Cholestatic jaundice

　　Cholestatic jaundice can be seen in primary biliary cirrhosis, viral hepatitis, alcoholism, pregnancy, hypoxia, familial intrahepatic cholestasis, stones, parasites (ascaris, Clonorchis sinensis), inflammation, tumors, stenosis (surgery, trauma, extracorporeal tumor or lymph node compression), and other conditions. Mechanical obstruction of intrahepatic bile ducts can also cause obstructive jaundice, seen in intrahepatic bile duct stones, liver parenchyma or (and) bile duct inflammation, liver tumors, biliary atresia or maldevelopment, and other conditions.

　　When there is biliary obstruction, bile stasis occurs in the bile ducts, the pressure in the bile ducts increases, and when it reaches a certain degree, the Hering's ampulla connecting the capillary bile ducts and the bile ducts ruptures, leading to bile entering the lymph and then entering the blood circulation, causing jaundice.

　　It is prone to complications such as gallstones, itchy skin, and cholecystitis, etc. Due to the continuous increase in bile stasis, the permeability of the capillary bile ducts increases, bile concentration and stasis reduce the flow, and eventually lead to the deposition of bile salts in the bile ducts, forming stones. At the same time, long-term bile stasis leads to vascular obstruction of the gallbladder, congestion of the gallbladder wall, edema of the mucosa, desquamation of the epithelium, and infiltration of leukocytes, leading to cholecystitis. Bile stasis reduces the amount of bile flowing into the small intestine, which increases the amount of bile salts in the blood, leading to the complication of pruritus.

　　First, medical history and symptoms

　　The disease is characterized by obstructive jaundice without visible obstruction of the extrahepatic and intrahepatic bile ducts, which can be caused by various etiologies such as drugs, viral hepatitis, alcoholism, pregnancy, and familial factors. Clinically, it can manifest with symptoms such as jaundice, itchy skin, and anorexia, as well as fatigue. During the medical history taking, attention should be paid to inquiring about the precipitating factors of the disease, and it should be distinguished from obstructive jaundice caused by biliary obstruction.

　　Second, experience findings

　　Jaundice, itchy skin with scratch marks, and liver enlargement.

　　Cholestasis of pregnancy is a special disease that only occurs in pregnant women, with 2.3 to 3.4 out of every 100 pregnant women affected. Skin itching is the first symptom to appear, most often occurring between the 28th and 30th weeks of pregnancy, but it can occur as early as the 12th week. As pregnancy progresses, the skin becomes more itchy, mainly affecting the trunk and lower limbs, and in severe cases, it can affect the whole body, especially at night, affecting sleep, and scratching is very difficult to bear. The itching disappears rapidly within 1 to 2 days after delivery, and a few cases may last for a week. After several weeks of itching, about 50% of pregnant women develop jaundice, but only the sclera of the eyes is slightly yellowish, and some pregnant women also have symptoms such as decreased appetite, diarrhea, fatigue, and abdominal distension, but these are not severe. Laboratory tests show that the level of serum conjugated bile acids is elevated, 1/5 to 2/3 of patients have a slight increase in serum bilirubin, and more than 80% of pregnant women have a slight increase in serum alanine aminotransferase.

　　During a subsequent pregnancy, the disease can occur again. Patients often have a family history, and their mothers and sisters often have the same medical history, so it is believed that the disease is related to autosomal dominant hereditary diseases.

　　Cholestasis of pregnancy is more common than viral hepatitis complicating pregnancy. Due to the similarity of symptoms between the two, it is easy to mistake it for hepatitis, and it should be distinguished. The characteristics of the disease are: first, the general condition of pregnant women is good after onset, and the symptoms of the digestive system are not obvious; second, itching is prominent, and jaundice is present; third, liver function is only slightly damaged; fourth, the condition does not worsen after delivery, and symptoms and jaundice disappear rapidly.

　　This disease has a great harm to the fetus, which is easy to cause premature birth, low birth weight, intrauterine asphyxia death, and neonatal asphyxia. If a pregnant woman has skin itching, she should check it in time. Before the itching appears or before the serum alanine aminotransferase level increases, the serum conjugated bile acid level increases first, which is a reliable indicator for early diagnosis. There is currently no specific effective drug treatment, and cholestyramine has a certain effect on itching; ursodeoxycholic acid, dexamethasone also has a certain curative effect; phenobarbital can not only alleviate itching but also help to sleep soundly at night. To prevent postpartum hemorrhage, vitamin K should be supplemented before delivery. When jaundice appears or when the monitor indicates the possibility of fetal hypoxia, it is necessary to be hospitalized in advance, and delivery should be terminated in time if necessary, and postpartum, it is necessary to be vigilant for massive hemorrhage.

