Jaundice

1

JaundicePROBLEM BASED LEARNING (PBL)

PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB

BACHELOR MEDICINE AND SURGERY (MBBS)

UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

What is jaundice?

• Rapidly form of bilirubin that it can be excreted and accumulate in the body.

• Patient : - appear yellowish (most seen in the whites of the

eyes) • Bilirubin• waste product produce when erythorcyte is break down by

macrophage.• Normal bilirubin level – 1-20μmol/L• Jaundice can be detectable when bilirubin concentrations

reach 50μmol/L.

Pathophysiology Of Jaundice

Type Of Jaundice

• Prehepatic jaundice (problem occur “before the liver”) – arises from excessive breakdown (hemolysis) of red blood cells (RBC).

- Result in the liver being presented with more bilirubin than it is capable.

• Hepatic (the problem is the “liver” – jaundice occur when the liver is diseased and cannot deal with even normal load of bilirubin.

• Posthepatic (problem occur “adter the liver”) –occurs when bile duct is obsturcted.

Causes of Jaundice• Prehepatic :

- Malaria: a blood-borne infection spread by mosquitoes.- Sickle Cell Anaemia: genetic condition that causes the RBC to develop abnormally.

• Hepatic :- Alcoholic liver disease: the liver is damaged as result of alcohol misuse.- Liver cancer: incurable cancer that develops in the liver.

• Posthepatic :- Gallstones: obstructing the bile duct system (bilirubincannot be eliminated in the feceas).- Gallbladder cancer or bile duct cancer

PATHOGENESIS OF

PERNICIOUS

ANAEMIA

MAIN CAUSES•DIFICIENCY OF VITAMIN B 12 -COBALAMIN

HOW CAN WE GET VITAMIN B12?

OYSTER

MUSSLE

BEEF

FISH-

MACKEREL

CRUSTACEAN

SOY PRODUCT

CEREAL

CHEESE

EGG

PATHOGENESIS• Normally, the vitamin B12 bind together with an Intrinsic Factor and

will be absorb at small intestine.

• IF is a protein made by the stomach’s mucosal (mucus-secreting) cells, called parietal cells. that is necessary for the absorption of vitamin B-12.

Pernicious anemia is considered to be an autoimmune disease,

The body produce autoantibody that fight against intrinsic factor.

Thus, absorption of Vitamin B-12 at small intestine decrease.

Decreasing vitamin B-12 disturb the production of red blood cell

The erythrocyte produced do not divide properly and will have abnormal feature :

The size of erythrocyte is too large – megaloblastic anaemia.

It cant undergo diapedesis – cant get out from bone marrow.

Thus, it will result with decreasing amount of erythrocyte.

Unadequate oxygen supply may occur.

This is how it work

Anaemia – in term it is a condition in which the body does not have enough healthy red blood cells.

AUTOANTIBODY PRODUCE

INTRINSIC FACTOR

DESTROY

VITAMIN B 12 CANNOT BIND

TOGETHER WITH THE INTRINSIC

FACTOR

VITAMIN B 12 CANNOT BE ABSORB AT

SMALL INTESTINE

ERYTHROCYTE PRODUCTION

DISTURB

OXYGEN SUPPLY ALSO

DISTURB

PERNICIOUS

ANAEMIA