Mechanical jaundice. Jaundice - description, treatment Concept and characteristics

What is the ICD 10 code for obstructive jaundice? In most cases, if the liver is diseased, the pathology is accompanied by obstruction of the bile ducts. It is noticeable on the outer skin and mucous membranes as they turn different shades of yellow. In this case, a diagnosis of obstructive jaundice is made.

Disease code

Not so long ago, obstructive jaundice was defined as an independent disease, but then scientists discovered that it is closely related to lesions of the hepatobiliary tract and is responsible for the occurrence of gallstones. If it is necessary to find data about this disease, then the ICD 10 code is used: K83.1, where it is defined as the cause of blockage of the bile duct.

In the international classification, this disease and purulent cholangitis are considered together, because they are preceded by the same processes. The yellow color appears due to the fact that increased bilirubin, having accumulated in the blood serum, fluids and tissues of the body, leaves a mark on the skin and mucous membranes. At various levels, disruptions occur in the flow of bile into the duodenum.

The liver should secrete an average of 50 ml of bile per day. If this is not possible, then the pressure in the bile capillaries increases; they cannot withstand such pressure, beginning to expand and burst, and the contents immediately enter the blood.

What happens in the body?

The permeability of hepatocyte membranes, which are located in liver cells, increases. All this leads to increased levels of bilirubin, cholesterol, liver enzymes and bile acids.

In those patients who have too light skin or suffer from anemia, jaundice is detected much faster, and on dark skin it is not noticeable for a long time. It is not for nothing that the pathology is singled out according to the international classification into a single disease, since over time it affects all organs and systems, but especially the kidneys and liver. As a result, it can be considered depending on a very complex pathological and physiological complex.

The more the biliary tract is damaged, the more the disease worsens, all systems belonging to homeostasis experience pathological changes.

If cholestasis is extrahepatic, then the following processes are observed in the body: direct bilirubin begins to return to the blood and lymph from the smallest intrahepatic bile ducts. Cholestasis progresses more and more, and with it the polarity of hepatocytes changes. Against this background, bilirubin, together with glucuronic acid, tries to exit through the blood vessels. Thus, not only does its content in the blood increase, but the synthetic and metabolic functions of the liver are also disrupted.

This subsequently becomes the reason for changes in the composition of the plasma and the rheological properties of the blood.
Bilirubin begins to be excreted in the urine, so it becomes unrealistic brown, and feces, on the contrary, become unnaturally white, since bile does not enter the intestines at this time, which is a reason for a person to panic.

The longer cholestasis lasts, the more damaged hepatocytes become. They're missing nutrients and oxygen, hypoxia sets in, and the work of capturing bilirubin almost stops.

Since bile acids are in excess, they begin to irritate the nerve endings, causing itching on the skin. However, they are not able to penetrate the intestines, which affects:

1. 1. On the digestive process.
2. 2. On motor skills: constipation appears. Can be found in feces increased amount undigested fat and nitrogen.

When stagnation occurs, immunity decreases, making it easier for any pathogenic bacteria to enter the body. They attack the hepatobiliary system, which is often the cause of cholangitis.

A tendency to form stones may develop, and this aggravates the course of the disease. In older women, gallstones can be detected in 20% of cases; in men, this pathology is detected 2 times less often. With choledocholithiasis, obstructive jaundice of varying severity may occur.

In order to identify the disease in time and prevent complications, it is necessary to quickly identify choledocholithiasis and eliminate it, which is carried out minimally invasive or surgically.

Obstructive jaundice does not belong to the category of diseases that are transmitted through blood or other biological fluids person.

The full severity of clinical manifestations is expressed mainly by diseases of the liver, kidneys, nervous, blood and cardiovascular systems. Problems with metabolism appear.

Obstructive jaundice, if caused by choledocholithiasis, can make itself felt within a few hours with an attack of pain, localized in the abdominal area. It will begin to progress quickly, with itching and burning of the skin occurring, the concentration is especially felt on the extensor surfaces and the anterior abdominal wall. At the same time, the color of urine and feces changes sharply.

