Infantile icterus 5
Teacher Huang then explained to the two interns the classification of icterus in clinical medicine. In clinical practice, we often divide icterus into four categories: hemolytic, hepatic, obstructed, and congenital non-hemolytic icterus.
(1) Hemolytic-type icterus can be seen in: 1. Hemolytic-type leukemia caused by congenital or hereditary factors such as hereditary sphereosis, horse-bean disease, and Thalassemia; 2. Acquired immune hemolytic anemias, such as systematic hemorrhoid, malignant hemorrhoid, and auto-immune hemolytic anemias;(3) Non-immune hemolytic anemias such as leukemia, toadstool poisoning, chronic sleep hemoglobinuria, and so on.
(2) Liver cell icterus can be seen in infectious liver disease, leptospirosis, toxic liver disease, liver Cirrus, Congestive Heart Failure, liver cancer, etc.
(3) Obstructive jaundices can be divided into two types: hepatic and extrahepatic. (1) The former can be caused by capillary-type viral liver inflammation, primary bile stiffness, drug-induced icterus, etc. The latter can be caused by inflammation and edema of the extrahepatic bile duct, scar formation, ascaris, stones, and tumors.
(4) Congenital non-hemolytic icterus is icterus caused by congenital defects in the metabolism of bile. Clinically, it was relatively rare, mostly seen in children and youth. Usually congenital, and have a family history, after most of the good.
Miss Xiaoying asked,"How do we distinguish whether the child is suffering from physiological or pathological jaundices?"”"This is the most difficult problem for doctors. Teacher, please explain its characteristics." Teacher Huang said,"It is very important to distinguish whether the child has physiological or pathological jaundices. According to the summary of my clinical contact with patients, we can identify them according to the following characteristics:
The newborn's physiological icterus is generally not deep. Its characteristics are: 1. Jaundiced usually begins to appear 2-3 days after birth. 2. The icterus gradually deepened and reached its peak on the 4th to 6th day, and then gradually reduced. 3. For newborns born at full term, the icterus usually subsided 2 weeks after birth, and for premature babies, it usually subsided 3 weeks after birth. The degree of icterus is generally not deep, the skin color is light yellow, icterus is often limited to the face and upper body, the child's general condition is good, the body temperature is normal, the appetite is normal, the color of the urine is normal, and the growth is normal. Blood test results show that the level of serum Bilirubin is higher than normal by 2 milligrams per deciliter, but less than 12 milligrams per deciliter per deciliter. If this is the case with the child's icterus, parents need not worry.
Pathological icterus has the following characteristics: (1) The icterus appears too early, appearing within 24 hours after birth. (2) The time for the disappearance of the icterus was too late, the duration was too long, or the icterus had already disappeared and appeared again, or the icterus gradually subsided and worsened after the peak time. The degree of icterus is too heavy, often affecting the whole body, and the skin and mucus are obviously yellow. 4. When checking serum Bilirubin, Bilirubin exceeds 12 milligrams per deciliter, or it rises too fast, rising more than 5 milligrams per deciliter per day. 5. In addition to icterus, it is accompanied by other abnormal conditions, such as mental fatigue, crying less, moving less, eating less, or unstable body temperature."
Miss Yulu asked again,"What is kernicterus?"”"Hehe, you must remember this: Pathological icterus can be complicated by Bilirubin Enpathy, commonly known as 'nuclear icterus,' which can cause damage to the nervous system, leading to serious sequelae such as mental disability in children, and even death. Therefore, when a child has icterus, if there is any of the above five aspects, it should be highly valued by parents, so that early detection of pathological icterus can be treated in time."
" Then, please tell me about the symptoms and treatment of kernicterus." The two interns got to the bottom of it. Professor Huang concluded that the symptoms of kernicterus were as follows:
1. Pre-kernicterus: Gradually worsening icterus, poor response, lethargy, inability to suck milk or refusal to suck milk, and increased uncombined Bilirubin> 256.5 umole/L (15 milligrams).
2. Kernicterus Stage 1 (Warning Period): Similar symptoms to precericterus, but much more severe, unbound bile level> 427.5 umole/L (> 25 milligrams).
3. Kernicterus stage 2 (spasms): Moaning, screaming, staring, nystagmus, opisthotonus, convulsions, fever, irregular breathing, double inhale, sobbing breathing, and even DIC.
4.[Sequela stage: Most patients who are successfully rescued will have sequelae.] Treatment: 1. Reduce serum uncombined Bilirubin. 2. Heat and liquid supply. 3. Avoiding the use of drugs that compete with bile for the receptor binding site of glucose or protein. 4. Treatment with phototherapy and Yinchen granules. 5. Blood transfusion therapy. 6. Strengthening nursing care to prevent complications. "Have you figured it out? If you don't understand, then tell me. One must not pretend to know what they did not know. It was no wonder that some people said that doctors were ascetics.”Doctor Huang asked tirelessly. Miss Xiaoying said,"Barely."”"I understand." Miss Yulu nodded.”Teacher Huang encouraged the two interns." Don't be afraid. True knowledge comes from practice. You'll understand after continuous clinical practice and summary in the future.”Xiao Ying said,"This doctor is indeed an ascetic monk.”Miss Yulu answered optimistically,"We firmly believe that perseverance will change the world."”With that, the follow-up practice for their children with icterus came to an end. Teacher Huang warned the two intern students to remember, If you don't study medicine well, it's easy to hurt others and yourself. Misleading oneself can be learned again, but harming others is a sin. Xiaoying and Yulu nodded gratefully." He remembered his teacher's words.
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