Bilirubin is a bile pigment, which is a residual product of processing of destroyed old red blood cells. Normally, a healthy adult in the blood plasma contains a small amount of this substance (3,4 - 22,2 μmol / l), and also a certain amount of urine in the form of urobilinogens (4 mg) daily.
Approximately 96% of bilirubin in the blood is an insoluble indirect bilirubin, which is insoluble in water and is toxic, because is able to easily penetrate through cell membranes and disrupt the vital functions of cells. The remaining 4% is direct bilirubin, soluble in water, filtered by the kidneys and excreted in the urine. Total bilirubin is the general level of direct and indirect bilirubin.
In certain pathologies, the content of bilirubin in the blood, and further in the urine, increases. This causes jaundice and darkening of the urine.
The causes of elevated bilirubin levels in adults
Let's consider, for what reasons the general or common bilirubin in an organism of the person can be raised or increased.
The causes of increased direct bilirubin
The level of direct bilirubin in the blood is increased due to a violation of the outflow of bile. As a result, bile is sent to the blood, not into the stomach. The reasons for this are most often the following pathologies:
- hepatitis of viral etiology in acute form (hepatitis A, B, with infectious mononucleosis);
- hepatitis of bacterial etiology (leptospirosis, brucellosis);
- chronic hepatitis;
- autoimmune hepatitis;
- medicamentous hepatitis (as a result of hormone therapy, non-steroidal anti-inflammatory drugs, antitumor drugs and anti-tuberculosis drugs);
- toxic hepatitis (poisoning with fungal poisons, industrial toxic substances);
- cancer of the gallbladder, liver or pancreas;
- cholelithiasis;
- biliary cirrhosis;
- syndromes of Rotor, Dabin-Johnson.
The causes of increased indirect bilirubin
An increase in the content of indirect bilirubin can be associated with the accelerated destruction of red blood cells or with a disruption in the processing of indirect bilirubin. It is worth noting that, since indirect bilirubin in water does not dissolve, even with a significant increase in its level in the blood, there are no deviations in the analysis of urine. So, the reasons for this can be:
- Congenital hemolytic anemia (sickle cell, spherocytic, nesferocytic, thallasemia, Marciyafawa-Michele disease);
- secondary hemolytic anemia (against rheumatoid arthritis, systemic lupus erythematosus, lymphocytic leukemia, lymphanganulmatosis, etc.);
- medicinal hemolytic anemia (associated with insulin, aspirin, levomycetin, levofloxacin, cephalosporins, etc.);
- syndromes of Lucy-Driskol, Gilbert, Kriegler-Nayyar;
- infectious diseases (malaria, typhoid, sepsis);
- toxic hemolytic anemia ( poisoning with poisonous mushrooms, poisons, insect bites, snakes, poisoning with mushrooms, lead, copper salts, etc.).
The causes of increased bilirubin in pregnancy
Increased bilirubin is often observed in pregnant women (jaundice in pregnancy). The reasons for this are divided into two groups:
- due to the pathology of pregnancy (acute fatty degeneration of the liver, gestosis, excessive vomiting, etc.);
- caused by various concomitant diseases (hepatitis, hemolytic anemia, etc.).
The causes of increased bilirubin in the urine
An increased level of bilirubin in urine is observed in diseases accompanied by damage to liver cells
- hepatitis;
- cirrhosis of the liver ;
- metastatic liver damage;
- liver injury, etc.
Treatment of elevated bilirubin
If the tests show that bilirubin in the blood or in the urine is elevated, the principles of treatment will depend on the causes of this pathology. Typically, therapeutic methods include taking medications and adjusting the diet.