Patients who come to the hospital to check for liver disease may know that bilirubin is a project in liver function tests. When you get the test results, you can see the arrow or some value of the indicator of bilirubin rising, while you are restless, you feel that you may have liver disease, and you are confused, and you don't know whether the results represented by these indicators are good or bad.
So, how to explain this phenomenon? Is elevated bilirubin really a liver disease?
Let's first understand what bilirubin is?
1. What is bilirubin? What are the types?
Bilirubin is the product of the metabolism of iron porphyrin compounds in the body, which is toxic and can cause irreversible damage to the brain and nervous system. Although bilirubin is very harmful, it is not good. It can also act as an antioxidant in itself, effectively inhibiting the oxidation of linoleic acid and phospholipids.
In addition, bilirubin is a kind of biliary pigment, which is the main pigment in our bile. Moreover, the liver has the functions of uptake, binding and excretion in bilirubin metabolism, and if any one of these functional links is impaired, it may cause jaundice.
Therefore, bilirubin can be used clinically to determine whether liver function is abnormal.
So, how does bilirubin determine the condition of liver function?
Since bilirubin is divided into total bilirubin, direct bilirubin (also known as combined bilirubin) and indirect bilirubin, so in the process of occurrence, the specific need to look at these three indicators of bilirubin.
First, total bilirubin refers to the sum of direct bilirubin and indirect bilirubin, which includes all bilirubin in the body. In general, elevated total bilirubin may be due to hemolysis, cholelithiasis, and cholestasis, but this does not necessarily mean that these phenomena are necessarily present when total bilirubin is elevated.
Furthermore, bilirubin, which is the product of hemoglobin catabolism. When uptaken by liver cells, it binds to glucuronate transferase on the liver to produce direct bilirubin. Moreover, the direct bilirubin produced also needs to be excreted into the biliary tract through liver cells, and then participate in the digestion and absorption of food.
Therefore, if the value of direct bilirubin is high, the common situations are biliary obstruction, cholestasis, and cholangitis.
Indirect bilirubin is the part of bilirubin that does not bind to glucuronic acid. Elevated levels of bilirubin often indicate the possibility of hemolysis as well as hematologic disorders.
If the direct and indirect bilirubin is significantly elevated at the same time, and the degree of elevation is basically the same, it indicates that the liver cell damage is more serious, and there may be a large number of hepatocyte necrosis.
As can be seen from the above, the level of bilirubin is elevated, and the chance of liver disease is indeed very large. However, if the level of bilirubin rises, is it really liver disease at work? Before answering this question, we need to figure out what causes elevated bilirubin levels.
Second, the increase in bilirubin level means that there is liver disease?
Clinically, the causes of elevated bilirubin levels are generally divided into two types, one is pathological causes and the other is non-pathological causes.
The pathological cause is caused by some liver diseases that we learned earlier.
Here, the pathological causes of elevation of bilirubin can be roughly divided into three conditions:
First: the levels of total bilirubin, direct bilirubin, and indirect bilirubin are all elevated. In this case, it is necessary to consider that the patient may have jaundice hepatitis, jaundice liver necrosis, cirrhosis and other liver diseases, and it is recommended to immediately further examine and confirm the diagnosis.
Second: total bilirubin is elevated, direct bilirubin is elevated. At this time, it is necessary to judge whether there is a possibility of biliary diseases such as cholecystitis and cholelithiasis.
Third: total bilirubin is elevated, indirect bilirubin is elevated. It is generally common in hemolytic jaundice, neonatal jaundice and other diseases.
Of course, this is also a preliminary judgment that the patient has the possibility of liver disease, and if the diagnosis is accurate, it is necessary to further verify the situation through ultrasound or CT.
In addition, it is a pathological cause. For example, common over-drinking, excessive exercise, overwork, long-term medication and physiologically high conditions can also cause the result of increased bilirubin levels. Physiologically high, it is more common in neonatal jaundice, which generally disappears on its own within a week or so after birth, and there are no other abnormal symptoms.
