Obstructive jaundice according to ICD 10. Treatment methods for conjugation jaundice in newborns

Giant cell hepatitis of the fetus or newborn

(Idiopathic) fetal or neonatal hepatitis

Excludes: congenital viral hepatitis (P35.3)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Obstructive jaundice ICD code 10

We invite you to read the article on the topic: “Obstructive jaundice code according to ICD 10” on our website dedicated to liver treatment.

Excluded: caused by inborn errors of metabolism (

Neonatal jaundice associated with preterm delivery

Hyperbilirubinemia of prematurity Neonatal jaundice due to delayed bilirubin conjugation associated with preterm delivery

Bile thickening syndrome

Neonatal jaundice due to other and unspecified liver cell damage

Excluded: congenital viral hepatitis (

Neonatal jaundice due to lactation inhibitors

Neonatal jaundice due to other specified causes

Neonatal jaundice, unspecified

Physiological jaundice (severe) NOS

If obstruction of the common bile duct increases gradually, over several weeks or months, the patient experiences jaundice and itching without biliary colic or symptoms of cholangitis. Painless jaundice occurs with choledocholithiasis, but it is much more common with malignant tumors of the head of the pancreas, malignant tumors of the bile ducts, and malignant tumors of the papilla of Vater. Patients whose bile duct obstruction is caused by choledocholithiasis often suffer from chronic calculous cholecystitis, and therefore the ability of the gallbladder to stretch is significantly limited. This feature underlies Courvoisier's rule: a palpable enlarged gallbladder indicates a malignant tumor rather than cholelithiasis.

Obstruction of the common bile duct leads to dilation of the intrahepatic bile ducts due to increased bile pressure. The secretion of bile by the liver is suppressed, and the release of direct bilirubin into the blood leads to jaundice, darkening of urine (bilirubinuria) and discoloration of feces (acholic feces).

Common bile duct stones should be suspected in every patient with cholecystitis if the serum bilirubin level exceeds 85.5 μmol/L (5 mg%). The maximum serum bilirubin level in choledocholithiasis rarely exceeds 256 μmol/L (15 mg%) unless there is concomitant liver damage or another additional cause of bilirubinemia. A bilirubin level exceeding 342 µmol/l (20 mg%) makes one suspect a malignant tumor. With bile duct obstruction, serum ALP activity is almost always increased. An increase in alkaline phosphatase activity often precedes the appearance of jaundice and may be the only abnormality in the study of biochemical indicators of liver function. It is also possible to increase the activity of serum aminotransferases by 2-10 times, especially with acute obstruction of the bile ducts. After eliminating the obstruction, aminotransferase activity normalizes quite quickly, while the bilirubin level decreases to normal within 1-2 weeks. Following bilirubin, alkaline phosphatase activity normalizes.

See Obstructive jaundice

Lung cancer: clinical picture Pancreatic cancer: clinical picture Acute viral hepatitis: differential diagnosis Study of the biliary tract: endoscopic cholangiopancreatography Endoscopic papillosphincterotomy Liver transplantation: hepatic complications Absorption disorders in diseases of the liver and biliary tract Hemobilia

Conjugation jaundice: description, symptoms, treatment, ICD code. Conjugation jaundice of newborns

With the birth of a child, a whole world opens up for a young mother. The first joys and excitement, anxiety and delight. Your baby will need a lot of time before he becomes big and strong, but for now he is completely dependent on you. Don't be shy about asking your pediatrician questions, as they can tell you so much about your child's development. In addition to following the regime, eating and walking, he will definitely advise you about such a phenomenon as conjugation jaundice. Don’t be alarmed, this is not hepatitis at all, but a normal, physiological phenomenon that almost every mother is familiar with.

general description

In the first days, the baby’s body has not yet completely adjusted to the new conditions. In this regard, the baby develops various ailments. The most important change is diet. Just yesterday, all nutrients were supplied to him through the umbilical cord, but today he needs to start eating on his own. At the same time, the intestines must start working and absorb everything that enters the body.

