Transcript
Jaundice
• Result of retention of bile
• Functions of bile – Elimination – bilirubin, cholesterol, xenobiotics – Bile salts / phospholipids – emulsification of
dietary fat
• Jaundice – yellowish discoloration of skin and sclera (icterus)
• Serum Bilirubin > 2.0 mg/dl (Normal <1.2)
• Cholestasis – systemic retention of bilirubin and other solutes of bile
Heme containing proteins
Bilirubin uridine diphosphate glucuronosyl transferase
ß- glucuronidases
20% enterohepatic circulation
Bilirubin productionHepatic Uptake
Conjugation Excertion
Normal – rates are equal – no jaundice
Unconjugated bilirubin (indirect)
Conjugated bilirubin(direct)
Increased Bilirubin production
Excess production of bilirubin • Hemolytic anemia • Resorption of blood – alimentary
canal/ hematoma • In-effective erythropoiesis
PRE-HEPATIC JAUNDICE
Reduced hepatic uptake• Drug interference • Diffuse hepatocellular disease –
hepatitis
Reduced uptake
HEPATOCELLULAR JAUNDICE
Impaired conjugation
Impaired bilirubin conjugation • Physiologic jaundice of the new born
HEPATOCELLULAR JAUNDICE
Decreased excretion
Decreased hepatocellular excretion • Deficiency in canalicular membrane
transporters • Drug induced membrane dysfunction • Hepatocellular damage / toxicity
HEPATOCELLULAR JAUNDICE
Impaired flow
Impaired intra- extrahepatic bile flow • Inflammatory destruction of bile ducts • Gall stones • Carcinoma of pancreas
Surgically treatable
OBSTRUCTIVE JAUNDICE
PRELIMINARY TESTS
• Total Serum Bilirubin• Ratio of Conjugated bilirubin total
bilirubin • Urine Bilirubin • Urine Urobilinogen • Stool – color
Test Pre- hepatic
Hepato-cellular
Obstructive
Total Bilirubin ↑ ↑ ↑
Conjugated to Total Bilirubin ratio
<20% 20-40% >50%
Urine bilirubin(Only conjugated is
filtrated)
Absent Present Increased
Urine urobilinogen Increased Present Absent
Stool Polycholic Polycholic Pale/acholic
OTHER MANDATORY TESTS
• Transaminases - AST & ALT • Alkaline phosphatase • 5 Nucleotidase • Gamma Glutamyl Transferase
AST & ALT
ALP, GGT5-Nucleotidase,
Test Hepatocellular Obstructive
AST / ALT ↑↑↑ ↑
ALP/ 5 Nucleotidase/
GGT
↑ ↑↑↑
ADDITIONAL TESTS
• Total Protein • Albumin• Pro-thrombin time • Cholesterol• Liver biopsy
To assess the degree of damage to liver
MISC TESTS
• Antibodies – Anti-mitochondrial • Serum Gamma Globulin
top related