The liver plays a central role in many essential physiologic processes. It is the primary organ of lipid synthesis, and it detoxifies endogenous and exogenous substancessuch as hormones, drugs and poisons. When the normal physiologic process are altered,numerous hepatic and extra hepatic manifestation of liver disease appear. Thesemanifestations offer the initial clue to liver disease, regardless of the cause.
Jaundice or icterus, is the yellow pigmentation of the sclerae, skin and deeper tissues caused by excessive accumulation of bile pigments in the blood. It is a commonmanifestation of a variety of liver and biliary disease and serves as a starting point for evaluating many of the disorders.Jaundice is a symptom, rather than a disease. The bilirubin level has to beapproximately three times the normal level (2-3mg/dl) for jaundice to occur.
The three types of jaundice are classified as hemolytic, hepatocellular andobstructive.
Hemolytic (pre-hepatic) jaundice is due to the increased break down of the red blood cells (RBCs) which produce an increased amount of unconjugated bilirubin in the blood. The liver is unable to handle this increased load. Causes of hemolytic jaundiceinclude:--Blood transfusion reactions-Sickle cell crisis-Hemolytic anemia
Hepatocellular (hepatic) jaundice results from the liver’s altered ability to takenup bilirubin from the blood or to conjugate or excrete it. Initially both unconjugated andconjugated bilirubin serum levels are increased. In hepatocellular disease, the hepatocytesare damaged and leak bilirubin. In severe disease, both unconjugated and conjugated bilirubin are elevated as a result of both the inability of hepatocytes to conjugate bilirubinand continued cell leaking of conjugated bilirubin and the number of unhealthyhepatocytes increases, the ability to conjugate bilirubin will eventually decrease becausethe conjugated bilirubin is water soluble it is excreted in the urine. The most commoncauses of hepatocellular jaundice are hepatitis, cirrhosis and hepatic carcinoma.
Obstructive (post hepatic) jaundice is due to decreased or obstructed flow of bilethrough the liver or biliary duct system. The obstruction may be intrahepatic or extrahepatic. Intrahepatic obstruction are due to swelling or fibrosis of the liver’s