The digestive system is one of the most complex in our body, so failures are most often observed here. The immaturity of the liver and enzymatic system leads to the fact that the metabolic processes of bilirubin are slow. The pigment that colors the skin is formed in the body after the breakdown of hemoglobin. If it was not possible to remove it in time, then accumulation occurs in the soft tissues. Conjugation jaundice develops. It occurs in most children and normally goes away without any consequences. In just two weeks the baby will become fair again.

How to find out

As a rule, this disorder develops quite early, on the second day of life. Conjugation jaundice is not a disease, but simply an external symptom, which indicates changes occurring in the body. Normally, this condition goes away without any intervention. The symptoms, as they say, are obvious. The mucous membranes, whites of the eyes and skin acquire a yellowish tint. But for now this is not a pathology, but a variant of the norm.

Alarming symptoms

Conjugation jaundice goes away on its own on days 7-10 of life. In this case, we can say that it does not pose any danger to the baby. But if by the middle of the second week of life the characteristic skin tone still remains, then be sure to notify your pediatrician. It is essential to evaluate for additional signs. This is a change in the color of feces and urine, drowsiness and vomiting, throwing back the head, convulsions. Parents tend to underestimate the seriousness of the situation and delay treatment, which is a big mistake.

Any of these symptoms, along with yellowing of the skin, is a reason to visit a doctor. Pathological forms of jaundice, nuclear and hemolytic, pose a great danger to the baby’s body. Both of these forms are characterized by the accumulation of bilirubin in the body. Therefore, it is extremely important to establish the cause of conjugation jaundice. You cannot do this on your own, so be sure to seek professional advice from a doctor. And the neonatal, physiological form of jaundice does not require hospitalization. The only thing that doctors recommend not to ignore is regular testing. Controlling bilirubin in the blood helps prevent the situation from worsening.

Why did the child turn yellow? A variant of the norm?

This question cannot but be of interest. If the baby was born full-term, all organs and systems must function correctly. Why then do doctors write: “liver immaturity”? And if this is a problem for every newborn child, then why was the neighbor’s boy or girl normally discharged from the maternity hospital, without any yellowing or recommendations?

In fact, it is difficult to answer this question unambiguously. However, it is known that the appearance of jaundice is influenced by many factors:

Maternal nutrition during pregnancy.
Deterioration of the mother's health during pregnancy, especially if this was accompanied by the use of antibiotics.
Bad habits of the expectant mother.
Iodine deficiency in the body of a pregnant woman.
Unfavorable state of the environment.
Taking medications during pregnancy and childbirth.

Pathological forms of jaundice

If a child develops physiological, conjugative jaundice, the concentration of bilirubin in the blood will be 171 IU or higher. Although the indicator is high, it does not represent anything terrible. We have already said that this is a normal condition for a newborn. Why are pathological forms of the disease that require immediate intervention diagnosed? There are quite a lot of reasons:

Asphyxia.
Diseases of the endocrine system.
Taking medications.
Low activity of the enzyme that breaks down bilirubin.
Liver immaturity.
Hyperbilirubinemia.

Risk group

Conjugation jaundice (ICD-10) quite often develops in babies whose mothers have diabetes. This also includes premature babies. In this case, their condition is associated solely with the immaturity of the liver and enzymatic systems. This is dangerous because with excessive concentrations of bilirubin, brain structures are affected. This can lead to neurological problems or even death!

Doctors regularly keep statistics according to which most often conjugation jaundice (ICD code - 10) occurs in newborns from Asian countries. And boys are much more susceptible to the disease than girls. A large percentage of infants who have jaundice are observed in peoples who live in mountainous areas, for which no explanation has yet been found.

Which doctor should I contact?

First of all, you should go for a consultation with your local pediatrician. He, like no one else, knows what conjugation jaundice in newborns is, its causes, and the main directions of therapy. This is not surprising, because this condition is typical for almost every newborn. It is best if it is a pediatric neonatologist. They work in maternity hospitals and deal exclusively with newborns. After the initial examination, the doctor may recommend treatment from specialists with a more specialized profile. These are infectious disease specialists, hematologists, gastroenterologists, and hepatologists.

