Jaundice

Prepared and presented by

Groupe (H)

In the name of Allah, the Entirely Merciful, the Especially Merciful.(Sahih International)

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E V Pathway for RBC Scavanging

Liver, Spleen & Bone marrow

Hemoglobin

Globin Heme Bilirubin

Amino acids Fe2+ Through Liver

Amino acid pool Excreted

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Bilirubin is a yellow pigment which causes discolorationof the skin and when serum levels exceed 35-40 µmol/L.

Concentrations may increase for three reasons:

- the production rate of bilirubin is increased, exceeding the excretory capacity of the liver (prehepatic jaundice);

- conjugating and / or excretory functions are reduced, (hepatic or hepatocellular jaundice);

- biliary obstruction interferes with the flow of bile and thus bilirubin excretion (posthepatic, obstructive or

cholestatic jaundice).

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Jaundice – is it a disease? Yellowish staining of the skin and sclerae

High levels of bilirubin in blood

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normal

jaundice

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Category Definition

Pre-hepaticPathology occurs prior to the liver

Hepatic Pathology located within the liver

Post-hepatic

Pathology located after the conjugation of bilirubin in the liver

What causes jaundice?

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Neonatal jaundice Yellowish staining of the skin and whites of the newborn's

eyes (sclerae) by pigment of bile (bilirubin) Breakdown of red blood cells (which release bilirubin into

the blood) and immaturity of the newborn's liver (which cannot effectively metabolize bilirubin and prepare it for excretion into urine)

Normal neonatal jaundice appears between the 2nd and 5th days of life and clears with time

Kernicterus – brain damage - lifelong disability

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What problems does jaundice cause? Skin and sclerae - yellow Stool - light colour, clay coloured Dark urine Pain in abdomen Itching Trouble with sleeping Fatigue Swelling Ascites Mental confusion Coma Bleeding

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Which diseases cause jaundice? Increased production of bilirubin Acute liver inflammation Infiltrative liver diseases Bile duct inflammation Blockage of bile ducts Drugs Genetic disorders Developmental abnormalities of bile ducts Jaundice of pregnancy

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History Physical examination Blood tests - laboratory Ultrasonography CT MRI Liver biopsy ERCP Endoscopic ultrasound

Diagnosis

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Laboratory Tests Bilirubin level in

serum (total and direct)

Aminotransferase Alkaline

phosphatase U/A for bilirubin and

urobilogen

Complete blood count

Prothrombin time Other laboratory

tests pertinent to history

Coombs test Electrophoresis of

hemoglobin Viral hepatitis panel

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Treatment Treatment requires a precise diagnosis

of the specific cause and should be directed to the specific problem

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Summary in liver function tests in the differential diagnosis of jaundice

Test Prehepatic Hepatic Cholestatic

Serum bilirubin Uncojugated MixedConjugated

Urine bilirubin Absent//Present Present Present

Urine Urobilinogen Increased Increased Decreased

ALT & AST Normal Marked Slight increase increase

ALP Normal Slight Marked increase increase

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Recognizing and Treating Jaundice

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The End http://en.wikipedia.org/wiki/Jaundice#Neonatal_jaundice

http://www.medicinenet.com/jaundice/article.htm

http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm

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