　　Firstly,Bilirubin tests:

　　1. Serum Bilirubin:In cholestatic jaundice, due to the inability of direct bilirubin (DBIL) to be excreted from hepatocytes and capillary bile ducts, serum bilirubin significantly increases, with total bilirubin (TBIL) reaching above 510μmol/L, mainly DBIL, and the ratio of DBIL to TBIL is often above 60%, with the highest reaching 90%. Calculus jaundice often presents with fluctuating jaundice, cancerous obstruction presents with progressive jaundice, but the jaundice in choledochal cancer can be temporarily alleviated due to ulceration of the tumor.

　　2. Urine Bilirubin:In cholestatic jaundice, the bile stasis increases the pressure in the intrahepatic bile ducts, leading to the rupture of the capillary bile ducts, causing DBIL to not be excreted into the intestines but to reflux into the blood and be excreted in urine, hence the positive test for urine bilirubin.

　　3. Urobilinogen:In cholestatic jaundice, due to the intrahepatic and extrahepatic bile stasis, the bile excretion into the intestines is obstructed, the bile pigment in the intestines is reduced, and the bile pigment that leaks into the portal vein through the enterohepatic circulation is also reduced, so the excretion of urobilinogen in urine decreases.

　　4. Fecal urobilinogen:In cholestatic jaundice, due to reduced bile flowing into the intestines, the fecal urobilinogen is significantly reduced or absent, causing a decrease in the further oxidation of fecal urobilin in the intestines, making the feces lighter or even clay-colored, which is a feature of extrahepatic bile stasis.

　　Secondly, other liver function tests:

　　1. Serum Alkaline Phosphatase (ALP):In obstructive jaundice, the activity of serum ALP is often significantly increased early, even reaching 10 to 15 times the upper limit of the reference value.

　　2. Serum Gamma-Glutamyl Transferase (GGT):In cholelithiasis, biliary inflammation, and extrahepatic obstruction, GGT is not only highly positive but also significantly elevated, which can reach 5 to 30 times the upper limit of the reference value, aiding in the differential diagnosis of hepatocellular jaundice and cholestatic jaundice.

　　3. Serum Total Bile Acids (TBA):Serum TBA measurement has a high sensitivity for the diagnosis of extrahepatic bile duct obstruction and intrahepatic bile stasis, including biliary obstruction, biliary cirrhosis, neonatal cholestasis, and gestational cholestasis, where TBA in serum can significantly increase.

　　4. Serum 5'-Nucleotide (5'-NT):5'-NT elevation is mainly seen in liver and gallbladder diseases, but the activity of 5'-NT is significantly elevated in cholestatic jaundice, generally 2 to 3 times that of a normal person, which is helpful for the differential diagnosis of hepatocellular jaundice and cholestatic jaundice. In extrahepatic biliary obstruction, the activity of 5'-NT is generally parallel to ALP, but the activity of 5'-NT generally does not increase during short-term obstruction. After the long-term obstruction is relieved, the decrease in the activity of 5'-NT is faster than that of ALP.

　　I, Diet

　　Bilirubin gallstone food therapy (the following information is for reference only, detailed consultation with a doctor is required)

　　1, Jincao and baijiangcao tea

　　Ingredients: 30 grams of jincao, baijiangcao, and茵陈 each, appropriate amount of sugar.

　　Cooking method: Boil the first three ingredients to make 1000 milliliters of decoction, add appropriate amount of sugar.

　　Dosing: Take warm as tea.

　　2, Cucumber vine and egg drink

　　Ingredients: 100 grams of cucumber vine, 1 fresh egg.

　　Cooking method: Wash the cucumber vine, boil 200 milliliters of water, and reduce to 100 milliliters, then pour it over the egg.

　　Dosing: Take once a day.

　　3, Dandelion gruel

　　Ingredients: 30 grams of fresh dandelion with roots, 50 grams of glutinous rice, appropriate amount of rock sugar.

　　Cooking method: Wash the fresh dandelion, chop it finely, decoct and remove the residue, then cook with glutinous rice and rock sugar to make a thin gruel. Alternatively, dandelion can be cooked with 30 grams of chrysanthemum flowers or 50 grams of corn silk with glutinous rice to make gruel, with similar effects.

