Symptomatology : Jaundice

approach





?

jaundice

carotenemia

carotene





jaundice

bilirubin
total bilirubin > 2.5

(
detect ) total bilirubin > 5


() **




i
sclera
cteric sclera

approach



admit
medical surgical
jaundice admit jaundic

e

abdominal pain jaundice



jaundice hyperbilirubinemia


hyperbilirubinemia direct indirect hyperbilirubinemia

indirect hyperbilirubinemia (DB/TB < 15%) hemolysis, conjugation defect medical

jaundice hemolytic disease G6PD with hemolytic crisis, HbH crisis, Thalassemia

conjugation defect, impair uptake pre-hepatic

hemolysis : +

Total bilirubin 5 mg%

hepatocellular injury o
bstructive
jaundice
 direct hyperbilirubinemia (DB/TB > 15%) hepatic + post-hepatic

bilirubin conjugate direct bilirubin hepatocyte

biliary tract intrahepatic bile canaliculi -> bile duct -> extrahepatic bile duct -> duodenu, -> GI tract

Hepatocellular injury obstructive jaundice

> Hepatocellular injury

direct hyperbilirubinemia

injur
y
infection viral hepatitis, inflammation autoimmune hepatitis, ischemia ischemic hepatitis,
toxin paracetamol toxicity, alcoholic hepatitis



liver failure : decompensated cirrhosis hepatocyte bilirubin excretion

Medical jaundice


> Obstructive jaundice bilirubin

clinical complete obstruction

100 m () surgical jaundice admit s

urgery

intraluminal obstruction: stone, stricture, tumor, parasite,
stent occlusion
intramural obstruction : hematoma, infiltrative tumor, stenosis

extraluminal obstruction : external compression, tumor, abdominal lymph node

stone intermittent jaundice stone

jaundice tumor, neoplasm
progressive

chronic obstruction

approach

Onset&Duration :

Character and progression:

Stool and urine : suggest obstructive jaundice

Pruritus : chronic obstruction

Associated symptoms ( pathophysiology )

> Pre-hepatic :

> Hepatic :
(viral
hepatitis)

(tropical
infection)

para overdose

:
abdominal symptoms

> Post-hepatic : (Stone) progr

essive painless
jaundice suggest malignancy (acute cholangitis)

:
Constitutionalsymptoms

Past medical history

>

>


>

> (IVDU) : viral hepatitis

>
: tropical infection

> : viral hepatitis, hereditary spherocytosis

V/S: fever

( medscape)

yellow -> indirect hyperbilirubinemia ()

orange -> hepatocellular injury

dark green tint -> prolonged biliary obstruction

focus abdominal exam tenderness, mass

 gallbladder Courvoisier's law stone tumor, mass

signs of chronic liver disease, portal hypertension


investigation

>

obstructive jaundice

investigation of choice Ultrasound

bile duct dilatation

obstruction

gallstone

tumor, mass

liver parenchyma cirrhosis

obstructive jaundice ultrasound

>CT scan

tumor
invasion, compression

> CBC, PBS

hemolysis

>Liver function test

Total bilirubin, direct indirect bilirubin

hepatocellular injury pattern

cholestasis

liver synthetic function

http://emedicine.medscape.com/article/171386-clinical#b4
http://www.aafp.org/afp/2004/0115/p299.html


()

1. ( 127-128)

.

(hemolytic
anemia)



(hemolytic


jaundice)


. (hepatocellular jaundice)

2. (


)

()

. (jaundice)

(1)
(
)
( 1)
(obstructive
jaundice)

(
)

( )



()

(2) (hepatocellular jaundice)

(
)

( )

(

)

(

) (

)


() ()
(
)

(3)
(hemolysis)


(hemolytic
jaundice)

(congenital red blood cell abnormalities
hemoglobinopathies)
(autoimmune hemolytic anemias)

(thalassemia)

. (carotenemia)

(carrot)

3-4





()
(
1)


()