Surveys

Even the most experienced doctor will not be able to prescribe treatment for conjugation jaundice without examining the newborn’s body. This will require taking an anamnesis. Parents should write down when they first noticed symptoms and how the condition changed later. Sometimes it is difficult for a young mother to assess for herself what is happening to her baby. She thinks that the baby was simply born “dark.” For this purpose, there is a visiting nurse who regularly comes home for up to a month and advises the mother.

In addition, to make a final diagnosis, it is necessary to undergo tests. This is blood and urine. Typically, blood is collected exclusively on an empty stomach. The doctor will ask you not to give your child anything other than water after 10 p.m. Blood is donated in the morning. In addition, an ultrasound of the pelvic organs is recommended.

Treatment of the disease

In some cases, there is no need to treat jaundice in newborns. The main thing is that there are no pathological symptoms described above. In the maternity hospital, pediatricians monitor the baby and, if necessary, take a blood test for bilirubin. After discharge, parents themselves must monitor the degree of yellowing of the baby’s skin and his general condition.

Typically, treatment of jaundice is usually accompanied by the following recommendations: drinking plenty of fluids, sunbathing and a 5% glucose solution. Often this becomes enough, the yellowness gradually disappears and the skin returns to its normal color.

Use of medications

Further treatment of conjugation jaundice in newborns involves the use of special medications. In this case, the course of treatment and dosage must be prescribed by the attending physician. Self-prescription of drugs is unacceptable!

Complex treatment includes UV irradiation, drinking regimen, diet therapy, intramuscular administration of glucose, as well as taking hepaprotectors, such as Ursosan. Before prescribing any of these drugs, it is necessary to evaluate the test results so that an individual treatment regimen can be selected. This disease occurs differently in each specific case. In the case of physiological jaundice, the symptoms will go away on their own during the day of the child’s life. The maximum that is required is to drink the baby with clean water and take it out into the sun. If treatment does not help, and the jaundice only worsens, then doctors may reconsider the treatment regimen.

Danger of disease

Yellowing of the skin is just the tip of the iceberg. The main thing is that bilirubin is poison for the baby’s body. And accumulating in large quantities, it can seriously affect its further development. This topic is of interest to all caring parents who are wondering why conjugation jaundice is dangerous in newborns. It is really necessary to know the causes and consequences, since this is the only opportunity to notice the problem in time and provide the necessary help.

However, there is no need to panic. If a child begins to develop jaundice, this does not mean that he has every chance of complications. They depend on the form, type of jaundice and timely medical care provided. If you delay in seeing a doctor, the following serious consequences may occur:

Toxic poisoning.
Reduced albumin production.
Toxic substances that enter the brain can cause impaired vision and hearing, retarded mental development, DCA, and paralysis.
The risk of developing cirrhosis or liver cancer increases.
Development of liver pathologies.

Once again, I would like to emphasize that this does not apply to every case when conjugation jaundice develops in newborns. Consequences can only appear if pathological jaundice occurs. Physiological does not affect the development of the baby in any way.

Instead of a conclusion

If your baby was born in the summer, then most likely he will not develop jaundice. Mom only needs to give the baby clean water and regularly place him in the sun. About three times a day for minutes will be enough. If symptoms do not go away on the 10th day, then you need to contact your pediatrician for a prescription and undergo an examination. Only based on the tests will it be possible to say what treatment the baby should receive. All this time, the mother needs to follow a gentle diet, not eat a lot of fatty and sweet foods, so as not to create a burden on the child’s liver.

What is conjugation jaundice: ICD 10 codes and hypothyroidism

Bilirubin is one of the main bile components, which is a product of hemoglobin metabolism. It circulates in the blood in two fractions: direct and indirect. Direct bilirubin (conjugated or bound) is not toxic. It is due to this that the skin can acquire a yellow tint, which is a characteristic sign of a number of diseases.