Characteristic symptoms

IN further symptoms Obstructive jaundice, in addition to yellowing of the skin and mucous membranes, manifests itself as follows:

1. 1. Biliary colic develops, which can be recognized by a sharp pain felt above the navel in the upper right part of the abdomen. Most often, pain can be felt simultaneously in the collarbone or scapula. They can often be triggered by too fatty or fried foods, alcohol, heavy physical activity, or bending forward.
2. 2. The liver is noticeably enlarged.
3. 3. The gallbladder is filled with bile, therefore it is also enlarged.
4. 4. Vomiting appears, most often bile, and nausea.
5. 5. Body temperature is increased.
6. 6. Body weight is lost.
7. 7. Weakness, fatigue, and dizziness occur.

At this time, cirrhosis may appear, in which nodes formed from fibrous tissue form in the liver. connective tissue, since hepatocytes are destroyed. Then liver failure occurs. Often, along with this type of jaundice, a tumor of the head of the pancreas is detected.

Complications due to obstructive jaundice arise because the body is poisoned by metabolic products: they are not excreted from the body as before, but return from the intestines to the blood. If toxins have crossed the blood-brain barrier, there is a high probability that, having penetrated the brain, the stage of hepatic encephalopathy will occur, when the central nervous system is affected.

Provided international classification diseases and jaundice, which occurs in newborns. It includes such a variety as neonatal. Its number is 59, which includes subsections related to various pathologies, for example, premature birth, thickening of bile, etc.

In newborns, conjugation jaundice is most often determined, which occurs due to the fact that the binding of indirect bilirubin in the liver with glucuronic acid is impaired. It was decided that the International Classification of Diseases No. 10 would not distinguish this species in any way.

Information: JAUNDICE - syndromes of various origins, characterized by icteric discoloration of the skin and mucous membranes. Jaundice (true) is a symptom complex characterized by icteric discoloration of the skin and mucous membranes, caused by the accumulation of bilirubin in the tissues and blood. Depending on the causes of hyperbilirubinemia, jaundice is divided into hemolytic (suprahepatic), parenchymal (hepatic) and mechanical (subhepatic). Hemolytic jaundice, see Diseases of the blood system. False jaundice (pseudojaundice) is an icteric discoloration of the skin (but not the mucous membranes!) due to the accumulation of carotenes in it during prolonged and abundant consumption of carrots, oranges, pumpkins, and also occurs when ingesting quinine, picric acid and some other drugs. Mechanical jaundice, see Surgical diseases. Parenchymal (hepatic) jaundice is true jaundice that occurs with various lesions of the liver parenchyma. Observed in severe forms viral hepatitis, icterohemorrhagic leptospirosis, poisoning with hepatotoxic poisons, sepsis, chronic aggressive hepatitis, etc. Due to damage to hepatocytes, their function of capturing free (indirect) bilirubin from the blood, binding it with glucuronic acid to form non-toxic water-soluble bilirubin glucuronide (direct) and release of the latter into the bile capillaries. As a result, the bilirubin content in the blood serum increases (up to 50-200 µmol/l, rarely more). However, not only the content of free but also bound bilirubin (bilirubin glucuronide) increases in the blood due to its reverse diffusion from the bile capillaries into the blood vessels during dystrophy and necrobiosis of liver cells. A icteric discoloration of the skin and mucous membranes occurs. Parenchymal jaundice is characterized by skin color - saffron-yellow, reddish ("red jaundice"). Initially, the icteric color appears on the sclera and soft palate, then the skin becomes colored. Parenchymal jaundice is accompanied by itching of the skin, but less pronounced than mechanical jaundice, since the affected liver produces less bile acids (the accumulation of which in the blood and tissues causes this symptom). With a long course of parenchymal jaundice, the skin may acquire, as with mechanical jaundice, a greenish tint (due to the conversion of bilirubin deposited in the skin into biliverdin, which has green). The content of aldolase and aminotransferases, especially alanine aminotransferase, usually increases, and other liver tests are changed. Urine acquires a dark color (the color of beer) due to the appearance of bound bilirubin and urobilin in it. Feces become discolored due to a decrease in the content of stercobilin in it. The ratio of the amount of stercobilin excreted in feces and urobilin bodies in urine (which is an important laboratory sign for differentiating jaundice), which is normally 10:1-20:1, is significantly reduced in case of hepatic cell jaundice, reaching 1:1 in severe lesions. The course depends on the nature of the liver damage and the duration of action of the damaging principle; in severe cases, liver failure may occur. Differential diagnosis includes hemolytic, mechanical and false jaundice; it is based on the anamnesis, clinical features of parenchymal jaundice and data laboratory research. Treatment. The underlying disease is treated.

