Bệnh nhân với nồng độ cao của bilirubin (100 mol / l) hoặc với bằng chứng của nhiễm trùng huyết hoặc viêm đường mật có nguy cơ cao bị các biến chứng phát triển và nên được gọi là trường hợp khẩn cấp vì sự chậm trễ trong điều trị bất lợi ảnh hưởng đến tiên lượng. | 1 Investigation of liver and biliary disease IJ Beckingham S D Ryder Jaundice is the commonest presentation of patients with liver and biliary disease. The cause can be established in most cases by simple non-invasive tests but many patients will require referral to a specialist for management. Patients with high concentrations of bilirubin 100 ìmol l or with evidence of sepsis or cholangitis are at high risk of developing complications and should be referred as an emergency because delays in treatment adversely affect prognosis. Jaundice Hyperbilirubinaemia is defined as a bilirubin concentration above the normal laboratory upper limit of 19 ìmol l. Jaundice occurs when bilirubin becomes visible within the sclera skin and mucous membranes at a blood concentration of around 40 ìmol l. Jaundice can be categorised as prehepatic hepatic or posthepatic and this provides a useful framework for identifying the underlying cause. Around 3 of the UK population have hyperbilirubinaemia up to 100 ìmol l caused by excess unconjugated bilirubin a condition known as Gilbert s syndrome. These patients have mild impairment of conjugation within the hepatocytes. The condition usually becomes apparent only during a transient rise in bilirubin concentration precipitated by fasting or illness that results in frank jaundice. Investigations show an isolated unconjugated hyperbilirubinaemia with normal liver enzyme activities and reticulocyte concentrations. The syndrome is often familial and does not require treatment. Prehepatic jaundice In prehepatic jaundice excess unconjugated bilirubin is produced faster than the liver is able to conjugate it for excretion. The liver can excrete six times the normal daily load before bilirubin concentrations in the plasma rise. Unconjugated bilirubin is insoluble and is not excreted in the urine. It is most commonly due to increased haemolysis for example in spherocytosis homozygous sickle cell disease or thalassaemia major and patients are often .
