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Symptom Analysis of Jaundice

Symptom Analysis of Jaundice

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Published by: mel_napster on Apr 18, 2010
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JAUNDICE
INTRODUCTION
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.
DEFINITION
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.
TYPES
The three types of jaundice are classified as hemolytic, hepatocellular andobstructive.
HEMOLYTIC JAUNDICE
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 JAUNDICE
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 JAUNDICE
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
 
canaliculi and bile ducts. This can be caused by damage from liver’s tumors, hepatitis or cirrhosis. Causes of extrahepatic obstruction include cammon bile duct obstruction from astone, biliary structures, sclerosing cholangitis, and carcinoma of the head of the pancreas. Laboratory findings show an elevation of both unconjugated and conjugated bilirubin and urine bilirubin. Because bilirubin doesn’t enter the intestine, there isdecreased or no fecal or urinary bilinogen. With the complete obstruction the stools areclay coloured.
ETIOLOGY AND RISK FACTORS
The etiology and risk factors of jaundice are:--Blood transfusion reactions-Sickle cell crisis-Hemolytic anemia-Hepatitis-Cirrhosis-Hepatic carcinoma-Biliary Tract Obstructions
GILBERT’S SYNDROME
Gilbert’s syndrome is a hereditary condition where the liver does not process bilirubin very well.PATHOPHYSIOLOGY [HEPATOCELLULAR CAUSE]Due to hereditary conditionReduced amount of an enzyme urodine diphosphate glucuronosyltransferase (UGT)Decreased processing of bilirubinBack-log of bilirubin can buitd up in blood streamJaundice.
BILIARY ATRESIA
Biliary atresia is a rare condition in newborn infants in which the common bileduct between the liver and the small intestine is blocked or absent. PATHOPHYSIOLOGY [POST HEPATIC CAUSE]Blockage of common bile duct/hereditary cholestatic syndromeBiliary tract cannot transport bile to the intestineBile retained in the liver Liver cirrhosis
 
Conjugated hyperbilirubinemiaJaundice.
SPHEROCYTOSIS
DEFINITIONHereditary spherocytosis is a genetic disorder. Here RBC are spherical in shape.This type of RBC are more prone for destruction while passing through narrowcapillaries result in excess hemolysis.PATHOPHYSIOLOGY [PRE-HEPATIC CAUSE]Due to etiological factors like genetic factor The RBC will become spherical in shapeWhile passing through blood vesselsHemolysis of RBC takes placeBilirubin level increasesJaundice.
TYPHOID
DEFINITIONTyphoid fever is the result of systemic infection mainly by Salmonella typhifound only in man. The disease is clinically characterized by a typical continuous fever for 3 to 4 weeks.PATHOPHYSIOLOGY [POST HEPATIC CASE]Due to the various etiological factors like ingestion of contaminated food, microbialinvasion.Salmonella typhi invades intestinal wall Narrowing of intestinal lumenIntestinal obstructionObstructive jaundice
LIVER CIRRHOSIS
DEFINITION

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