Gilbert's syndrome: the more dangerous, how to treat, the prognosis
Gilbert syndrome is a hereditary disease that is transmitted with the dominant genes of one of the parents and is a pigmentary hepatosis. It is characterized by a constant increase in unbound bilirubin and a violation of its transport in hepatocytes. For a simple philistine nothing will say the phrase "Gilbert's syndrome".What is the danger of such a diagnosis? Let's look at it together.
Unfortunately, this is the most common form of hereditary liver damage. It is especially widespread among the African population, among Asians and Europeans is much less common.
In addition, it is directly related to gender and age. At young and young age the probability of manifestation is several times higher than in the adult. Approximately ten times more common in men.
Now let's look at the details of how Gilbert's syndrome works. What is it, in simple words you will not describe. This requires specific training in pathomorphology, physiology and biochemistry.
At the heart of the disease is a disruption of the transport of bilirubin to hepatocyte organelles for its binding to glucuronic acid. The reason for this is the pathology of the cell wall of the transport system, as well as the enzyme that binds bilirubin to other substances. Together, this increases the content of unbound bilirubin in the blood. And since it dissolves well in fats, all tissues, cells of which contain lipids, accumulate it, including the brain.
There are at least two forms of the syndrome. The first takes place against the background of unchanged erythrocytes, and the second promotes their hemolysis. Bilirubin in Gilbert's syndrome is the same traumatic agent that destroys the human body. But he does it slowly, so it does not feel until a certain moment.
It is difficult to find a more covert somatic disease than Gilbert's syndrome. Symptoms of it either are absent or weakly expressed. The most common manifestation of the disease is mild jaundice of the skin and sclera.
Neurological symptoms are weakness, dizziness, fatigue. Possible insomnia or sleep disturbances in the form of nightmares. Even more rarely characterize the Gilbert syndrome symptoms of dyspepsia:
- strange taste in the mouth;
- disorder of stool;
- nausea and vomiting.
There are some conditions that can provoke Gilbert's syndrome. Symptoms of the manifestation can be caused by a violation of the diet, using drugs such as glucocorticosteroids and anabolic steroids. It is also not recommended to drink alcohol and practice professionally. Frequent colds, stress, including surgery and trauma, can also have a negative effect on the course of the disease.
The analysis for Gilbert's syndrome, as the only reliable diagnostic feature, does not exist. As a rule, these are several characteristics that coincide in time, place and space.
It all starts with an anamnesis. The doctor asks suggestive questions:
- What are the complaints?
- How long have pains in the right hypochondrium and what are they?
- Is there a liver disease in relatives?
- Did the patient notice darkening of the urine? If so, with what does it connect?
- What is the diet?
- Does it take medicine? Do they help him?
Then comes the inspection. Pay attention to icteric skin color and sclera, painful sensations when feeling the stomach. After the physical methods, a series of laboratory tests begins. The "Gilbert syndrome" test has not yet been invented, so therapists and general practitioners are limited to the standard protocol of the study.
It necessarily includes a general blood test( characterized by an increase in hemoglobin, the presence of immature forms of blood cells).Behind him goes the biochemistry of blood, which has already deployed to evaluate the state of the blood. Bilirubin rises in small amounts, liver enzymes and acute phase proteins are also not a pathognomonic symptom.
In cases of liver disease, all patients are given a coagulogram to adjust the blood coagulation ability, if necessary. Fortunately, with Gilbert's syndrome deviations from the norm are insignificant.
Special laboratory studies of
An ideal diagnostic option is a molecular study of DNA and PCR on specific genes that are responsible for the exchange of bilirubin and its derivatives. To exclude hepatitis, as a cause of liver disease, put a serological response to antibodies to these viruses.
Of the general studies, a urine test is mandatory. Its color, transparency, density, presence of cellular elements and pathological impurities are evaluated.
In addition, special diagnostic tests are done to more closely check the level of bilirubin. There are several types:
- A test with fasting. It is known that after a two-day low-calorie diet in humans, the level of this enzyme rises by a factor of 1.5 or 2.It is enough to take the analysis before the start of the study, and then after 48 hours.
- Nicotine test. Forty milligrams of nicotinic acid is injected intravenously to the patient. An increase in the level of bilirubin is also expected.
- Barbituric test: taking phenobarbital three milligrams per kilogram for five days causes a persistent decrease in the level of the enzyme.
- Rifampicin test. It is simply enough to introduce nine hundred milligrams of this antibiotic to increase the level of unbound bilirubin of the blood.
