Scribd Logo
Upload

Welcome to Scribd!

  • 170 views

    JAUNDICE Internal Medicine Presentation

    Uploaded by

    Shitanjni Wati
    This document discusses hyperbilirubinemia and jaundice. It defines jaundice as a yellowish pigmentation of the skin, sclerae, and mucosa due to increased bilirubin levels in the blood. It then classifies jaundice based on the type of circulating bilirubin (conjugated vs unconjugated) and the site of the problem (pre-hepatic, hepatic, or post-hepatic). The document provides details on the causes, characteristics, evaluation, and treatment of the different types of jaundice.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    JAUNDICE Internal Medicine Presentation

    Uploaded by

    Shitanjni Wati
    170 views34 pages
    This document discusses hyperbilirubinemia and jaundice. It defines jaundice as a yellowish pigmentation of the skin, sclerae, and mucosa due to increased bilirubin levels in the blood. It then classifies jaundice based on the type of circulating bilirubin (conjugated vs unconjugated) and the site of the problem (pre-hepatic, hepatic, or post-hepatic). The document provides details on the causes, characteristics, evaluation, and treatment of the different types of jaundice.

    Original Description:

    Jaundice causes

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses hyperbilirubinemia and jaundice. It defines jaundice as a yellowish pigmentation of the skin, sclerae, and mucosa due to increased bilirubin levels in the blood. It then classifies jaundice based on the type of circulating bilirubin (conjugated vs unconjugated) and the site of the problem (pre-hepatic, hepatic, or post-hepatic). The document provides details on the causes, characteristics, evaluation, and treatment of the different types of jaundice.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    170 views34 pages

    JAUNDICE Internal Medicine Presentation

    Uploaded by

    Shitanjni Wati
    This document discusses hyperbilirubinemia and jaundice. It defines jaundice as a yellowish pigmentation of the skin, sclerae, and mucosa due to increased bilirubin levels in the blood. It then classifies jaundice based on the type of circulating bilirubin (conjugated vs unconjugated) and the site of the problem (pre-hepatic, hepatic, or post-hepatic). The document provides details on the causes, characteristics, evaluation, and treatment of the different types of jaundice.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 34

    HYPERBILIRUBINEMIA

    JAUNDICE
    (Icterus)

    Presenter: Abdul Mushib Ibrahim


    MBBS Year 4
    UPSM
    Definition
    • Refers to YELLOWISH pigmentation of:
    SKIN
    SCLERAE
    MUCOSA
    -Due to increased levels of bilirubin in the blood.
    VALUES
    NORMAL PLASMA Bilirubin:
    0.5mg/dl

    ABNORMAL PLASMA Bilirubin:


    > 1.5mg/dl or > 35micromoles/L
    Classification of Jaundice
    Jaundice is classified by
    1-Type of Circulating Bilirubin:
    a)Conjugated
    b)Unconjugated

    2-Site of Problem:
    a)Pre-Hepatic
    b)Hepatic
    c)Post Hepatic/Cholestatic/Obstructive
    RBC BREAK DOWN
    GLOBIN
    1-Gilbert’s
    Syndrome
    2-Crigler Najjar
    YELLOW Syndrome
    HEME DISCOLOURATION
    OF SKIN
    Bilary Tree &
    Cystic Duct->
    biliverdin BILE
    Unconjugated-
    (green bilirubin-
    color) yellow
    Intestinal Bactria
    ALBUMIN
    BLOOD STREAM
    Urobilinogen

    UDP-glucuronyl Conjugated
    LIVER transferase Bilirubin

    stercobilin urobilin
    Uncongugated Bilirubin
    -Is water insoluble.
    -It does not enter urine.
    -Bound to plasma Albumin-> travels to Liver->to
    form congugated Bilirubin.
    -Results in ACHOLURIC Hyperbilirubinaemia.
    Classification of Jaundice
    Jaundice is classified by
    1-Type of Circulating Bilirubin:
    a)Unconjugated
    b)Conjugated

    2-Site of Problem:
    a)Pre-Hepatic
    b)Hepatic
    c)Post Hepatic/Cholestatic/Obstructive
    Pre-Hepatic-Uncongugated

    • The pathology is occurring prior to the liver

    • caused by anything which causes an increased


    rate of breakdown of red blood cells

    • ISOLATED raised Bilirubin levels-


    (Uncongugated)
    Hemolytic Jaundice:

    Genetic diseases, such as:

    1-sickle cell anemia


    2-spherocytosis
    3-thalassemia
    4 glucose 6-phosphate dehydrogenase
    deficiency
    Infective Causes:

    5-Malaria-In tropical countries


    6-Leptospirosis.

    Congenital Causes:

    7-Gilbert’s Syndrome
    8-Cringler Najjar Syndrome
    TYPE I
    TYPE II
    Classification of Jaundice

    1-Type of Circulating Bilirubin:


    a)Unconjugated
    b)Conjugated

    2-Site of Problem:
    a)Pre-Hepatic
    b)Hepatic
    c)Post Hepatic/Cholestatic/Obstructive
    Hepatic Jaundice-Congugated
    DEFINITION

    Results from the inability of the liver to


    transport bilirubin across the hepatocyte into
    the bile duct, occuring as a consequence of
    parenchymal liver disease.
    • Bilirubin transport is impaired because of:
    Uptake of Uncongugated Bilirubin into the cells
    Transport of Congugated Bilirubin into the Canaliculi.
    • In Hepatic Jaundice, concentrations of both
    congugated and Uncongugated Bilirubin
    increase.
    • CARACTERISTICS OF HEPATIC JAUNDICE
     Increase in Transaminases
     AST (Aspartate Transaminase-5-35 iu/L)
    ALT (Alanine Aminotransferase-5-35iu/L)
    NOTE: Increase in other LFTS suggest other specific
    aetiologies.
    • Acute Jaundice in presence of AST > 1000U/L
    is HIGHLY SUGGESTIVE of:
    1.An Infectious Cause
     Hepatitis A, B,C, Alcoholic,
     CMV
     EBV