　　Dosing: Take 2 times a day at room temperature, for 3 to 5 consecutive days.

　　4, Bile-promoting tea

　　Ingredients: 30 grams of corn silk, dandelion, and茵陈 each, appropriate amount of sugar.

　　Cooking method: Boil the first three ingredients with 1000 milliliters of water, remove the residue, and add sugar to taste.

　　Dosing: Take 3 times a day, 200 milliliters each time, for 15 consecutive days.

　　5, Watermelon jelly

　　Ingredients: 14 grams of red-fleshed watermelon, 1.5 grams of gelatin, 60 grams of sugar, 1 drop of banana oil, 90 grams of water.

　　Cooking method: Remove the seeds from the watermelon rind, chop it up, squeeze out the watermelon juice. Cut the gelatin into inch-long pieces, add 15 grams of sugar to the watermelon juice, dissolve the gelatin in the juice, stir well, cool, and set to make watermelon jelly. Boil the remaining sugar with water, cool, add banana oil, cut the watermelon jelly into small pieces, pour the syrup around the plate, and it's ready.

　　Dosing: Take as desired.

　　6, Pig bile and mung bean pills

　　Ingredients: 10 pig bile (including bile juice), 250 grams of mung beans, 50 grams of gancao.

　　Cooking method: Place mung beans separately in the bile, sew tightly with thread, wash off the external dirt of the bile, steam in a pot for about 2 hours, remove and crush, then mix with the decoction of gancao to make pills, dry and reserve.

　　Dosing: Take 1 pill each time in the morning, afternoon, and evening, with a course of 10 days.

　　7, Chinese wild cherry and huangqi honey

　　Ingredients: 250 grams of Chinese wild cherry, 500 grams of huangqi, 1000 grams of honey.

　　Cooking method: Wash the Chinese wild cherry and huangqi, soak in water for 1 hour, then simmer in an earthen pot with appropriate amount of water over low heat for 1 hour, filter out the first juice of 500 milliliters, add water again and simmer, filter out the second juice of 300 milliliters. Mix the herbal juice with honey in a pot, simmer over low heat for 5 minutes, cool and bottle.

　　Method of use: Take 1 tablespoon, dissolve in hot water after meals, take once a day, 30 days as a course of treatment.

　　What foods are good for cholestatic jaundice?

　　1. To protect the function of the digestive system, use beets, myrica, yam, Job's tears, radishes, etc.

　　2. Eat more foods beneficial for bile promotion and anti-cancer, such as buckwheat, Job's tears, mushrooms, dregs of tofu, chrysanthemum, sea cucumber, figs, sesame, sea buckthorn, etc.

　　3. Choose more coarse grains. Eat more foods high in fiber, including corn, millet, sweet potatoes, oatmeal, buckwheat, etc., to promote bile excretion.

　　4. Vegetables and fruits maintain health. Vegetables and fruits are rich in vitamins, minerals, and dietary fiber, which can reduce the formation of cholesterol, reduce the absorption of fat and sugar, and thus improve the metabolic disorder of patients, reducing blood lipids and blood sugar. The daily intake of vegetables should be more than 500 grams, and at least 2 types of fruits.

　　What foods should be avoided for cholestatic jaundice?

　　1. Limit the intake of cholesterol. The daily intake of cholesterol should be less than 300 milligrams, and animal fats and foods high in cholesterol, such as organs and fish roe, yolks, etc., should be limited.

　　2. Avoid刺激性 or gas-producing foods, such as radishes, onions, etc., and ban smoking and alcohol.

　　3. Avoid moldy, fried, smoked, and preserved foods.

　　4. Avoid hard, sticky, and difficult-to-digest foods.

　　5. Avoid animal fats and greasy foods. Such as lard, fried dough sticks, etc.

　　One-third of the causes of intrahepatic bile stasis are unknown, but more than half can be traced, so actively eliminating the causes has a positive effect on the regression of bile stasis. For those with unknown causes, symptomatic treatment is given. Phenobarbital 30-180mg/d. Cholestyramine 6-10mg/d. If there are obvious symptoms of poisoning, especially in those accompanied by allergic reactions, prednisone 40μg/d, taken continuously for a week, the bilirubin in most cases can be reduced by 50%. After the bilirubin returns to normal, the dose can be gradually reduced to 10mg, which can be maintained for 1-2 months to prevent relapse. However, if there is no significant decrease in bilirubin after one week, the use should be stopped to prevent side effects, and the traditional Chinese medicine Yin Chen decoction has a certain effect on the regression of bile stasis.