{ Jaundice Clinical round By Dr. Ehab M. Oraby
Jan 05, 2016
{Jaundice
Clinical roundByDr. Ehab M. Oraby
2Dr. Ehab M. Oraby
Yellowish discoloration of: Tissues ex. Sclera and palate except
brain. Body fluids urine and stool except CSF,
tears and saliva.
Definition
3Dr. Ehab M. Oraby
Destruction of RBCs release of HB Haeme + Globin
Haeme iron + bilirubin (in unconjugated form = water insoluble).
Conjugation occurs in liver (bilirubin becomes water soluble).
Pathophysiology:
4Dr. Ehab M. Oraby
Secretion of conjugated form of bilirubin to biliary tract then to GIT stool coloration.
Some of conjugated bilirubin absorbed from GIT to circulation renal excretion.
Pathophysiology:
5Dr. Ehab M. Oraby
Hemolytic Anemia: Young age. Congenital or Acquired. Attacks of “crisis” ++ Hemolysis ++
unconjugated bilirubin, ++ conjugation, ++ conjugated bilirubin dark stool & normal urine.
Pathophysiology:
6Dr. Ehab M. Oraby
Hemolytic Jaundice: Anemia (chronic with periodic
exacerbations). During attacks diffuse abdominal pain +
bony pains + fever with rigors. Splenomegaly. Gall stones “pigment stones”. Leg ulcers.
Pathophysiology:
7Dr. Ehab M. Oraby
Hepatocellular Jaundice: Any age. Mostly viral hepatitis cirrhosis. Others:
drug induced hepatitis.
Pathophysiology:
8Dr. Ehab M. Oraby
Hepatocellular Jaundice: Liver fail to conjugate bilirubin + fail to
properly secrete conjugated fraction to biliary tree ++ blood level of conjugated bilirubin and bile salts.
Conjugated bilirubin jaundice + excreted in urine dark urine.
Bile salts in blood pruritus. Stool is normal.
Pathophysiology:
9Dr. Ehab M. Oraby
Hepatocellular Jaundice: Other stigmata of LCF: gynecomastia,
spider naevi, palmar erythema, ascites and lower limb edema
Pathophysiology:
10Dr. Ehab M. Oraby
Obstructive Jaundice: Failure of bile drainage ++ blood level
of conjugated bilirubin and bile salts jaundice, dark urine, pale clay stool and pruritus.
Obstruction is either calcular or malignant.
Pathophysiology:
11Dr. Ehab M. Oraby
Calcular obstruction: Females, Middle age. By gall stone impacted in ampulla of vater.
Pathophysiology:
12Dr. Ehab M. Oraby
Calcular obstruction: Intermittent jaundice + pain “biliary” +
fever.
Pathophysiology:
13Dr. Ehab M. Oraby
Calcular obstruction: Gall Bladder is non-palpable except in cases with:
double impaction or strategic impaction.
Pathophysiology:
14Dr. Ehab M. Oraby
Re Calcular obstruction: Females, Middle age. By gall stone impacted in ampulla of vater. Intermittent jaundice + pain “biliary” + fever. Gall Bladder is non-palpable except in cases with double impaction or
strategic impaction.
Pathophysiology:
15Dr. Ehab M. Oraby
Malignant Obstruction: Males, old age. By:
Pancreatic head tumors Malignant LN in porta hepatis Bile duct cancer”cholangiocarcinoma”.
Pathophysiology:
16Dr. Ehab M. Oraby
Malignant Obstruction: Painless except late. Epigastric pain referred to back patient
position is leaning forward.
Pathophysiology:
17Dr. Ehab M. Oraby
Malignant Obstruction: Jaundice is progressive except:
in cases with peri-ampullary carcinoma.
Pathophysiology:
18Dr. Ehab M. Oraby
Malignant Obstruction: Gall Bladder is palpable “courvoiser law”
except in cases with: double pathology “cancer + gall stone” or malignant LN ???coming from cancer Gall
Bladder.
Pathophysiology:
19Dr. Ehab M. Oraby
ReMalignant Obstruction: Males, old age. By:
Pancreatic head tumors Malignant LN in porta hepatis Bile duct cancer”cholangiocarcinoma”.
Painless except late. Epigastric pain referred to back patient position is leaning forward.
Jaundice is progressive except in cases with peri-ampullary carcinoma.
Gall Bladder is palpable “courvoiser law” except in cases with double pathology “cancer + gall stone” or malignant LN ??? coming from cancer Gall Bladder.
Pathophysiology:
20Dr. Ehab M. Oraby
21Dr. Ehab M. Oraby
General examination Look Fascies Complexion Body built and position Vital signs Regional survey
Examination
22Dr. Ehab M. Oraby
Local abdominal examination: Inspection:
General look: Movement with respiration Contour Scars Dilated veins Pigmentation
Specific look: Subcostal angle Linea alba Umbilicus Hair distribution Hernial orifices
Examination
23Dr. Ehab M. Oraby
Palpation: Superficial palpation Deep palpation:
Liver Gall Bladder Spleen Lymph Nodes swelling
Examination
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Percussion: Liver Gall Bladder Spleen Ascites Swelling
Auscultation: Venous hum with portal hypertension
Examination
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Anatomical Pathophysilogical Functional
Diagnosis