IKTERUS atau

JAUNDICE

Tim Pengajar
 Introduction

 Jaundice or icterus is a clinical symptom with

yellowish color in the sclera, skin, and mucose
membrane due to the increase in the
concentration of billirubin in the blood.

 Bilirubin is the product of hemoglobin

metabolism
 PATHOPHYSIOLOGY

 Heme released from

hemoglobin during
erythrocytes degradation in
the spleen, liver and bone
marrow.
 Heme converted into
Biliverdin by heme oxygenase
 Biliverdin reduction into
Bilirubin by biliverdin
reductase
 Bilirubin in the blood is
unconjugated bilirubin
 Conjugated bilirubin is excreted
into the bile canaliculi by the
ATP dependent active
transporter
 Conjugated bilirubin is stored in
the gallbladder and excreted
into the duodenum via bile duct
 Bilirubin is converted to
urobilinogen, urobilin,
stercobilinogen and stercobilin
in the intestine
Bilirubin Metabolism & Elimination
Types of JAUNDICE

Jaundice divided into 3 forms :

1. Juandice Pre Hepatic
2. Juandice Hepatic
3. Jaundice Post Hepatic
Pathophysiology Jaundice
 Jaundice Pre Hepatic
Bilirubin is
Bilirubin levels
returned to Blood
exceed the
Increased red circulation hemolysis +
liver's
blood cell and hypoxia can
capacity to
destruction unconjugated cause
be
(hemolysis) Bilirubin intrahepatic
conjugated
accumulates cholestasis
and excreted
in the blood

Increasing the
formation of
urobilinogen
and
stercobilinogen
Cause of Jaundice Pre Hepatic
 Jaundice Hepatic
Hepatocellular
disorders
(decreased Bilirubin is not Some conjugated
hepatocellular conjugated and bilirubin is excreted
uptake, inability to conjugated back by the kidneys and
conjugate, into the detected in urine
decreased bloodstream (urobilinogen)
excretion of bilirubin
to bile canalicular)
 Jaundice Post Hepatic
Bilirubin is
Extrahepatic excreted by
Bile retention
Disorders of cholestastasis the kidneys
causes reflux
the biliary causes and
of bile into
system bilirubin to be detected in
the liver tissue
(extrahepatic conjugated urine (not
(intrahepatic
cholestasis) back into the uribilinogen
cholestasis)
circulation and not
stercobilin)
Hypothyroidism

Tim Pengajar
Produksi tiroxin
Fungsi fisiologis hormon thiroid;

1. Menstimulasi sintesis protein didalam sel

2. Meningkatkan konsumsi oksigen seluler
3. Meregulasi metabolisme lemak
4. Merangsang pertumbuhan umum dan pematangan
5. Menstimulasi kerja insulin intraseluler
 T3 dan T4 lepas dari ikatan protein masuk
sel dan berikatan dgn respteor pada inti
sel dan efeknya al.

• Metabolic rate ↑
• Konsumsi oksigen ↑
• Denyut jantung ↑
• Katabolisme otot dan jar adiposa ↑
• Sintesis Protein
• Eritropoiesis