L2: Jaundice Flashcards
Def of Jaundice
Yellow discoloration of the skin and mucous membrane due to hyperbilirubinemia.
where is Jaundice Best observed?
in the sclera since elastin in the sclera binds bilirubin.
Sites of Jaundice
appears first in soft palate (frenulum of the tongue), sclera (2-2.5 mg/dl), then skin (7 mg/dl) and mucous membranes
what is the normal Bilirubin level?
Normal bilirubin level < 1 mg/dl
when does jaundice appear?
Jaundice > 2.5 mg/dl.
What is PseudoJaundice
hypercarotenemia, the skin may turn yellowish due to the presence of beta-carotene.
Sources of Bilirubin
- 85% from the breakdown of old RBCs-the normal RBC survives 120 days, so every day 1/120 of blood is turning over.
- 15% from other heme containing enzymes, cytochromes, myoglobin, and immature RBCs in the bone marrow.
Bilirubin Metabolism
Compare between Conjugated & Unconjugated Bilirubin in terms of:
- Solubility?
- Normal Site
- Filtration by Kidney?
Normal Bile Composition
Major causes of Jaundice
Pre-Hepatic Causes of Jaundice
Hepatic Causes of Jaundice
Post-Hepatic Causes of Jaundice
Causes of Recurrent jaundice
DDx of Jaundice
- Carotenemia
- Atabrine toxicity
- Diffuse Xanthomatosis
pathogenesis of Hemolytic jaundice
Etiology of Hemolytic jaundice
CP of Hemolytic jaundice
Investigations of Hemolytic jaundice
Pathogenesis of Hepatocellular Jaundice
Etiology of Hepatocellular Jaundice
CP of Hepatocellular Jaundice
Investigations for Hepatocellular Jaundice
Pathogenesis of Obstructive Jaundice
Etiology of Obstructive Jaundice
CP of Obstructive Jaundice
Investigations for Obstructive Jaundice
what Causes elevated Indirect Bili?
What causes elevated Direct Bili?
Causes of elevated uncojugated hyperbilirubinemia
what is the Most common cause of unconjugated hyperbilirubinemia?
Gilbert’s syndrome
Gilbert’s syndrome
- Most common cause of unconjugated hyperbilirubinemia; an inborn error of metabolism affecting bilirubin uptake as well as conjugation in
the liver; totally asymptomatic: mild hyperbilirubinemia.
Crigler-Najjar Syndrome (Types I and II)
Usually lethal, pediatric illness; congenital total or relative deficiency of glucuronyl transferase.
Neonatal jaundice
- In infants, the liver may be unable to function at full capacity, therefore there is decreased conjugation.
- The high levels of bilirubin may cause seizures (kernicterus).
- Treatment is phototherapy, which makes bilirubin more water soluble to be excreted into the bile.
Compare between Hereditary causes of Isolated hyperbilirubenemia in terms of:
- genetic Status
- deficit
- CP
- TTT
what are causes of isolated hyperbilirubenemia?
Hx
Approach to jaundice
General Ex
Approach to jaundice
Local Ex
Approach to jaundice
Investigations
Approach to jaundice
Compare between approach of Calcular Obstruction & malignant obstruction
Compare between approach of intra & extra hepatic cholestasis
- Jaundice with fever
- Isolated hyperbilirubenemia
- Jaundice with pain
- Recurrent jaundice
- 3 types of jaundice
- Painless jaundice
