definition, causes , types and treatment of jaundice

5. RBCs last 120 days, degraded by reticuloendothelial
(RE) system .
When hemoglobin is destroyed in the body, globin
is degraded to its constituent amino acids, which are
reused, and the iron of heme enters the iron pool,
also for reuse.
Bilirubin :-

8. Congenital hyperbilirubinemia :-
1.Gilbert syndrome
1. It is due to DEFECT in the uptake of bilirubin by the liver
cells (due to mild deficiency of UDP-glucoronyltransferase ).
2. It is asymptomatic unconjugated hyperbilirubinemia .
3. Bilirubin concentrations is usually less than 3 mg/dL .

9. 2. Crigler – najjar syndrome
1. It is due to defect on the conjugation of bilirubin (due to absence of
UDP-GLUCORONYL TRANSFERASE ).
2. It is a rare abnormal recessive disorder .
3. There is two type of Crigler - Najjar :-
a.Type I :-
-severe
-unconjugated hyperbilirubinemia
-Bilirubin concentration is usually exceeds
20mg/dl
-Early Death

10. b. Type II :
-Milder
-Bilirubin below 20 mg/dl
3. Dubin-johnson syndrome
 Rare,benign conjugated
hyperbilirubinemia &bilirubuinuria
 Defect in the transfer of conjugated
bilirubin into the biliary canaliculus.

11. Types Of Jaundice :
1- Congenital jaundice ( explained previously)
2- Acquired jaundice :
a- Physiological jaundice
b- Breast milk jaundice
3- Hemolytic jaundice (pre-hepatic jaundice) :
a- Hemolytic disease of new born
b- Hemolytic disease of adults
4- Hepatocellular jaundice ( hepatic jaundice)
5- Obstructive jaundice ( post hepatic jaundice )

12. Physiological Jaundice :
*Also called Neonatal Jaundice
- In newborn infants
- In the 2nd day of life Mild Jaundice appears .
- Due to 1- an accelerated rate of destruction of RBCs
2- Immature hepatic system of conjugation of bilirubin
- Bilirubin does not increase above 5 mg/dl.
- It disappears by the second week of life .

13. Breast Milk Jaundice
- In some breast-fed infants , prolongation of the jaundice has been attributed
to high level of an estrogen derivative in maternal blood, which is excreted
through the milk. This would inhibit the glucuronyl- transferase system.
- Sulpha and such other drugs may release bilirubin from albumin, and may
cause jaundice in newborn.

14. Hemolytic disease of newborn
A- Incompatibility between maternal and fetal blood : RH+ fetus may produce
antibodies in RH- mother.
B- The child is born with severe hemolytic disease (ex: erythroblastosis
fetalis)
C- In children before the age of 1 year, the blood-brain barrier is not fully
matured, and therefore free Bilirubin enters the brain (kernicterus). It is
deposited in the brain, leading to mental retardation, fits, toxic encephalitis and
spasticity.

15. Hemolytic disease of adults
- Seen in increased rate of hemolysis
- features: - Increase in unconjugated bilirubin.
- Absence of bilirubinuria.
- Excessive excretion of UBG in urine and SBG in feces.
- Common causes are :
1- Congenital spherocytosis.
2- GPD deficiency.
3- Autoimmune hemolytic anemias.
4-Toxins.

16. Hepatocellular Jaundice (hepatic jaundice)
Most common cause is Hepatitis (A, B, C, D, E)
In pure hepatocellular disease :
Compression on
intracellular
canaliculi at the site
of bile formation
Element of
obstruction
Mixed
Bilirubin
jaundice
Conjugation in the
liver
Free bilirubin Inflammatory edema

17. Both conjugated and unconjugated will be increased in hepatocellular
jaundice .
UBG level in urine will be normal or decreased.
Other causes of hepatic jaundice :
alcohol liver disease
Primary biliary cirrhosis
Gilbert's syndrome
Liver cancer

18. Obstructive Jaundice (post-hepatic)
- Conjugated bilirubin is increased in blood and it is excreted in urine.
- If there is complete obstruction, UBG will be decreased in urine or even
absent.
- In total obstruction, the bile does not enter the intestine. And because the
pigments are not entering into the gut , the feces become clay colored.

19. The common causes of obstructive jaundice :
Intrahepatic
1- Chronic active hepatitis.
2- Biliary cirrhosis.
3- Lymphomas.
4- Primary hematoma.
5- Obstructive stage of viral
hepatitis.
Extrahepatic
1- Stones in gallbladder or biliary
tract.
2- Carcinoma of head of pancreas.
3- Enlarged lymph glands in the
porta hepatis.

20. Jaundice complications :
1- Anemia.
2- Bleeding.
3- Infection, sepsis.
4- Chronic hepatitis .
5- Cancer.
6- Liver failure.
7- Kidney failure.
8- Hepatic encephalopathy.
9- Death.

21. Diagnosis of jaundice
1- Urine test : used to measure the level of urobilinogen.
A- If it was higher than expected suggest pre-hepatic jaundice hepatic jaundice.
B- Lower level suggest post-hepatic jaundice.
2- Liver function and blood test :
-- liver function test is type of blood test used to diagnose certain liver
conditions : cirrhosis, alcoholic liver disease.
- When the liver damage it releases enzymes into the blood, and the level of
proteins that the liver produce to keep the body healthy falls.

22. 3- Imaging test : can be used to check abnormalities in liver and bile duct
systems. It includes:
A- Ultrasound scan
B- CT-scan
C- MRI imaging scan
D- ERCP
4- Liver biopsy : may be recommended to assess the condition of liver tissues.
Diagnosis of jaundice :

23. Jaundice Treatment :
- Depends on the causes and types of jaundice.
- Jaundice caused by drugs and toxins requires discontinuation of offending
agent.
- Patients with cirrhosis may require diuretic and lactulose.
- Antibiotics may be required for infectious causes of jaundice.
- Blood transfusion may be required in patients with anemia from hemolysis
or as result of bleeding.
- Patients with cancer leading to jaundice their treatment will vary depending
on type and extent of the cancer
- Surgery may be required for certain patients with jaundice, ex: patients with
gallbladder.

24. Phototherapy :
- Baby may be placed under special lighting that emits light in the blue-green
spectrum
- The light changes the shape and structure of bilirubin molecules in such a
way that they excreted in the urine and stool.
- The light isn’t an ultraviolet light, and a protective plastic shield filters out
any ultraviolet light may be emitted.
- During treatment , the baby will wear only a diaper and protective eye
patches,
- The light therapy may be supplemented with the use of light-emitting pad or
mattress.