JAUNDICE

PRESENTED BY: ATHARVA DESHMUKH

CONTENTS:

 WHAT IS JAUNDICE?
 ETIOLOGY
 DIFFERENT TYPES OF JAUNDICE
 CLINICAL SINGS AND SYMPTOMS
 HISTOLOGICAL ALTERATIONS IN LIVER
 DIAGNOSTIC TEST’S FOR JAUNDICE
 IS JAUNDICE DANGEROUS?
 THINGS TO REMEMBER WHILE TREATING A JAUNDICE PATIENT
 TREATMENT
 SUMMARY
JAUNDICE

 Jaundice, also known as icterus, is a term used

to describe a yellowish tinge to the skin and
sclera that is caused by an excess of bilirubin in
the blood. Body fluids may also be yellow.
What causes Jaundice?
 alcohol abuse
 Acute inflammation of the liver
 Inflammation of the bile duct
 Obstruction of bile duct
 Gallstones
 parasites in the liver
 Haemolytic anaemia
 Cholestasis
 an adverse reaction to or overdose of a medication
Other causes
 Crigler-Najjar syndrome
 Dubin-Johnson syndrome
 Rotor syndrome
 Gilberts syndrome
Types of Jaundice
1 based upon the underlying derangement of bilirubin metabolism
 Predominantly unconjugated hyperbilirubinemia
 Predominantly conjugated hyperbilirubinemia

2 based upon pathological mechanism giving rise to jaundice

 Haemolytic jaundice
 Hepatocellular jaundice
 Cholestasis jaundice
 Neonatal jaundice
Signs and symtoms

 Yellow tinge to the skin and the whites of the eyes, normally starting at the
head and spreading down the body
 Pruritus (itchiness)
 fatigue
 Abdominal pain - typically indicates a blockage of the bile duct
 Weight loss
 Vomiting
 Fever
 Paler than usual stools
 Dark urine
Yellowing of skin
puritis
CHARCOT’S TRIAD

 It is a triad of three common signs and symptoms seen when there is presence
of stones in bile ducts
 It is named after Jean-Martin Charcot (1825–1893), a French neurologist who
first described the combination of signs and symptoms
1. Pain in the right hypochondrium
2. Intermittent or persistence jaundice
3. Fever with chills and rigors
Haemolytic jaundice
 This type results from increased destruction of red blood cells or their
precursor.
 Causes
 Intraerythrocytic defects
1. Hereditary- spherocytosis, sickle cell disease, thalassaemia
2. acquired- B12 and folate deficiency
 Extraerythrocytic defects-haemolytic anaemias, prosthetic hear valves, drugs
like sulphasalazine and dapsone.
Clinical features of haemolytic jaundice

 Pallor due to anaemia

 Jaundice is mild and no other sign of liver disease
 Hepatosplenomegaly due to increased reticuloendothelial activity
 Dark stools
 Urine turns dark yellow on standing
Cholestatic jaundice

 Cholestasis means failure of bile flow.

 It can be due to small duct obstruction or large duct obstruction

Intrahepatic cholestasis Extrahepatic cholestasis

Drugs, alcohol Gall stones in the CBD
Viral hepatitis Carcinoma in head of pancreas
Severe bacterial infections Stricture of bile duct
Hodgkin's disease Sclerosing cholangitis
hypotension Helminths in CBD
cirrhosis Carcinoma of bile duct
Signs and symptoms

 Signs
1. Pale or clay coloured stools
2. Fever with chills and rigors
3. Haemorrhagic tendency
4. Bone pains
 Symptoms
1. Xanthomas over tendons
2. Xanthelasmas on eyelids
3. Palpable gall bladder
4. Sign's of liver failure
Xanthelasmas on eyelids
xanthoma over tendons
Hepatocellular jaundice

 Bilirubin transport across the hepatocyte may be impaired at any point

between the uptake of unconjugated bilirubin into the cell and transport of
conjugated bilirubin into biliary canaliculi.
 In hepatocellular jaundice concentration of both unconjugated and
conjugated bilirubin rise in blood level
Conjugated and unconjugated bilirubin

feature conjugated unconjugated

Normal serum level less More
Affinity to lipids Absent present
Water solubility Absent present
Serum albumin binding Low High
Renal excretion Present Absent
Van den Bergh reaction direct indirect
Causes

 Viral hepatitis
 Alcoholic hepatitis
 Chronic hepatitis
 Cirrhosis
 Drug induced hepatitis
Histological alterations in liver

 Bile pugs
 Feathery degeneration of hepatocytes
 Small bile duct destruction
 Portal oedema
 Peri cholangitis
 Bile lakes and infarcts
 Biliary cirrhosis
Diagnostic test’s

 liver function tests

 complete blood count (CBC)
 imaging studies
 liver biopsies
Lever function Test results
How dangerous is jaundice

 Acute liver failure-Acute liver failure is the culmination of severe liver cell
injury from a variety of causes including viral hepatitis, toxins, metabolic
disorders of liver and alcohol abuse . The etiology varies with geography.
 In India, viral hepatitis A and E are the most common cause for ALF.
Things to remember treating jaundice
treatment
 Depending on the etiology, specific therapies may be effective. Such
treatment should be started early in the course of the disease, and careful
assessment of disease progression is necessary to prevent liver failure.
 N-acetyl cysteine, when administered early, can reduce liver damage and
hasten recovery in patients with acetaminophen-induced jaundice.
 Prehepatic jaundice- In treating pre hepatic jaundice ,the objective is to
prevent the rapid breakdown of red blood cells that’s causing the bilirubin
levels to buildup in blood
1. Malaria-antimalarial drugs
2. Genetic blood disorders –blood transfusion
 Intrahepatic jaundice-In cases of intra hepatic jaundice little can be done to
repair any liver damage. The aim of treatment is to prevent further damage
1. Alcoholic liver- reduce the alcohol consumption
2. Excessive damage- liver transplant
 Posthepatic jaundice- in most cases of post hepatic jaundice surgery to
unblock the bile system is recommended
summary

 Its is the accumulation of bilirubin in liver

 Jaundice can be caused due to various factors
 It can even be congenital
 Function of liver is altered
 No specific age group or sex predilection
 If underlying cause is not treated it can be dangerous
References

 Davidson- textbook of medicine

 K George Mathew –medicine for undergraduates
 https://www.healthline.com
 http://www.pathpedia.com
 http://www.medlineplus.gov