Indirect or free bilirubin is considered the most toxic, as it can cause disruption of cell function. An increase in the level of indirect bilirubin fraction (hyperbilirubinemia) can cause conjugation jaundice, which will be discussed in today’s article.

Conjugation jaundice - what is it?

Conjugation jaundice is one of the types of jaundice that occurs due to improper production of indirect bilirubin. Often a similar phenomenon can be observed in children during the newborn period, but it does not bypass adults either.

You can compare them with other types of jaundice by reading about them in separate materials:

What causes conjugation jaundice?

The appearance of jaundice is associated with a failure in the combination of indirect bilirubin with glucoronic acid, due to which its transition to the direct fraction does not occur. The reason may be:

Prematurity of the baby;
Lack of oxygen (hypoxia) during pregnancy;
Injuries during childbirth;
Enzyme deficiency and congenital liver pathologies (Gilbert syndrome, Crigler-Najjar disease, Lucey-Driscol syndrome);
Congenital hypothyroidism (ICD code 10 E03) and other diseases of the endocrine system;
Taking certain medications.

Types of conjugation jaundice

Conjugation jaundice can have several types:

Physiological jaundice in newborns

Conjugation jaundice of newborns is observed in every second child, even completely healthy ones. The first symptoms begin to appear approximately on the 2nd day after birth and disappear in the third week of life.

This type of jaundice is a response to some changes in the body. It begins to develop due to the dysfunctional functioning of liver enzyme systems, due to which the metabolism of bilirubin slows down. The bile component accumulates in the blood, which explains the yellowing of the skin. Other alarming symptoms usually do not bother the child.

Physiological jaundice in premature infants

Jaundice in children born prematurely is more severe than in full-term ones. Coloring of the skin usually occurs on days 5-6 and persists for a month.

A high level of bilirubin in the blood of a small child (laboratory values reach 171 μmol/L or higher) can cause kernicterus, a dangerous condition that can lead to brain damage. In addition to the pronounced coloration, the child feels a general malaise, sucks sluggishly, and convulsions may appear. This condition requires emergency help.

Hereditary jaundice

There are three types of hereditary jaundice:

Gilbert's syndrome (ICD-10 code E80.4) is characterized by a genetic disorder in the formation of liver enzymes. With proper treatment, a favorable prognosis is guaranteed.
Crigler-Najjar syndrome is characterized by a deficiency of the enzyme responsible for the conversion of bilirubin. It can lead to the development of kernicterus, therefore it is a dangerous condition that requires qualified treatment.
In Lucey-Driscol disease, jaundice occurs due to a deficiency of liver enzymes; this condition is temporary. If detected early, severe consequences can be avoided.

Jaundice in breastfed children

Breast milk jaundice or, as it is also called, Aries syndrome (pregnane jaundice) is characterized by an increase in bilirubin in the baby’s blood due to a reaction to certain components of mother’s milk. This condition does not require stopping breastfeeding and is temporary.

Drug-induced jaundice

Some medications can cause an increase in bilirubin. Such medications include sulfonamides, levomecithin, vitamin K. When the drugs that provoke jaundice are discontinued, all its manifestations go away.

Pathological jaundice

This form of jaundice is caused by various disorders in the functioning of body systems, including the endocrine one. Pathological jaundice is divided into: mechanical, hemolytic and parenchymal. If physiological jaundice can go away on its own, then the pathological form without treatment can cause complications.

Diagnosis and treatment

Jaundice requires timely diagnosis and differentiation. If physiological jaundice is characterized only by a change in skin color, then with pathological jaundice a person may experience lethargy, cramps, nausea with vomiting and fever.

If a pathological form is suspected, the doctor must prescribe a series of laboratory tests (general analysis of urine and blood, biochemical blood test) and instrumental studies (ultrasound). An increase in bilirubin levels is detected by examining blood and stool.

