lean meats, poultry, fish, low-fat dairy and fermented milk products, steam omelet, soft-boiled eggs, vegetable oil, white stale bread, biscuits, dry biscuits, ripe sweet fruits, weak tea, dried fruit compotes, juices diluted with water.

Bilirubin is formed in the liver during the process of hemolysis (destruction of old red blood cells). It is a yellow pigment that gives urine its characteristic hue. Normally, it is contained in urine in very small quantities, so reagents do not detect it. With the development of pathologies, the concentration of bilirubin increases.

How is bilirubin detected in urine?

In human blood there are red cells - erythrocytes, some of which die off all the time and are replaced by new cells. When they break down, they release hemoglobin, which breaks down into heme molecules and globin chains. Heme is exposed to enzymes and converted into indirect bilirubin, which is a fat-soluble toxic substance. Indirect bilirubin in the liver is converted into direct (water-soluble), then it is simultaneously excreted into the duodenum along with bile. When the function is impaired, direct bilirubin is released into the blood from bile, enters the kidneys and is found in the urine. The indirect fraction cannot penetrate into them because it is not water-soluble.

Bilirubin in urine is detected by several methods: Rosin's test and Fouche's test. When performing the Rosin test, layer 2-3 ml of urine alcohol solution iodine (1%). If a green ring appears at the border of the two liquids, this means that there is increased bilirubin in the urine. The Fouche test is performed using a barium chloride solution (15%). It is added to urine, mixed and passed through a filter. Fouche's reagent is then dropped onto the filter. The appearance of green crystals indicates the presence of bilirubin in the urine.

Reasons for increased bilirubin in urine

The appearance of bilirubin in the urine (bilirubinuria) is a symptom of liver problems. In particular, this happens when obstructive jaundice when the duct through which bile is discharged into the small intestine. This is usually caused by inflammation of the pancreas. Bilirubin in the urine increases due to liver inflammation (hepatitis) of a bacterial, viral or toxic nature, due to cirrhosis, trauma, metastases in the liver. In these cases, a urine test reveals only direct bilirubin that has entered the blood and kidneys. Its content in the blood also turns out to be higher than normal. There are disorders in which there is an excess of indirect bilirubin (for example, with hemolytic anemia), in which case a blood test shows it, but a urine test does not.

A symptom of bilirubinuria is jaundice: the patient’s sclera of the eyes, mucous membranes and skin become yellowish. This is visible to the naked eye. Liver diseases are also accompanied by heaviness in the hypochondrium, increased body temperature, nausea, and bitter belching. Urine becomes dark and stool becomes light. Itching of the skin appears, and sometimes hepatic colic occurs. If one or more symptoms appear, you should immediately consult a doctor, as bilirubinuria is a sign of serious illness. Depending on the root cause of the increase in bilirubin in the urine, appropriate treatment is prescribed.