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Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
Jaundice
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Jaundice
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Jaundice

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  • 1. Jaundice Dr E M Said
  • 2. objectives <ul><li>About jaundice </li></ul><ul><li>History taking </li></ul><ul><li>Discussion </li></ul>
  • 3.  
  • 4. definition <ul><li>Jaundice (or icterus) is a term used to describe the yellow pigmentation of a patient's skin and sclerae caused by excess bilirubin in the blood. </li></ul><ul><li>Jaundice become visible at >35umole/L </li></ul><ul><li>Jaundice is not itself a diagnosis and the cause should always be sought. </li></ul><ul><li>Many diseases cause jaundice through a variety of different mechanisms. </li></ul>
  • 5. Classification & causes
  • 6. Pre-hepatic hepatic post-hepatic <ul><li>haemoglobin bile duct </li></ul><ul><li>breakdown </li></ul><ul><li> Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  • 7. Prehepatic jaundice: <ul><li>excess production or failure of uptake into liver </li></ul><ul><li>Haemolysis, eg G6PD deficiency </li></ul><ul><li>Autoimmune </li></ul><ul><li>Congentital hyperbilirubinaemia eg Gilberts, </li></ul><ul><li>Crigler Najar </li></ul>
  • 8. Pre-hepatic hepatic post-hepatic <ul><li>haemolysis bile duct </li></ul><ul><li>haem breakdown Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  • 9. Hepatocellular jaundice <ul><li>Hepatocyte failure / damage (ALT>ALP) </li></ul><ul><li>Alcohol </li></ul><ul><li>Viral Hepatitis A, B and C , EBV </li></ul><ul><li>Cirrhosis </li></ul><ul><li>Drugs </li></ul><ul><li>Auto immune </li></ul><ul><li>Hepatoma </li></ul><ul><li>Metastases </li></ul><ul><li>Wilsons </li></ul><ul><li>Hepatic congestion from cardiac failure </li></ul>
  • 10. Pre-hepatic hepatic post-hepatic <ul><li>blood bile duct </li></ul><ul><li>haem Hepatocyte damage </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  • 11. Chronic liver disease <ul><li>Alcohol & viral hepatitis are the most common causes of chronic liver disease and cirrhosis. </li></ul><ul><li>Develop when the functional capacity of the liver can no longer maintain normal physiological conditions </li></ul><ul><li>Jaundice is a feature of chronic liver disease </li></ul>
  • 12.  
  • 13.  
  • 14. Cholestatic jaundice <ul><li>impaired excretion of bile (ALP>ALT) </li></ul><ul><li>Gallstones </li></ul><ul><li>Head of pancreas cancer </li></ul><ul><li>Porta hepatis lymph nodes </li></ul><ul><li>PBC </li></ul><ul><li>Sclerosisng Cholangitis </li></ul>
  • 15. Pre-hepatic hepatic post-hepatic <ul><li>blood bile duct </li></ul><ul><li>haem Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>Bilirubin conjugation </li></ul><ul><li>Liver uptake </li></ul><ul><li>obstruction </li></ul><ul><li>conjugated bilirubin </li></ul>
  • 16.  
  • 17.  
  • 18. History <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>
  • 19. History <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>Painful jaundice Alcoholic,infective,biliary colic,pancreatitis,cholecystitis,metastasis.
  • 20. <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>History Painless jaundice Haemolysis,PBS pancreatic/ biliary malignancy,cirrhosis Heamochromatosis,
  • 21. <ul><li>Associated symptoms? </li></ul>Continue history…
  • 22. Continue history… <ul><li>Associated symptoms? </li></ul><ul><li>N/V </li></ul><ul><li>Haematamesis </li></ul><ul><li>Fatigue </li></ul><ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Loss of apetite/Wt </li></ul><ul><li>Rash/arthritis </li></ul><ul><li>Abd swelling </li></ul><ul><li>Confusion </li></ul><ul><li>Sleep pattern </li></ul>
  • 23. Continue history… <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul>
  • 24. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx. </li></ul>Continue history…
  • 25. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx </li></ul>Continue history… <ul><li>CAGE questionnaire </li></ul><ul><li>Drinking at work </li></ul><ul><li>Driving offences </li></ul><ul><li>Psychological/social problems </li></ul>
  • 26. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul>Continue history…
  • 27. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul>Continue history… Liver & gall stone disorder Malignancy,recent anaesthesia,blood transfusion,autoimmune disorders
  • 28. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul>Continue history…
  • 29. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul>Continue history… Antibiotics,antirhuematic,etc
  • 30. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul><ul><li>Risk factors for viral hepatitis </li></ul>Continue history…
  • 31. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul><ul><li>Risk factors for viral hepatitis </li></ul>Continue history…
  • 32. examination <ul><li>Temp, pulse, BP </li></ul><ul><li>Anaemia, lymph nodes </li></ul><ul><li>Features of cirrhosis </li></ul><ul><li>Encephalopathy </li></ul><ul><li>Nutritional status </li></ul><ul><li>Hepato / splenomegaly </li></ul><ul><li>Tattoos </li></ul>
  • 33. Investigations
  • 34. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul>
  • 35. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul>
  • 36. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul>blood film, reticulocytes, low haptoglobin, high LDH, DCT
  • 37. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul>
  • 38. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Immunoglobulins, </li></ul><ul><li>Auto antibodies (smoth muscle, ANA, AMA, LKM) </li></ul><ul><li>Viral hepatitis serology </li></ul><ul><li>ferritin, </li></ul><ul><li>caeruloplasmin </li></ul><ul><li>alpha 1 anti-trypsin </li></ul>
  • 39. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Radiology USS </li></ul><ul><li>MRCP </li></ul>
  • 40. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Radiology USS </li></ul><ul><li>MRCP </li></ul><ul><li>Invasive Tests </li></ul><ul><li>ERCP </li></ul><ul><li>Liver biopsy </li></ul>
  • 41. Treatment <ul><li>Remove toxin </li></ul><ul><li>Antibiotics </li></ul><ul><li>Fluids </li></ul><ul><li>Relieve obstruction – ERCP, Percutaneous drainage (PTC) </li></ul><ul><li>Ursodeoxycholic acid </li></ul><ul><li>Steroids / immunosupressants </li></ul><ul><li>Liver transplant </li></ul>
  • 42. Any Question?

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