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Jaundice Overview

Jaundice Overview

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Published by Anwar Asyhraff
Basic things about jaundice
Basic things about jaundice

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Published by: Anwar Asyhraff on Sep 27, 2013
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CLASSIFICATION AND CAUSES OF JAUNDICE

2 mg/dL (<25µmol/L). • Concentration of bilirubin in blood plasma is normally below 1.5 mg/dL (>50µmol/L) leads to jaundice . A concentration higher than 2.Jaundice • Jaundice is a yellowish pigmentation of the skin. This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid. the conjunctival membranes over the sclerae and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood).

bacterial. metabolic diseases (Wilson’s) Post-Hepatic or Obstructive Jaundice . G6PD deficiency. Dubin-Johnson. Anaemia. Acquired autoimmune haemolytic.Pre-Hepatic or Hemolytic Jaundice • E.g Gilbert’s syndrome.g Hereditary spherocytosis. cirrhosis. Crigler-Najjar. poisons). alcohol. drugs. Rotor • Acquired: hepatocellular dysfunction • E.g Hepatitis (viral. Haemoglobinopathies Hepatic or Hepatocellular Jaundice • Hereditary/congenital: Impaired hepatic bilirubin transport • E.

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unconjugated) in urine is suggestive of hemolytic jaundice. Bilirubin is not usually found in the urine because unconjugated bilirubin is not water-soluble. . the combination of increased urine-urobilinogen with no bilirubin (since. leads to the increased production of urine-urobilinogen.Pre-Hepatic or Hemolytic Jaundice • Pre-hepatic jaundice is caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells) • In jaundice secondary to hemolysis. so. the increased production of bilirubin.

• Occurs prior to the liver. • Common conditions: Hereditary spherocytosis. Acquired autoimmune haemolytic. Urine colour (Normal). Haemoglobinopathies • C/F: Anaemia. Anaemia. Fatigue. Spleenomegaly (May present). . G6PD deficiency. • Diagnosis : LFT (normal). Urobilinogen (Increase).

cirrhosis. hepatotoxicity. drug induced hepatitis and alcoholic liver disease. .Hepatic or Hepatocellular Jaundice • Hepatocellular (hepatic) jaundice can be caused by acute or chronic hepatitis. • Cell necrosis reduces the liver's ability to metabolize and excrete bilirubin leading to a build up of unconjugated bilirubin in the blood.

Liver Cirrhosis. ascites. • C/F : Pain in RHC.• Occurs within the liver. Alcoholic Liver Disease. Liver CA. varicose vein. • Concentration of both unconjugated and conjugated bilirubin rises in the blood. . • Common conditions: Hepatitis.

no urobilinogen is found in the urine. either intra-hepatic or post-hepatic. also called obstructive jaundice. since bilirubin has no access to the intestine and it is in the intestine that bilirubin gets converted to urobilinogen to be later released into the general circulation. presence of bilirubin (conjugated) in the urine without urine-urobilinogen suggests obstructive jaundice.Post-Hepatic or Obstructive Jaundice • Post-hepatic jaundice. In this case. • In complete obstruction of the bile duct. is caused by an interruption to the drainage of bile in the biliary system. .

cholangitis.• Occurs after the conjugation of bilirubin in the liver. . • Common condition: Gallstone. liver fluke infestation. pancreatic cancer. • Due to the obstruction to the drainage of conjugated bilirubin in the biliary system. • Courvoisier's law applied. • C/F: Colicky pain in RHC.

Function test Pre-hepatic Jaundice Hepatic Jaundice Post-hepatic Jaundice Total bilirubin Normal / Increased Increased Increased Increased Decreased Dark (urobilinogen + conjugated bilirubin) Normal/Pale Increased Normal Decreased / Negative Dark (conjugated bilirubin) Pale Conjugated bilirubin Normal Unconjugated bilirubin Urobilinogen Normal / Increased Normal / Increased Urine Color Stool Color Alkaline phosphatase levels Normal Normal Increased Alanine transferase Normal and Aspartate transferase levels Conjugated Bilirubin Not Present in Urine Splenomegaly Present Increased Present Present Absent .

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