Liver pathologies that are caused by partial or complete blockage of the bile ducts are quite common. Their symptoms are usually a yellow color of the skin and mucous membranes. This condition is called obstructive jaundice. We will consider its description, symptoms, signs and treatment in this article.

Causes

Previously, obstructive jaundice (ICD-10 code - K83.1) was perceived as an independent disease, but numerous studies have proven that it is only a symptom. It is caused by disturbances in the hepatobiliary tract and the formation of bile stones. In the registry - K83.1) obstruction of the bile ducts is called obstruction of the bile ducts. Its other names are subhepatic or

But cholangiocarcinoma is accompanied by this disease only when it reaches a large size.

Signs of the disease

The main sign of obstructive jaundice (ICD-10 code has already been indicated earlier) is the yellowing of all tissues in the body, including the whites of the eyes and mucous membranes. This phenomenon is caused by an increased concentration of bilirubin. Its other signs are:

• Biliary colic. Characterized by sudden attacks pain syndrome in the upper right side of the abdomen. The pain radiates to the right shoulder, scapula or collarbone and is usually caused by physical activity, eating fried or fatty foods, as well as eating alcoholic drinks.
• Enlarged liver, or hepatomegaly.
• Increased body temperature.
• Nausea and vomiting of bile.
• Itching on the skin.
• Light-colored stool and darkened urine.

Symptoms

Jaundice may also occur as a consequence of another disease that invariably accompanies cholestasis. The symptoms are:

1. Dyspeptic syndrome, which is characterized by nausea and heaviness in the epigastric region.
2. Courvoisier's symptom, when an enlargement of the gallbladder is obvious even on palpation due to its overcrowding with bile. There is no pain upon palpation.
3. Abnormal weight loss.

Chronic form

In its chronic form, obstructive jaundice causes concern in the right side, in the hypochondrium area. The pain is aching and dull, aggravated by vibration, bending and lifting heavy objects.

Nausea with jaundice is constant, worsening after taking fatty foods and alcoholic drinks. In addition, this condition is characterized by weakness, fatigue and dizziness, which are signs of asthenic syndrome.

Complications

Regardless of what causes disruptions in the process of bile outflow, this can cause cirrhosis. This disease is characterized by the formation of nodes in the liver, which consist of connective tissue fibrous tissue. This pathology develops as a result of the death of active hepatocytes. In the future, cirrhosis risks developing into liver failure and dysfunction.

Another complication of unspecified obstructive jaundice (ICD diagnosis code - R17) is intoxication with metabolic products that are not properly excreted from the body, being absorbed from the intestines into the bloodstream. This disease is called toxemia. The tissues of the kidneys and liver are primarily affected, which ultimately leads to failure of these organs.

When toxins penetrate the brain, hepatic encephalopathy occurs, which typically affects the entire nervous systems s. This occurs as a consequence of disruption of the blood-brain barrier.

Cholecystitis, cholangitis and other bacterial infections can also accompany obstructive jaundice. Lack of timely therapy and generalization of the process can create a risk of septic shock.

Note that different types Jaundice has similar symptoms, which can complicate diagnosis. Thus, hemolytic jaundice is characterized by increased breakdown of red blood cells and excessive production of hemoglobin, which is transformed into bilirubin. And it is characterized by an inflammatory process in the liver tissues.

During diagnosis, in addition to external signs, special attention is paid to the results of the studies, and specifically to bilirubin fractions (direct or indirect) and enzyme levels.

Jaundice of newborns

The ICD-10 code - P59 - denotes an unspecified disease that affects newborns. It can be physiological and pathological. The first of them appears in the first week of the baby’s life and after some time goes away on its own. But sometimes it can be a symptom of some underlying disease.

In newborns, the metabolic process of the bilirubin enzyme may be disrupted. This leads to pathological pigmentation of the mucous membranes and skin.

