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A basic summary on the different types and causes of jaundice which served as a supplementary report for our Physiology (HSC 83) lecture on the liver.

Chiu, Jo
Ribaya, Vincent
Urtula, Migs

October 1, 2011

Published in: Health & Medicine
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  1. 1. Jaundice<br />A Supplementary Report on the Gastrointestinal System (Liver)<br />Chiu,Ribaya, & Urtula<br />IV-BSHSc<br />October 1, 2011<br />
  2. 2. Part I: Background<br />The Liver<br />Hepatic Lobule<br />Enterohepatic Circulation (Bile & Blood)<br />Bile Components<br />Jaundice<br />2 External, Physical Characteristics<br />4 Types of Jaundice<br />
  3. 3. The Liver (a summary)<br />Some functions:<br />Glycogen formation, storage, and break-down<br />Synthesis & secretion of bile<br />Cholesterol synthesis<br />Detoxifies by acting like a “sieve” for the hepatic portal system<br />Vitamin, iron, and copper storage<br />
  4. 4. Hepatic Lobule (liver unit)<br />Hepatic Portal System / Triad:<br />Portal artery for oxygenated blood from aorta)<br />Portal vein for blood from SI<br />Bileduct<br />
  5. 5. Enterohepatic Circulation<br />Blood:<br />Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries)<br />Liver cells or hepatocytes get nutrients from sinusoids. Old/damaged erythrocytes are broken down<br />Blood drained out via the central vein -> hepatic veins -> vena cava<br />Bile:<br />Hepatocytes, in turn, synthesize and secrete bile into bile canaliculi<br />Bile ducts constantly secrete bile into the duodenum of the small intestine.<br />The rest is concentrated in the gallbladder.<br />The most important components of bile, bile salts, are taken back via the PV.<br />
  6. 6. Bile (4 parts)<br />Bile Salts & Lecithin:<br />Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries) [e.g.: used in bile soaps]<br />Cholesterol & Trace Metals:<br />Synthesized/stored material excreted for maintaining blood homeostatis. Cholesterol is a raw material for bile salts.<br />HCO3- and related salts:<br />Neutralizes acids in the duodenum of the intestine<br />
  7. 7. Bile (4 parts)<br />Bile Pigments:<br />“left-over” material of broken down hemoglobin from the damaged erythrocytes sieved-out as old or damaged<br />Urine (yellow)-reduced into urobilin<br />Feces (brown)-processed by enzymes into stercobilin<br />BILIRUBIN (cooked in pinapaitan) <br />
  8. 8. Jaundice<br />CHARACTERISTIC 1: IcterusYellowing of the skin– extreme increase of bilirubin levels in extracellular fluid<br />Hyperbilirubinemia: an excess of bilirubin in the blood<br />
  9. 9. Jaundice<br />CHARACTERISTIC 2: IctericscleraeThe yellowing of the conjuntival membranes of the sclera.<br />Hyperbilirubinemia: an excess of bilirubin in the blood<br />
  10. 10. Types of Jaundice<br />Pre-Hepatic:<br />Pathology occurs prior to the liver.[e.g.: malaria, caused by Plasmodium (protist parasites)][e.g.: Gilbert’s syndrome, genetic defect in bilirubin metabolism]<br />Hepatic (or Hepatocellular):<br />Pathology occurs within the liver (or hepatocytes).[e.g.: Cirrhosis, scarring of liver tissue][e.g.: Hepatitis, inflammation of the liver]<br />Post-Hepatic:<br />Pathology after formation of bilirubin in the liver.[e.g.: Obstructive jaundice by gallstones (cholesterol precipitation)][e.g.: Obstructive jaundice by liver fluke (trematode flatworm)]<br />
  11. 11. Types of Jaundice<br />Neo-Natal:<br />Commonly known as “yellow baby”.<br />-jaundice in neonates that is usually non-fatal<br />-affects about50% of all babies during their first week of life outside the womb<br />-usually caused by:<br /><ul><li>the excessive breakdown of hemoglobin during this period in life as fetal hemoglobin is being replaced by adult hemoglobin
  12. 12. relatively immature liver still trying to cope up with the excretion of bilirubin</li></li></ul><li>Part II: Common Causes<br />Impairment of Liver Cells<br /><ul><li>[1] Parasitic Infection, [2] Viral Infection, [3] Liver Cancer, [4] Congenital Disorders, [5] Autoimmune Hepatitis</li></ul>Excessive Breakdown of Erythrocytes<br /><ul><li>[1] Hemolytic Anemia</li></ul>Blockage/Narrowing of Biliary Ducts<br /><ul><li>[1] Obstructive Jaundice (Stenosis / Stricture, Inflammation, Trauma, Gallstones), [2] Tumors, [3] Cirrhosis, [4] Pregnancy /Cholestasis</li></li></ul><li>I. Impairment of Liver Cells<br />
  13. 13. Parasitic Infections<br />2 Common Parasitic Diseases:<br />Trichinosis<br /><ul><li>Eating uncooked meat
  14. 14. Roundworm: Trichina worm
  15. 15. Parasites also block the bile ducts
  16. 16. Causes right-sided abdominal pain, fever, enlarged liver and jaundice
  17. 17. Treatment: Anti-parasitic drug therapy</li></li></ul><li>Parasitic Infections<br />2 Common Parasitic Diseases:<br />2. Clonorchiasis<br /> - Eating raw fish<br /> - Liver fluke: Clonorchissinensis<br /> - Parasites also block the bile ducts<br /> - Mistaken for cancer of the bile ducts<br /> - Treatment: Bithionol<br />