Treatment for jaundice may vary depending on the form and cause of its occurrence. The goal of therapy is to activate the full functioning of the liver. The treatment regimen and duration of procedures are determined by the doctor. To combat jaundice use:

Phototherapy;
Infusion therapy
Taking barbiturates and hormonal drugs;
Blood transfusion.

Particular attention should be paid to feeding children suffering from jaundice. Breastfeeding should not be stopped; on the contrary, the child needs to eat at least 7 times a day. After discharge from the maternity hospital, the child's condition must be monitored. In most cases, conjugation jaundice disappears by the 3rd week of life; if the skin color has become more pronounced, or the child has become lethargic and sleepy, then it is necessary to seek help from a doctor as soon as possible.

Obstructive jaundice

K83.1. Blockage of the bile duct.

Epidemiology

Prevention

Screening

Classification

Stenosis of the major duodenal papilla;

Polyps of the major duodenal papilla;

Cicatricial stricture of the main bile ducts;

Malignant neoplasms (20%):

Greater duodenal papilla;

Liver (primary or metastatic lesion).

The nature of the course of jaundice:

Etiology

Pathogenesis

Clinical picture

Diagnostics

In recent years, in parallel with the increase in the incidence of cholecystitis, the number of operations on the biliary tract has increased, and the frequency of complications has also increased.

During operations for acute cholecystitis and its complications, multicomponent endotracheal anesthesia is used. General anesthesia with the use of muscle relaxants can reduce the duration of the operation, facilitates intervention on the extrahepatic bile ducts, and is one of the factors of Prof.

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Treatment methods for conjugation jaundice in newborns

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.

Concept and characteristics

In newborns, a condition such as a violation of the metabolic process of the bilirubin enzyme is often observed, when indirect bilirubin is not completely converted into a direct element.

In this case, pathological pigmentation of the skin and mucous membranes occurs (they acquire a yellowish tint). This condition is commonly called conjugation jaundice of newborns.

With cephalohematoma

Childbirth is a difficult process not only for the expectant mother, but also for the fetus. Disturbances and disruptions during childbirth can lead to birth trauma for the newborn.

One such injury is the formation of a cephalohematoma, an accumulation of blood in the area between the cranial bone (one or more of its sections) and the periosteum.

This pathology requires treatment, which is carried out by puncture. During such treatment, it is possible to develop a concomitant phenomenon - conjugation jaundice.

Causes

The occurrence and development of the disease can be caused by such unfavorable factors and diseases as:

Gilbert's syndrome is a pathology in which a child has a deficiency of liver enzymes.

Crigler-Nayjar syndrome is a disease associated with the absence or insufficient activity of liver enzymes necessary for binding bilirubin. In this situation, other concomitant diseases, for example, encephalopathy, may develop.

Lucy-Driscoll syndrome is a pathology in which there is a temporary decrease in the enzymatic function of the liver. The disease in this case is severe, its symptoms develop rapidly. Possible brain damage. Moreover, after recovery, relapses of the pathology are impossible.

Asphyxia that occurs during a complicated birth process. In this case, the child has hyperbilirubinemia, liver function is impaired, and there is a risk of developing kernicterus.

Diseases of the endocrine system, for example, hypothyroidism.

Excess vitamin K.

The use of certain medications based on chloramphenicol and salicylic acid.

Read about the symptoms and treatment of vesiculopustulosis in newborns here.

Types and forms

There are such forms of the disease as:

physiological. Develops in the first days after the birth of a child. It occurs due to imperfect development of the baby’s enzymatic system. Usually this condition goes away on its own within 7-10 days. No specific treatment is required;

jaundice of a premature baby. In children born prematurely, there is a gradual accumulation of bilirubin in the body. When its content is elevated, symptoms of pathology appear. The disease can have a physiological form, but there are cases of the development of a complicated form. With a significant increase in bilirubin levels, kernicterus develops, that is, the pathology leads to damage to the subcortical structures of the brain. And this is fraught with certain negative consequences, such as impaired vision or hearing, death of brain cells, death;

hereditary form. In this case, the child experiences such abnormalities as insufficient levels or decreased activity of liver enzymes responsible for binding bilirubin. The course in most cases is favorable, the risk of developing kernicterus is minimal;

jaundice during breastfeeding. It is considered a very rare occurrence. It develops due to the inability of the baby’s body to absorb the components of mother’s milk, and the occurrence of a pathological reaction to their entry into the child’s body.

