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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