Task 1

Answer the questions

1.What are the reasons of parenchymatous jaundices appearance?

Parenchymal jaundice is caused by a viral hepatitis, usually hepatitis A or B.

Gilbert's syndrome
Alcoholic hepatitis
Liver cirrhosis
Epstein-Barr virus
Autoimmune disease
Drugs

2.Indicate the special features of anamnestic data and diagnostics of parenchymatous jaundices
according to the syndrome, please.

Jaundice syndrome

Skin color organ or yellow

Stool color - Pale

Urine color -Dark

Biochemical blood - Hyperbilirubinemia, elevation of transaminase level

Hepatomegaly - Pain in right hypochondrial region

Splenomegaly

3.What are the main diagnostic tests used for parenchymatous jaundices confirmation?

Liver Chemistry PanelSerum total and fractioned direct bilirubin should be obtained. In cholestasis,
predominantly direct hyperbilirubinemia (more than 50% of total bilirubin) is observed. Serum alkaline
phosphatase is also evaluated 3 times more than the upper normal limit in cholestasis, while normal or
mild elevation in transaminases (ALT/AST) is a pure form of cholestatic jaundice. Serum albumin is
usually normal except in cirrhosis and chronic liver disease where albumin is decreased.

Hematology

Leukocytosis is found in cholangitis, alcoholic hepatitis, and underlying malignancy.

Acute severe anemia can be found due to hemolysis. Evaluation of peripheral smear, reticulocyte count
can help to differentiate. Chronic anemia can be seen in cirrhosis or underlying malignancy.
Radiological Evaluation

Abdominal ultrasound can help to identify if there is any biliary ductal dilation and help differentiate
hepatocellular causes of cholestasis (where ducts will be normal size) versus biliary obstruction (where
ducts will be dilated).

Liver biopsy

4.What are the bilirubin abnormalities typical for parenchymatous jaundices?

Unconjugated hyperbilirubinemia is usually a result of too much bilirubin presented to the conjugating
machinery (from increased red blood cell destruction). Increased red blood cell breakdown may be caused
by red blood cell membrane disorders, red blood cell enzyme disorders, hemoglobin disorders,
autoimmune red blood cell destruction, or some cancers. The excess turnover of red blood cells results in
increased heme metabolism, producing large amounts of bilirubin that overwhelm the conjugating
machinery, leading to decreased excretion and clinical jaundice.

5.Enumerate the another biochymycal indexes which can be used for differential diagnostics of
parenchymatous jaundices from the jaundices of another nature?

Specific antibodies against viral hepatitis, amylase level

6.What are the reasons of hemolytic jaundices appearance?

Hemolytic anemia cause by malaria, glucose-6- dehydrogenase deficiency, hereditary abnormality and
autoimmune disease

7.Indicate the special features of anamnesis and diagnostics according to the syndrome in hemolytic
jaundices?
Jaundice syndrome -

Skin color - Pale- yellow lemon shade

Stool color - Normal or pale

Urine color -Dark urine

Hepatomegaly

8.Which are the diagnostic tests used for hemolytic jaundices confirmation?
Biochemical blood analysis, urinalysis, coombs' test, ultrasound of liver

9.What are the special anamnestic data and diagnostics according to the syndrome in stones
obstructive jaundices?
Hepatomegaly syndrome: palpation and percussion liver is enlarged
Jaundice syndrome: increase ALP, hyperbilirubinemia, pale stool

10. Indicate the stones obstructive jaundices diagnostic tests, please. What is the bilirubin index
typical for these jaundices?
Ultrasound of the gall bladder, in palpation showing mass of stones and thickening of gall bladder

Bilirubin index for obstructive jaundice> 1mg / dl

11. What are the special anamnestic data and diagnostics according to the syndromes in obstructive
jaundices due to cancer?
Jaundice syndrome: skin is yellow-gray or greenish color, hyperbilirubinemia 100-150 micrl / l,
increase transaminase level
Hepatomegaly syndrome: enlargement of liver, pain in right hypochondrial region

12. What are the diagnostics tests used for obstructive jaundices due to cancer?
Ultrasound of liver
CT of liver
Liver biopsy

13. What is the bilirubin index typical for these types of jaundices?
More than 1mg / dl

Task 2

Signs Hemolytic jaundice Parenchymatous Obstructive jaundice

jaundice
Typical cause Excessive Hemolysis Liver tissue damage Obstruction in biliary
disrupting uptake, ducts for bile flow.
conjugation or
abnormal secretion of
bilirubin by liver cell.
Serum indirect / ++ + Normal
unconjugated
bilirubin
Serum direct / Normal + ++
conjugated bilirubin
Urine direct bilirubin # + ++
Urine urobilin ++ ++ #
Feces pigment Dark feces Pale feces Pale feces
Feces fat None + ++
AST, ALT N ++ N/+
ALP, GGT N N/+ ++
Liver size N/+ Increase / N / decrease +
Spleen size + + Usually none
Skin color Pale-yellow Orange / yellow Yellow-gray, greenish
Special test to Coombs test Liver biopsy, Liver biopsy,
determine jaundice laparoscopy percutaneous
type intrahepatic
cholangiography,
Laparoscopy.