If the jaundice is of a physiological form, then this does not affect the child’s well-being, appetite, sleep and wakefulness. In the case of a pathological form of the disease, the clinical picture is complemented by the following symptoms:

1. The baby develops significant yellowing of the skin and sclera.
2. He is drowsy and in a lethargic state.
3. Refuses to feed.
4. Body temperature is increased.
5. She often cries, throwing her head back and arching her body.
6. There is profuse vomiting.
7. Cramps.

We will look at how obstructive jaundice is treated below.

Diagnostics

The instrumental and laboratory methods research in the diagnosis of obstructive jaundice, the ICD-10 code of which is indicated in the article. After all, only they can help find out real reasons development of the named syndrome. The prognosis for recovery depends on the timely placement of the patient in the surgical department. To identify the causes of obstructive jaundice, the following diagnostic methods are used:

• General blood test. If anemia is detected, which is characterized by a decrease in the level of hemoglobin and red blood cells, this indicates chronic form diseases. An increase in ESR and leukocytosis indicates the presence of an inflammatory process.
• Blood test for biochemistry. In this case, attention is paid to an abnormal increase in the level of ALT, AST, gamma-glutamyltransferase, alkaline phosphatase, cholesterol, etc. This type of study also reveals the advantage of the direct bilirubin fraction over the indirect one.
• Computed tomography and organ examination abdominal cavity Using ultrasound, they help determine the size and structure of the gallbladder and liver, detect the presence of gallstones and assess blood flow and the level of cholestasis.

• Esophagogastroduodenoscopy. Is an examination of organs gastrointestinal tract through an endoscope. The latter is a flexible optical tube and helps to detect existing pathology.
• Magnetic resonance cholangiopancreatography. It is performed by injecting a contrast fluid, which allows visualization of the bile ducts.
• Scintigraphy. During the study, radiopharmaceuticals are distributed into tissues, which are controlled according to established time parameters.
• Laparoscopy and biopsy. Collecting material from the tumor for further research and cytology.

Obstructive jaundice: prognosis and treatment

What this is is discussed earlier. Now it’s worth learning about methods of treating the disease. The presence of obstructive jaundice requires immediate medical intervention, regardless of whether it manifests itself in a child or an adult patient. The first goal of therapy is to eliminate bile stagnation. This is achieved by using drug treatment the following drugs:

• hepatoprotectors, which include vitamins from group B, ursodeoxycholic acid, Hepabene, Essentiale, Silymarin, etc.;
• the drug "Pentoxyl", which helps stimulate metabolic processes;
• amino acids such as methionine and glutamic acid;
• hormonal drugs, including Prednisolone;
• medicines "Neorondex", "Reosorbilakt" and "Reopoliglyukin", which stimulate blood circulation in the liver.

If a secondary is added infectious disease, antibacterial therapy is carried out with drugs such as Imipenem, Ampicillin, etc.

Operation

Patients diagnosed with cholestasis often require surgery. But icteric syndrome is a contraindication for such measures, since this is considered a great risk to the life and health of the patient. Therefore on initial stage disease, the pressure in the bile ducts is reduced by the endoscopic method. Lithotripsy is also allowed.

Subsequent steps are to install a stent or anastomoses. These measures are aimed at expanding the bile duct and draining the accumulated substance.

Complete removal of the gallbladder is prescribed to patients who have been diagnosed with calculous cholecystitis in chronic or acute form. This surgical intervention does not leave its mark on the condition of the body. Complications after surgery may include vomiting, nausea, and pain on the right side. In this case, it is recommended to maintain a sleep and work schedule, adhere to proper nutrition and take antispasmodic drugs and hepatoprotectors. Sometimes therapy with enzyme preparations, for example Pancreatin, may be prescribed.

Diet

Absolutely everyone who has suffered obstructive jaundice is advised to follow certain dietary principles, avoid fried, fatty and spicy foods, and drink alcoholic beverages. You need to eat fractionally, in small portions. Intense loads should be avoided. Treatment of obstructive jaundice is a complex and lengthy process, in which the main thing is patience and compliance with all specialist advice.

We hope that the information presented in the article about obstructive jaundice, treatment, diagnosis and causes of this disease will be useful to you.

Conjugation jaundice in newborns is a fairly common phenomenon.

Its occurrence is due to the fact that The child’s enzymatic system is not yet fully developed, in particular, in the newborn’s body there is an insufficient amount of the enzyme - bilirubin (or this element is not formed correctly).

