Ictère

A ictère or jaundice corresponds to yellow coloring of the Tégument S (skin and mucous membranes: one speaks about cutanéo-mucous ictère) due to the accumulation of Bilirubine , which can be free or combined this is why one distinguishes two types of ictère:

  • free Ictère with bilirubine
  • Ictère with bilirubine combined

The ictère can be more or less intense, but when it begins it is only visible with the level of the conjunctive ones of the eye (“white” of the eye). It must be required with the natural light.

General information

The red globules have one lifespan of approximately 120 days. At the conclusion of this period, they are destroyed in spleen, which produces free bilirubine. The free bilirubine is toxic and can be harmful; at a healthy individual, it is then transformed by the liver into bilirubine combined not poison. This substance gives its yellow color to the urine and the saddles.

A ictère or jaundice is caused by the excessive presence of bilirubine (which can be free or combined) in human blood.

Physiopathology

The bilirubine is the breakdown product of the heme (component of the Hémoglobine) transported in the Sang in partnership with the Albumine until the Foie where it is collected by the cells of the liver (hépatocytes) then combined and excreted in the Bile by those in order to be then eliminated in the saddles.

The bilirubine is thus known as free until the hepatic conjugation, then combined then. The bilirubine combined is soluble, it can thus be filtered by the kidney: a ictère with bilirubine combined will have then as a consequence of the sunk urines, as well as a Prurit because the bilirubine will be able to settle in the skin.

There exist ictères at any age of the life and for multiple reasons:

At the newborn

A ictère is frequently found; several causes are possible:

Free Ictères with bilirubine

* the ictère known as " physiologique" , It is due only to the immaturity of the liver to the birth: the newborn has a very great number of red globules containing of hemoglobin F (fetal), globules which must be replaced by globules charged with hemoglobin has (adult). That causes a hémolyse (destruction of red globules) important in very little time! Sometimes the liver did not develop its enzymatic equipment yet well to transform all the free bilirubine, which then will accumulate and cause a ictère.

* the ictère with the milk of mother: Not very intense Ictère observed in a child nourished with the center, and which is prolonged all the duration of the breast-feeding. One can make the diagnosis of it by heating the mother's milk with 60 °C before giving it to the child: the ictère disappears.

  • haemolytic ictères:

At the newborn, one can also find pathological causes; the risk is that the accumulation of bilirubine is such that it becomes neurotoxic about it: indeed, starting from a certain rate, the bilirubine crosses the hemato-encephalic barrier and touches the brain seriously, involving a nuclear Ictère by attack of the gray cores of brain;

    • incompatibility Rhesus between the mother and the child: case it + at the intense risk of ictère: the mother is Rh -, the Rh+ child, with presence of antibody antiD in the mother. The child will thus develop a hémolyse following the contact with maternal blood during the childbirth.

    • incompatibility ABO: mother of group O, child has, AB or B

    • infectious ictère: had with an infection of the newborn

    • diseases of the red globules: deficit in G6-PD, disease of Minkowski-Roadhog

    • ictère due to the resorption of hématomes important: séro-blood bump, céphalhématome,…

ictères with bilirubine combined

  • ictères cholestatiques : rare at the newborn

Treatments of the ictère at the newborn

  • for a light ictère: to expose the child in the light of the day (not in full sun), and to make it téter to support much the eliminitation of the bilirubine via the saddles and the urine.

  • Phototherapy: one places the child sleep some with ophthalmic protection under lamps emitting of the light in the blue spectral area between 400 and 550 Nm, so that this light degrades the bilirubine

  • drugs: enzymatic inductors, albumin perfusion

  • exsanguinotransfusion: ictère serious, with nuclear risk of ictère: it is a question of removing the blood of the child (exsanguiner) and of replacing it by a hematoma (transfusion). It gradually is done, of 5ml in 5ml

In the adults

Free Ictère with bilirubine

  • Hémolyse : Massive destruction of the red globules involving an excess of production of bilirubine. One will find a Anémie at the patient.

The hémolyses can occur in the event of infection with septicaemia (hémocultures if fever); in the event of immunoallergic disease (test of Coombs); in the event of medicamentous catch (to check all the drugs taken recently. Regression of the ictère after stop of the causal drug); in the event of mechanical obstacle (cardiac valve; arteriovenous dent; presence of schizocytes)…
  • Disease of Gilbert or Syndrome of Gilbert: in spite of the collecting of the bilirubine by the cells of the liver, there is a defect of conjugation of this one which is due to a deficit in enzyme glucuronyltransférase.

Ictère with bilirubine combined

  • By obstruction of the bile ducts:

* Calculation S of cholédoque (or lithiasis): ictère fugacious, with pain, then fever (Angiocholite)…
* Tumor S: Pancreas, Bulb of Vater, or bile Ducts. The ictère is then progressive, not decreasing, and often without pain. A large blister can direct towards the diagnosis.
  • By passage of the bile in blood: bilio-venous dent, post traumatic.
  • By problem of excretion of the hépatocytes:
* acute Hepatitis
* Cirrhosis

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