In short, these non-pathological bilirubin elevations are basically unimpeded, and generally only need to rest well and adjust living habits to return to normal on their own.
In this way, the increase in bilirubin levels sometimes does not mean that your liver is not good, and it may be caused by some non-pathological reasons. However, for the pathological elevation of bilirubin, we must pay attention to it. You should go to a regular hospital in time to check out the cause, actively treat it, and find liver abnormalities in a timely manner.
Some patients may wonder, so how can you get your bilirubin levels to drop and return to normal levels? Can I usually take some liver protection drugs to achieve the effect?
3. If the level of bilirubin is pathologically elevated, is it useful to take liver protection drugs?
Previously, we have learned that even pathological elevations in bilirubin levels are caused by multiple types of liver disease. Moreover, the general means of treatment of different liver diseases are also different. Therefore, we should find out the specific cause of the phenomenon of elevated bilirubin, and then treat the cause. And just taking liver protection drugs does not make much sense, but is a waste of money.
Everyone should have a clear understanding that the role of liver protection drugs, mainly to protect liver cells and reduce the level of transaminases in the body for the purpose, for some because of hepatitis caused by the rise of bilirubin, the role played is limited. Therefore, liver protection drugs are almost useless in the treatment of liver disease caused by excessive destruction of red blood cells or enzyme deficiency, and we also need to treat the symptoms.
So, how can it be treated symptomatically?
In fact, in the clinic, the reasons for the increase in bilirubin levels can also be divided into elevated prehepatic bilirubin, posthepatic bilirubin elevation, and posthepatic bilirubin elevation. The elevation of prehepatic bilirubin is mainly due to some hematologic diseases, such as megaloblastin. In this condition, bilirubin is elevated and requires treatment of the primary disease to decrease.
The causes of hepatic bilirubin elevation are more complex, mainly due to their own liver disease. Common hepatitis B, hepatitis C, etc., these viruses can lead to a decrease in the function of liver cells in the body, causing an increase in bilirubin levels.
Of course, there are also some drugs that are taken daily, such as antipyretic drugs, anti-inflammatory drugs, hypolipidemia drugs, etc. May also lead to hepatic bilirubin elevation. These drugs need to be metabolized by the liver. If it is taken for a long time, it will cause certain damage to the liver and bring side effects. At this point, liver function impairment can affect the level of bilirubin.
The level of bilirubin indirectly caused by the drug is elevated, and sometimes after discontinuation, the level of bilirubin will decrease on its own, which is reversible. However, some drugs are irreversible, and even if the bilirubin level is discontinued, it cannot return to normal levels. Therefore, patients and friends must not eat too many and excessive drugs, and should be taken under the advice of the doctor to reduce the risk of liver damage.
Not only drugs can cause hepatic bilirubin levels to rise, but some toxic substances, metal substances, etc. can also cause liver function damage. Therefore, for the case of hepatic bilirubin elevation, we must identify specific causes and distinguish between them, because the increase in bilirubin levels caused by some reasons does not require special treatment.
Finally, there is the more important posthepatic bilirubin. For example, gallstones, biliary obstruction, and biliary tract tumors and other diseases. Mainly because the biliary tract is blocked, causing an increase in bilirubin. In this case, it is best to use surgery, the lesion is removed, the biliary tract is drained, and the bilirubin level will be reduced.
If some patients cannot undergo surgery for special reasons, other treatments can also be taken, such as transsplenic and transhepatic punctures.
If some patients have elevated bilirubin levels due to cirrhosis, according to the patient's own situation, it may also be necessary to take drugs, liver transplantation and other means of comprehensive treatment.
Write at the end
We should realize that the results of elevated bilirubin in the physical examination do not necessarily indicate liver disease. Moreover, taking liver protection pills can not reduce the level of bilirubin, so it is necessary to find a scientific and correct way to treat it.