    2.Hepatic Ischaemia
    3. Drugs
     Paracetamol Overdose
     Isoniazid, Rifampicin, Pyrazinamide
     Monoamine Oxidase Inhibitors
     Sodium Valproate
     Halothane
     Statins
    Other Causes of Hepatic Jaundice
    4. Failure to excrete Congugated Bilirubin
     Dubin Johnson Syndrome
    Rotor Syndrome
    5-Sepsis ,hypoperfusion states
    6-Toxins
     Fungi-Amanita Phalloides
    Carbon Tetrachloride
    DIAGNOSING HEPATIC JAUNDICE
    • Blood Test-LFTS
    • Imaging-essential to identify features
    suggestive of cirrhosis.
     Irregular liver outline
     Splenomegaly
    Define Patency of Hepatic Arteries, Veins, Portal
    Vein.
    • Liver Biopsy-to define the cause of Hepatic
    Jaundice.
    Classification of Jaundice

    1-Type of Circulating Bilirubin:


    a)Unconjugated
    b)Conjugated

    2-Site of Problem:
    a)Pre-Hepatic
    b)Hepatic
    c)Post Hepatic/Cholestatic/Obstructive
    POST HEPATIC-Obstructive
    (Cholestatic) Jaundice
    Caused by:
    -Failure of hepatocytes to initiate bile flow.
    -Obstruction of Bile flow in bile ducts
    Disease States
    • Obstructive Jaundice– extrahepatic cholestasis
    – Choledocholithiasis (CBD stone)
    – Cancer (peri-ampullary or cholangio CA)
    – Strictures after invasive procedures
    – Acute and chronic pancreatitis
    – Primary sclerosing cholangitis (PSC)
    – Parasitic infections
    • Ascaris lumbricoides, liver flukes
    • Drug induced Cholestatsis
    Flucloxacillin
    Augmentin
    Nitrofurantonin
    Steroids (Pill)
    Sulfonylureas
     Prochlorperazine
     Chlorpromazine.
    • Congugated BilirubinDark UrineBut less
    Congugated Bilirubin enters the gut thus
    feaces is pale.
    • When severeassociated with pruritis RX-
    relief of obstruction.
    Cholestatic Jaundice is CHARACTERISED by:
    INCREASED: ALP -Alkaline Phosphatase-30-150
    GGT(-g- Glutamyl transpeptidase
    U/S is indicated to determine mechnical
    obstruction & Dilatation of bilary tree.
    EVALUATION
    Initial Evaluation: History
    • Jaundice, pale stool, tea-colored urine
    • Fever/chills, RUQ pain (cholangitis)
    – Could lead to life-threatening septic shock
    • Reasons to have hepatitis or cirrhosis?
    – Alcohol, Viral, risk factors for viral hepatitis
    • Exposure to toxins or offending drugs
    • Inherited disorders or hemolytic conditions
    • Recent blood transfusions or blood loss?
    • Is patient septic?
    • Recent gallbladder surgery? (CBD injury)
    Initial Evaluation: Physical Exam
    • Signs of end stage liver disease (cirrhosis)
    – Ascites, splenomegaly, spider angiomata, and
    gynecomastia
    • Jaundice evident first underneath the tongue, also
    evident in sclerae or skin
    • Courvoisier’s sign = painless, but palpable or
    distended gallbladder on exam
    – Could indicate malignant obstruction (e.g Pancretic
    Cancer)
    – Unlikely to be caused by gallstone obstruction.
    Screening Labs
    URINE TEST
    -Bilirubin is absent in pre-hepatic cause.
    -Urobilinogen is absent in obstrcutive cause.

    HAEMATOLOGY
    -FBC
    -Clotting
    BIOCHEMISTRY
    -U&E –LFT (Bilirubin,ALT,AST, ALK PHOS, GGT,
    Total Protein, Albumin)
    • ↑Alk Phos moreso than AST/ALT implies
    “cholestasis” (intrahepatic vs obstruction)
    – ↑Alk Phos also seen in sarcoid, TB, bone
    – In this case, GGT is specific for biliary origin
    • Predominant ↑AST/ALT implies intrinsic
    hepatocellular disease
    – AST/ALT ratio > 2 in alcoholic hepatitis
    • ↓albumin or ↑INR c/w advanced liver dz
    Imaging for Obstructive Jaundice
    • RUQ Ultrasound
    – See stones, CBD diameter->6mmobstruction.
    • ERCP
    – Direct visualization of biliary tree/panc ducts
    – Procedure of choice for choledocholithiasis
    – Diagnostic –AND- therapeutic
    • Endoscopic Ultrasound
    • CT scan
    – Identify both type & level of obstruction
    – If abdominal malignancy is suspected
    Treatment
    • If Medical, then treat the etiology
    • If Obstructive Jaundice:
    – Ascending cholangitis
    • For cholangitis: IVF, IV Antibiotics, Decompression
    – Stones (remove stones vs stent vs drainage)
    • Done via ERCP or open (surgery)
    – Benign stricture (stent vs drainage catheter)
    – Cancer (Stent vs drainage +/- resect the CA)
    THE END
    REFERANCE

    -DAVIDSON’S-PRINCIPLES & PRACTICE OF


    MEDICINE
    -OXFORD HAND BOOK OF CLINICAL MEDICINE
    -WIKIPEDIA

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy