The copyright page: 2 hepatic uptake of bilirubin in the blood of the low capacity of unconjugated bilirubin and albumin bound most, per gram of albumin bound bilirubin 256.5 μ mol (1.5mg). And the albumin binding of unconjugated bilirubin circulation to the liver, is micro protruding uptake of liver cells, and the intracellular Y and Z carrier protein, Y protein content more, is the main receptor of bilirubin. The neonatal birth, less Y protein content in the liver of adult, for 5% ~ 20%, influence the uptake of liver of bilirubin, born after 5 ~ 10d close to the adult level. 3 hepatocellular bilirubin capability and Y, Z protein binding of bilirubin was running to the smooth endoplasmic reticulum in the liver cells, catalytic transferase in glucuronic acid, and glucuronic acid binding, formation of bilirubin glucuronide esters, also known as conjugated bilirubin. Neonatal birth glucuronosyltransferase content is low, and the activity was only 0 of normal adult levels close to 30%, 1 weeks after birth. 4 defects in bilirubin bilirubin excretion by hepatocyte bile secretion is secreted into the bile canaliculi, into the biliary system, some organic anion excretion can compete with the binding of bilirubin and conjugated bilirubin excretion effect. Neonatal liver cells on the excretion of bilirubin in temporary defect, especially in produce too much bilirubin or in vivo organic anion increased, bilirubin excretion disorder, premature infants is more obvious. There may be a temporary intrahepatic cholestasis. 5 characteristics of enterohepatic circulation of conjugated bilirubin is a polar substance, not easy to be absorbed in the small intestine. When combined with biliary excretion of bilirubin to the terminal ileum and colon, by intestinal bacterial β - glucuronidase hydrolysis, reduction of urobilinogen. Urobilinogen upon contact with air oxidation for urobilin and stercobilin, make defecate tan. The large intestine urinary bile original 10% ~ 20% by intestinal re absorption, via the portal vein to liver, most the prototype into the intestines, constitute the enterohepatic circulation of bile pigment. Intestinal bacteria was born normal neonatal plexus has not yet been established, urobilinogen formation is very few, most of bilirubin in the intestinal lumen of β - glucuronidase under off glucuronyl, into the lipid soluble unconjugated bilirubin, a part is absorbed from the intestine into the blood, part excreted with the feces, re the intestinal absorption of unconjugated bilirubin by portal vein to liver, composition characteristics of enterohepatic circulation of bilirubin in neonates. Neonatal intestinal cavity in the meconium contains large amounts of bilirubin, such as delayed meconium exclusion, can make the circulation of enterohepatic bilirubin is obviously higher than adult. Two, neonatal jaundice jaundice of the newborn baby, classification and similar to adults, usually divided into prehepatic jaundice, liver bacterial jaundice and hepatic jaundice, or by increasing serum bilirubin into the nature of the unconjugated and conjugated hyperbilirubinemia and mixed with hyperbilirubinemia. Three, the diagnosis of jaundice in newborn babies is common symptoms, easy to ignore in the newborn skin darker color or skin congestion situation, should be observed at this time the color of the sclera. The sclera was not affected by the color and hyperemia of the skin, can more accurately reflect the situation of tissue stained yellow. Also can use your fingers to skin leveled or with a slide pressure on the skin, make the skin hyperemia subsided, can clearly see the yellowing of the skin condition. Jaundice appears first on the face and trunk, gradually extended to the limbs and hand foot heart, from jaundice distribution, can be roughly estimated level of bilirubin in serum. Jaundice color if orange or golden yellow, suggesting that unconjugated bilirubin increased jaundice; if it is dark yellow or yellow green, with increased conjugated bilirubin. Neonatal pseudojaundice relatively rare, but in severe anemia of newborn, can behave for sallow skin, not to be mistaken for jaundice. As long as the newborn jaundice. It should beThe differential diagnosis.
The first chapter of common symptoms of differential
second > third day crying edema on
sixth day weight cyanosis abnormal
second chapter newborn common symptoms of
the first section
second vomiting jaundice.
third chapter breath cyanosis
the first symptoms of cough
fourth chapter dyspnea symptoms of digestive system
second first quarter vomiting diarrhea
Fourth hematochezia abdominal pain.
fifth chapter circulatory symptoms.
first heart murmur.
Fourth congestive heart failure
sixth chapter symptoms of nerve system.
the first headache
section second seizure
third day paralysis
Fourth mental retardation
seventh chapter hematologic symptoms of
the first section anemia
second ganglia hemorrhage
third lymph nodes
eighth chapter urinary symptoms.
Article A section of oliguria or anuria polyuria
second > third > Fourth proteinuria hematuria
reference @##@ pyuria Li Yawei, Ding Shuyu, Li Xueping editor of "pediatric disease diagnosis technology" with the growth and development of children's characteristics, from the doctor's point of view. Analysis of children of different system common disease etiology, pathogenesis and differential diagnosis. "Pediatric disease diagnosis technology" with the new technology, new progress of pediatric diagnosis, provide guidance for doctors diagnosis. The book concise, practical, standardized, in order to improve the level of clinical diagnosis and the pediatrician, suitable for pediatricians and medical students, medical workers to read.
"Pediatric disease diagnosis technology" is a data rich, systematic and comprehensive professional work, has the authority, reflects the overall level of China's current pediatric diseases control. Writing in scientific, advanced and readability principle, strive to innovation, build quality. Suitable for pediatricians and medical students, medical workers to read.
Medical Science @ 2017