First of all, this, of course, ultrasound. With its help, you can see the structure and blood supply of not only the liver and the biliary system, but also the other organs of the abdominal cavity, to exclude their pathology.
Then comes a computer scan. Again, to exclude all other probable diagnoses, since in Gilbert's syndrome the structure of the liver remains unchanged.
The next step is a biopsy. Excludes tumors and metastasis, allows additional biochemical and genetic studies with a sample of tissue and make a final diagnosis. An alternative is elastography. This method allows you to assess the degree of connective tissue transformation of the liver and exclude fibrosis.
Gilbert syndrome in children manifests itself from three to thirteen years. It does not affect the quality and life expectancy, therefore, there are no significant changes in the development of the child. Provoke its manifestation in children can stress, exercise, the beginning of menstruation in girls and puberty in boys, medical intervention in the form of operations.
In addition, chronic infectious diseases, high temperatures for more than three days, hepatitis A, B, C, E, ARI and ARVI push the body to malfunction.
Disease and military service
A young person or adolescent is diagnosed with Gilbert's syndrome."Are they taking part in the army with this disease?" His parents immediately think, and he himself. After all, with such a disease it is necessary to treat your body with care, and the military service does not have anything to do with it.
According to the order of the Ministry of Defense, youths with Gilbert syndrome are called on for urgent service, but there are some reservations about the venue and conditions. It will not be possible to completely escape from the obligation. In order to feel good, you must follow the following simple rules:
- Do not drink alcohol.
- It's good and right to eat.
- Avoid intensive workouts.
- Do not take drugs that adversely affect the liver.
Such recruits ideal work at headquarters, for example. However, if you cherished the idea of a military career, then it will have to be abandoned, since Gilbert's syndrome and the professional army are incompatible things. Even when submitting documents to a higher educational institution for the relevant profile, the commission will be compelled to reject them for understandable reasons.
So, if you or your loved ones were diagnosed with Gilbert's syndrome, "Are they taking to the army?"- this is no longer an urgent issue.
No specific continuous treatment for people with this disease is required. However, it is nevertheless recommended that certain conditions be met so that there is no exacerbation of the disease. First of all, the doctor should explain the rules of nutrition. The patient is allowed to eat compotes, weak tea, bread, cottage cheese, light vegetable soups, dietary meat, poultry, porridges and sweet fruits. Strongly banned fresh yeast baked goods, lard, sorrel and spinach, fatty meat and fish varieties, spicy spices, ice cream, strong coffee and tea, alcohol.
Secondly, a person is required to comply with the sleep and rest regime, do not load himself with physical exertion, do not take medicines without consulting the attending physician. As a basis of a way of life it is necessary to choose the rejection of bad habits, since nicotine and alcohol destroy red blood cells, and this affects the amount of free bilirubin in the blood.
If everything is observed correctly, this makes Gilbert's syndrome almost invisible. What is dangerous for a relapse or a diet breakdown? At least the appearance of jaundice and other unpleasant consequences. When manifesting the symptoms, barbiturates, cholagogue and hepatoprotectors are prescribed. In addition, prevent the formation of gallstones. To reduce the level of bilirubin, enterosorbents, ultraviolet radiation and enzymes are used to help digestion.
As a rule, there is nothing terrible in this hereditary disease. The bearers of it live for a long time, and if they comply with the prescriptions of the doctor, then happily. But from any rule there are exceptions. So, what surprises can present Gilbert's syndrome? What is dangerous is a slow, but true failure of the compensatory capabilities of the human body?
Violent regime violators and diets eventually develop chronic hepatitis, and it is no longer possible to cure it. It is necessary to perform a liver transplant operation. Another unpleasant extreme is cholelithiasis, which also does not manifest itself for a long time, and then it strikes a decisive blow to the body.
Because this disease is genetic, there is no special prevention. The only thing that can be advised is to conduct a genetic consultation before planning a pregnancy. People who have a hereditary predisposition can be recommended to lead a healthy lifestyle, exclude hepatotoxic drugs, alcohol and smoking. In addition, it is necessary to undergo regular medical check-ups, at least once every six months, in order to identify diagnoses that can trigger the onset of the disease.
That's it, Gilbert's syndrome. What it is, in simple words it is still difficult to answer. The processes in the body are too complicated to be immediately understood and accepted.
Fortunately, people with this pathology have no reason to fear for their future. Especially hypochondriacs may be any malaise on Gilbert's syndrome. Why is this approach dangerous? Hyperdiagnostics of everything at once.