There are physiological and pathological forms. With physiological conjugation jaundice, its manifestations occur in the first week of a child's life.

Over time, the disease goes away on its own. In some cases, conjugation jaundice acts as a symptom of any concomitant disease.

How dangerous is the pathology?

In some cases, conjugation jaundice develops rapidly, while there is risk of developing brain diseases, damage to certain areas of it.

This can lead to loss of hearing, vision, and, in especially severe cases, to the death of the child.

Diagnostics

When making a diagnosis, assessing the clinical picture of the disease is important. However, to differentiate the types of jaundice A number of laboratory tests will be required, such as:

Treatment methods

There are several therapeutic methods that allow normalize the condition of the newborn child.

The choice of one method or another is made by the doctor, based on the form of the pathology, general condition the body of a small patient, the reasons that contributed to the development of the disease.

First of all, it is necessary to eliminate the unfavorable factors that caused conjugation jaundice. Today, the following treatment methods are used:

Forecast

The course of the disease depends, first of all, on its form. Thus, physiological conjugation jaundice has a favorable course, and, 7-10 days after occurrence, it goes away on its own.

Other forms of the disease have different prognoses. For example, the pathology caused by Gilbert's syndrome also has a favorable course.

Other forms may be complicated by the development of kernicterus. This condition is considered very dangerous, the prognosis here depends on how timely qualified assistance was provided.

Is it possible to prevent development?

It is possible to prevent the accumulation of bilirubin in the child’s body if put the baby to the breast as often as possible.

Set up the process breastfeeding It is necessary as early as possible, when the woman is still producing colostrum instead of milk.

Colostrum is considered good natural laxative, promotes the passage of the baby’s original feces, and along with meconium, bilirubin is also removed from the baby’s body.

Conjugation jaundice is a common phenomenon in children in the first days of life. In this case, the disease may have various shapes currents. The clinical picture depends on this.

The physiological form has a favorable course, does not require specialized treatment. In the pathological form, serious complications may develop that threaten the life and health of the child.

Therefore, treatment must be started as soon as possible. The best way prevention possible problems– breastfeeding.

With my experience in the treatment of prolonged conjugation jaundice A young mother will share with you in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

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Obstructive jaundice and purulent cholangitis are considered together in this chapter, since their occurrence is due to similar reasons, they often occur simultaneously and the methods of their treatment are largely similar.

Obstructive jaundice

Jaundice is a syndrome characterized by icteric staining of the skin, mucous membranes and sclera, caused by increased accumulation of bilirubin in the blood serum, as well as in other fluids and tissues of the body. Obstructive jaundice is caused by a violation of the flow of bile into the duodenum due to pathological processes that can occur at various levels of the bile ducts. Despite the variety of diseases leading to the development of obstructive jaundice, the main pathophysiological links of the syndrome are similar, which allows one to be guided by a single diagnostic and treatment tactic, regardless of the causes of its occurrence.

ICD-10 CODE
K83.1. Blockage of the bile duct.

Epidemiology

GSD is the most common cause of obstructive jaundice. In elderly and senile women it is detected gallstones in about 20% of cases. Among men, the prevalence of cholelithiasis is 2-3 times lower. Choledocholithiasis occurs in 8-20% of patients with cholelithiasis. In 60-70% of cases of choledocholithiasis, obstructive jaundice of varying severity develops.

Prevention

Prevention of obstructive jaundice and its complications consists of timely diagnosis of choledocholithiasis and its elimination (minimally invasive or surgical). In the absence of jaundice, traditional ultrasound can detect choledocholithiasis in no more than 30% of patients.

Screening

Multifactorial analysis of clinical, laboratory and instrumental data allowed us to identify several indicators that allow us to reasonably suspect the presence of choledocholithiasis and continue to search for it using invasive research methods. These include dilation of the extrahepatic bile ducts (more than 8 mm) according to ultrasound, clinical signs of cholangitis, increased levels of aminotransferases and the direct fraction of bilirubin in the blood serum, small stones in the gall bladder (less than 5 mm). It is also recommended to evaluate anamnestic data (the presence of episodes of jaundice, exacerbations of chronic cholecystitis or pancreatitis).

