11. Accumulation of iron-free hemoglobinogenic pigments. Jaundice

Question 1

When Does Jaundice Appear?

Answer 1

Bilirubin Content of Serum MORE THAN > 34 mmol / L

Question 2

What are the 3 Types of Jaundice?

Answer 2

1. Prehepatic Jaundice = Haemolytic
2. Intrahepatic Jaundice = Hepatocellular
3. Post-Hepatic Jaundice = Obstructive

Question 3

1| What is Pre-Hepatic Jaundice? (Haemolytic)

Answer 3

DUE to EXCESSIVE Breakdown of RBC Membrane

Occur in Sickle Cell Anaemia / Haemolytic Disease of New-born / Incompatible Blood Transfusion / Leukaemia

Question 4

1| What is the Pathogenesis of Pre-Hepatic (Haemolytic) Jaundice?

Answer 4

1) EXCESSIVE Amount of Pigment NOT PASSED Via Liver for Conjugation
2) Liver’s Capacity to Conjugate HAS EXCEEDED
3) LEADS to INCREASED LVLS of Unconjugated Bilirubin IN PLASMA
4) Unconjugated Bilirubin in Plasma CRYSTALLISES OUT of Tissues + Brain, CAUSING NECROSIS
5) LEADS to BRAIN INJURY, RESULTING in BILIRUBIN ENCEPHALOPATHY

Question 5

2| What is Intrahepatic Jaundice (Hepatocellular) ?

Answer 5

FAILURE of Hepatocytes TO CONJUGATE Bilirubin

WHERE Bilirubin PASSES VIA Liver –> Intestines

INCREASED LVLS of BOTH Un / Conjugated Bilirubin IN BLOOD

Question 6

2| What is the MACROSCOPIC Observation of Intrahepatic (Hepatocellular) Jaundice?

Answer 6

AKA Saffron Liver

LIGHT Yellow/Green

Question 7

2| What can Conjugation Failure Lead to?

Answer 7

a. Hepatocellular Jaundice = Viral Hepatitis + Hypoxic Necrosis
b. Drug-Induced Jaundice = Disturbance of Glucuronide Conjugation
c. Intrahepatic Cholestasis = Congenital Intrahepatic Occlusion / Tumours/ Inflammation / Cirrhosis
d. Mushroom / Arsenic / Phosphorous Poisoning

Question 8

3| What is Post-Hepatic (Obstructive) Jaundice?

Answer 8

INCREASED DIRECT Bilirubin in Serum / Alcholic Stools

INCREASED Bilirubin in Urine

DUE to OBSTRUCTION of PASSAGE for Conjugated Bilirubin from Hepatocytes –> Intestines

Where Conjugated Bilirubin = Water-Soluble + EXCRETED Via Urine

Question 9

3| What is the MACROSCOPIC Observation of Post-Hepatic (Obstructive) Jaundice?

Answer 9

Liver is DARK GREEN

Question 10

3| What are the Causes of Post-Hepatic (Obstructive) Jaundice?

Answer 10

• Stenosis of EXTRAHEPATIC Bile Ducts

- GALL STONES in Major Ducts

Question 11

How do Bile Pigments Appear in the Liver?

Answer 11

(i) Bile Pigment Droplets in Hepatocytes
(ii) Bile Impregnations in Necrotic Areas
(iii) Bile Casts
(iv) Kupffer’s Cells