Jaundice - 1
Jaundice - 1
Jaundice - 1
PATIENT WITH
JAUNDICE
Laboratory tests
LFT raised both ALTand AST levels
bilirubin raised both total and direct .
2. Conversion to Bilirubin:
- Hemoglobin is broken down into heme and globin.
- The heme is converted to biliverdin (green pigment) and then to
bilirubin (yellow pigment).
4. Liver Processing:
- In the liver, unconjugated bilirubin is converted into conjugated
bilirubin (water-soluble) through a process called conjugation. This
involves adding glucuronic acid.
5. Excretion in Bile:
- Conjugated bilirubin is secreted into bile and stored in the
gallbladder. It then enters the intestine.
6. Intestinal Conversion:
- In the intestine, bacteria convert bilirubin into urobilinogen and
stercobilin. Stercobilin gives stool its brown color, while some
urobilinogen is reabsorbed into the bloodstream
Types of jaundice
According to
According to According to the
pathophysiolo
gy severity site of pathology
3.Post-Hepatic Causes
These occur when there is
obstruction in the biliary tract,
preventing bilirubin from being
excreted:
- Biliary Obstruction: Gallstones,
strictures, or tumors in the bile duct.
- Pancreatic Cancer: Causing
compression of the bile duct.
- Cholangiocarcinoma: Cancer of the
Other Causes of jaundice
Dietary causes :
1-Malnutrition
2-alcohol consumption
3- high fatty diets
4-excessive iron or copper intake
5-contaminnated food
6- excessive carrot intake *psuedo
Drugs :
1-acetaminophen overdose
2-methotrexate long term
3-Anti TB drugs: isoniazid rifampicin pyrazinamide
4- Antiepileptic drugs : phenytoin carbamazepine
Clinical Approach
History:
personal data
Drug history
Family history
Dietary history
Travel history
Bad habits
Clinical Approach
Clinical Examination:
General look
Vital signs
Signs of complications
Signs of liver disease
Laboratory investigations
1-COMPLETE BLOOD COUNT :
WBC >raised in INFECTION OR INFLAMMATION OF LIVER
or Biliary system or reduced due to BM suppression
HB ANEMIA FOR HEMOLYSIS
PLATELET COUNT IN CIRRHOSIS, HYPERSPLENISM
4- Endoscopic retrograde
cholangiopancreatography ERCP
Therapeutic and diagnostic evaluation of
biliary obstruction and for removal of common
bile duct Stones
Asses pancreatitis or tumors affecting the
pancreas
5- percutaneous transhepatic cholangiography PTC
Indicated when ERCP is not possible or unsuccessful
To relieve biliary obstruction e.g (placing a stent )
acetaminophen toxicity
Autoimmune hepatitis
Wilson's disease
Clinical features:
Jaundice
Hepatic encephalopathy: confusion, altered mental status, coma
Coagulopathy: prolonged PT and increased risk of bleeding
Multisystem involvement: possible renal failure, metabolic disturbances,
infections
Diagnosis :
hyperbilirubinaemia,
high serum aminotransferases
low levels of coagulation factors, including prothrombin and factor V.
hypoglycemia
electrolytes disturbance
electroencephalogram (EEG) is sometimes helpful in grading the
encephalopathy.
Ultrasound will define liver size and may indicate underlying liver pathology
lines of TTT
Treatment of the underlying cause
treatment of the associated abnormalities ( encephalopathy, coagulopathy,
etc)
treatment of complications
Hepatic transplantation
شكرًا جزيًال