The solution in this situation is to stop breastfeeding and transfer the baby to artificial milk formula.

The pathological form of the disease, in turn, is divided into several types, among which are:

mechanical type. Occurs as a result of abnormal development of the biliary tract. At the same time, the process of bile distribution is disrupted, which contributes to an increase in bilirubin levels;
hemolytic. Jaundice develops as a result of a high rate of destruction of red blood cells and hemoglobin;
parenchymatous. Jaundice occurs as a consequence of liver diseases, which can also develop in a child during the prenatal period of his life.

Symptoms and signs

Depending on the form of conjugation jaundice, its manifestations may be different.

A common symptom is a change in color (yellowing) of the skin and whites of the eyes.

However, with the physiological form, the child’s well-being, appetite, sleep and wakefulness are not disturbed. In the pathological form of the disease, the clinical picture is supplemented by such symptoms as:

Significant yellowness of the skin and sclera.
Drowsiness, lethargy.
Refusal to feed.
Hyperthermia.
Frequent and loud crying, accompanied by throwing back the head and arching of the body.
Profuse vomiting.
Cramps.

What is used to prevent gonoblennorrhea in newborns? Find out about this from our article.

How dangerous is the pathology?

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

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:

general blood, stool, urine tests;

blood test to determine the resistance of red blood cells;

analysis to determine bilirubin content;

analysis to determine the concentration of protein in the blood;

Ultrasound of the liver, spleen, gall bladder.

Treatment methods

There are several therapeutic methods to normalize the condition of a newborn baby.

The choice of one method or another is made by the doctor, based on the form of the pathology, the general condition of the little patient’s body, and 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:

Phototherapy. The method involves influencing the child’s body using a special UV lamp. UV rays stimulate the process of converting bilirubin into other enzyme elements that are better absorbed by the body. The duration of the procedure and the duration of the course of treatment are determined by the doctor on an individual basis.
Diet therapy. Often, the consumption of breast milk (except in cases where its enzymes are not absorbed by the child’s body) promotes better removal of bilirubin from the body, resulting in a decrease in its content.

If breastfeeding is impossible, the child is prescribed infusion therapy. This method involves intravenous administration of saline and glucose solution to the child. This also promotes better removal of bilirubin from the body.

Taking medications - barbiturates. The action of the drug is aimed at normalizing metabolic processes and stimulating the production of enzymes that bind bilirubin.

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 its 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 baby's body if you put the baby to the breast as often as possible.

It is necessary to establish the process of breastfeeding as early as possible, when a woman still produces colostrum instead of milk.

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

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

The physiological form has a favorable course and 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 to prevent possible problems is breastfeeding.

A young mother will share her experience in the treatment of prolonged conjugative jaundice with you in this video.

With the birth of a child, a whole world opens up for a young mother. The first joys and worries, anxieties and delights... Your baby will need a lot of time before he becomes big and strong, but for now he is completely dependent on you. Don't be shy about asking your pediatrician questions, as they can tell you so much about your child's development. In addition to following the regime, eating and walking, he will definitely advise you about such a phenomenon as conjugation jaundice. Don’t be alarmed, this is not hepatitis at all, but a normal, physiological phenomenon that almost every mother is familiar with.

general description

In the first days, the baby’s body has not yet completely adjusted to the new conditions. In this regard, the baby develops various ailments. The most important change is the diet. Just yesterday, all nutrients were supplied to him through the umbilical cord, but today he needs to start eating on his own. At the same time, the intestines must start working and absorb everything that enters the body.

How to find out

Alarming symptoms

Why did the child turn yellow? A variant of the norm?

In fact, it is difficult to answer this question unambiguously. However, it is known that the appearance of jaundice is influenced by many factors:

Maternal nutrition during pregnancy.
Deterioration of the mother's health during pregnancy, especially if this was accompanied by the use of antibiotics.
Bad habits of the expectant mother.
Iodine deficiency in the body of a pregnant woman.
Unfavorable state of the environment.
Taking medications during pregnancy and childbirth.

Pathological forms of jaundice

Asphyxia.
Diseases of the endocrine system.
Taking medications.
Low activity of the enzyme that breaks down bilirubin.
Liver immaturity.
Hyperbilirubinemia.

Risk group

Which doctor should I contact?

Surveys

Treatment of the disease

Use of medications

Complex treatment includes UV irradiation, drinking regimen, diet therapy, intramuscular administration of glucose, as well as taking hepaprotectors, such as Ursosan. Before prescribing any of these drugs, it is necessary to evaluate the test results so that an individual treatment regimen can be selected. This disease occurs differently in each specific case. In the case of physiological jaundice, the symptoms will go away on their own on the 10-15th day of the child’s life. The maximum that is required is to drink the baby with clean water and take it out into the sun. If treatment does not help, and the jaundice only worsens, then doctors may reconsider the treatment regimen.

Danger of disease

Toxic poisoning.
Reduced albumin production.
Toxic substances that enter the brain can cause impaired vision and hearing, retarded mental development, DCA, and paralysis.
The risk of developing cirrhosis or liver cancer increases.
Development of liver pathologies.

Instead of a conclusion

If your baby was born in the summer, then most likely he will not develop jaundice. Mom only needs to give the baby clean water and regularly place him in the sun. About three times a day for 10-15 minutes will be enough. If symptoms do not go away on the 10th day, then you need to contact your pediatrician for a prescription and undergo an examination. Only based on the tests will it be possible to say what treatment the baby should receive. All this time, the mother needs to follow a gentle diet, not eat a lot of fatty and sweet foods, so as not to create a burden on the child’s liver.

Jaundice— syndromes of various origins, characterized by icteric discoloration of the skin and mucous membranes.

Code according to the international classification of diseases ICD-10:

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. It is observed in severe forms of 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 is reduced. - glucuronide (direct) and the 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 can acquire, as with mechanical jaundice, a greenish tint (due to the conversion of bilirubin deposited in the skin into biliverdin, which has a green color). 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 secreted 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 up to 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 history, clinical features of parenchymal jaundice and laboratory data.

Treatment

Treatment. The underlying disease is treated.

Diagnosis code according to ICD-10. R17

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 of pain in the upper right part of the abdomen. The pain radiates to the right shoulder, shoulder blade or collarbone and is usually caused by physical activity, eating fried or fatty foods, and drinking alcoholic beverages.
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:

Dyspeptic syndrome, which is characterized by nausea and heaviness in the epigastric region.
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.
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 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 system. 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 of jaundice have similar symptoms, and this 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.

When diagnosing, 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 impaired. 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:

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

We will look at how obstructive jaundice is treated below.

Diagnostics

Instrumental and laboratory research methods cannot be underestimated 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 the true causes of the development of this 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 analysis. If anemia is detected, which is characterized by a decrease in the level of hemoglobin and red blood cells, this indicates a chronic form of the disease. 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 ultrasound examination of the abdominal organs 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. It is an examination of the 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 through the use of drug treatment with 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 infectious disease is added, 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, at the initial stage of the disease, the pressure in the bile ducts is reduced using 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 follow 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.

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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, gallstones are detected in approximately 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 a leading symptom only in the initial stages of the 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 determines 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 ones). 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. The clinical picture depends on the severity, duration and nature of jaundice.

Rice. 45-2. Clinical manifestations of 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 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. At the 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 performing bile duct decompression, etc.

S.T. Shapovalyants