Pathogenesis

Under physiological conditions, the liver secretes up to 250 mg of the bile pigment bilirubin into the bile during the day. It is formed in the cells of the reticuloendothelial system from the released hemoglobin of mature red blood cells. The scheme of biochemical transformations of bilirubin is presented in Fig. 45-1.

Rice. 45-1. Biochemical transformations of bilirubin (scheme).

When the level of bilirubin in the blood serum increases to more than 40 µmol/l, the sclera, mucous membranes and skin become icteric. Bilirubin penetrates almost all fluids and white parts of the body tissues, causing yellow coloration of exudates and transudates, secretions of various glands (pancreas, salivary, sweat, etc.). In patients with anemia and fair skin, jaundice is detected earlier, while in dark-skinned patients it goes undetected longer.

Obstructive jaundice syndrome should be considered as a complex pathophysiological complex, manifested by signs of damage to all organs and systems, mainly the liver and kidneys. With obstruction of the biliary tract, as the duration and intensity of jaundice increases, all homeostasis systems undergo increasing pathological changes. In extrahepatic cholestasis, direct bilirubin returns to the blood and lymph from the small intrahepatic bile ducts. As cholestasis progresses, a change in the polarity of hepatocytes occurs, as a result of which the complex of bilirubin with glucuronic acid begins to be excreted through the blood vessels, which leads to an increase in the content of direct bilirubin in the blood.

As pressure increases in the bile capillaries, microcirculation and blood supply to liver cells are disrupted, and the membranes of the bile ducts and hepatocytes are damaged. Thus, there is a progressive disruption of the synthetic and metabolic functions of the liver and, as a consequence, the composition of the plasma and the rheological properties of the blood. The severity of clinical manifestations in patients with obstructive jaundice is determined by profound disorders of the liver, kidneys, cardiovascular and nervous systems, as well as disorders of the blood coagulation system and metabolism.

Jaundice is the leading symptom only in initial stages disease, reflecting the resulting disturbances in the outflow of the biliary tract. As the intensity of jaundice increases and its duration increases, functional and morphological changes in all body systems gradually intensify. At a certain stage of development, jaundice ceases to be only a symptom; it becomes an independent leading factor, which has its own pathophysiological and clinical characteristics and determining the severity of the patient’s condition and the prognosis of the disease.

The duration of obstructive jaundice and its intensity largely determine the development of liver failure and deaths (including postoperative). The accumulation of toxic metabolic products in the blood serum (bilirubin, bile acids, ammonia, etc.) leads to endotoxemia, the severity of which is associated with the duration of the disease, therefore early diagnosis of the cause of jaundice and decompression of the bile ducts largely determine the outcome of the disease.

Clinical picture

Clinical symptoms that are considered typical manifestations of jaundice are presented in Fig. 45-2. Clinical picture depends on the severity, duration and nature of jaundice.

Rice. 45-2. Clinical manifestations obstructive jaundice.

Obstructive jaundice, caused by choledocholithiasis (up to 80% of cases), appears several hours or days after a severe attack of pain in the abdomen. Characterized by rapid progression. The development of jaundice is accompanied by skin itching. Scratching occurs predominantly on the anterior abdominal wall and extensor surfaces of the limbs. Patients pay attention to darkening of urine and the appearance of discolored feces.

Obstructive jaundice caused by a tumor of the head of the pancreas or the major duodenal papilla is characterized by the absence of pain and the gradual development of the disease. Courvoisier's syndrome is considered pathognomonic, which manifests itself as a palpable, enlarged, painless gallbladder against the background of jaundice.

Diagnostics

The diagnostic search for obstructive jaundice consists of confirming its obstructive nature and determining the immediate cause of obstruction of the biliary tract. On outpatient stage Up to 20% of diagnostic errors occur, leading to hospitalization of patients in non-core medical institutions. Patients with obstructive jaundice are often initially hospitalized in infectious diseases departments; somewhat less often, patients with hepatitis of various natures or other types of jaundice of non-surgical origin are admitted to surgical hospitals. In both cases, erroneous hospitalization has negative consequences associated with the choice of incorrect management tactics, violations of the anti-epidemic regime, delays in the implementation of bile duct decompression, etc.

S.T. Shapovalyants