  18. 18. Viral Infections<br />Viral Hepatitis<br />Inflammation of the liver <br />Body will not be able to manufacture bile<br />Bilirubin accumulates in the blood and leaks to surrounding tissue <br />
  19. 19. Causes:<br />Hepatitis A – Ingestion of contaminated food and water<br />Hepatitis B – Exposure to contaminated blood or needles, body fluids<br />Hepatitis C – Exposure to contaminated blood<br />Hepatitis D – Occurs only when Hepatitis B is present in person<br />Hepatitis E – Ingestion of contaminated food and water<br />
  20. 20. Liver Cancer<br />Originates in the liver<br />Malignant tumors inside or on the surface of the liver<br />Tumors form in the liver<br />Destruction of liver cells around the tumor<br />Body will not be able to manufacture bile<br />Bilirubin accumulates in the blood and leaks to surrounding tissue <br />
  21. 21. Congenital Disorders<br />These are disorders present since birth that makes it hard for the body to process bilirubin.<br />Common Disorder:<br />Gilbert’s Syndrome<br /><ul><li>Harmless, genetic condition
  22. 22. Abnormality in the enzyme glucoronyltransferase
  23. 23. Disposal of bilirubin
  24. 24. Results in mild elevations of bilirubin in the bloodstream</li></li></ul><li>Autoimmune Hepatitis<br />Chronic form of hepatitis <br />Leads to the progressive damage of the liver<br />Immune system attacks the liver<br />More common in women than in men<br />Signs and Symptoms<br />Same as those of hepatitis in general<br />Treatment<br />Immune system suppressors <br />Prednisone<br />
  25. 25. 2 Types:<br />Type I<br /><ul><li>Affects young women
  26. 26. Associated with other autoimmune disorders
  27. 27. Type 1 Diabetes</li></ul>2. Type II<br />- Less common<br /> - Affects girls between ages 2 to 14<br />
  28. 28. II. Excessive Breakdown of Red Blood Cells<br />
  29. 29. Hemolytic Anemia<br />Not enough red blood cells in the blood<br />Types -> reason for destruction of RBC<br />Could be w/in RBC itself (Intrinsic factors) or outside the RBC (Extrinsic factors)<br />Intrinsic Factors<br />Defects in hemoglobin production<br />Sickle-cell disease<br />Defects of red blood cell membrane production<br />Hereditary spherocytosis<br />
  30. 30. Intrinsic Factors (Continued)<br />Defective red cell metabolism<br />Pyruvatekinase deficiency<br />Extrinsic Factors<br />Abnormal immune system responses<br />Blood clots in small blood vessels<br />Certain infections and diseases<br />Malaria<br />Side effects from medications<br />
  31. 31. III. Blockage/Narrowing of Biliary Ducts<br />
  32. 32. Obstructive Jaundice<br /><ul><li>Stenosis or Stricture of the biliary duct
  33. 33. Narrowing or constriction
  34. 34. Due to various reasons
  35. 35. Inflammation
  36. 36. Trauma
  37. 37. Gallstones
  38. 38. Tumors
  39. 39. Cirrhosis
  40. 40. Pregnancy
  41. 41. Accumulation of bilirubin in the blood and tissues</li></li></ul><li>Trauma<br />Inflammation <br />Caused by bile duct diseases<br />Inflammed organs/glands exert pressure that narrows the ducts<br />Causes narrowing<br />May lead to scarring<br />Surgery<br />Injuries to abdominal area<br />Disease<br /><ul><li>Leads to scarring</li></li></ul><li>Gallstones<br />Most common cause of obstructive jaundice<br />Crystallized cholesterol from bile<br />Cholesterol concentration is higher than other bile contents<br />Obstruction of bile<br />Gallbladder opening<br />Common bile duct<br />Sphincter of Oddi<br />
  42. 42.
  43. 43. Tumors<br />Tumors/cysts that block or narrow the bile ducts<br />Can be caused by cancers of <br />Liver<br />Bile duct (rare)<br />Pancreas (more common)<br />Mass exerts pressure on the ducts<br />
  44. 44. Cirrhosis<br />Scarring in the liver<br />Final phase of chronic liver disease<br />Causes poor liver function<br />Accumulation of toxins in liver<br />
  45. 45. Pregnancy<br />Pressure<br />Causes the narrowing of biliary ducts<br />Impedes the flow of bile<br />AKA cholestasis of pregnancy<br />
  46. 46. IV. In Focus: Drug Abuse & Jaudice<br />(a) Acetaminophen<br />(b) Alcohol Hepatitis <br />(c) Amatoxin<br />
  47. 47. Part III: Other Cases<br />Acetaminophen Overdose<br /><ul><li>Jaundice from the abuse of paracetamol</li></ul>Alcohol Hepatitis / Alcohol Liver Disease<br /><ul><li>Jaundice from the abuse of alcoholic beverages</li></ul>Amatoxin Poisoning<br /><ul><li>Jaundice from the ingestion of the fungal toxin amatoxin</li></li></ul><li>Acetaminophen Overdose<br />AKA Paracetamol Toxicity<br />Jaundice is a sign of liver failure<br />Overdose causes liver damage & failure<br />Low blood sugar<br />Low blood pH<br />Easy bleeding<br />Hepatic encephalopathy (worsening of brain function due to toxins)<br />
  48. 48. Alcohol Hepatitis<br />Earliest stage of alcoholic liver disease<br />Excessive intake of alcohol<br />Leads to jaundice<br />Sign of liver failure<br />Inflammation of liver <br />Impediment of function <br />When alcohol is still consumed chronically-> <br /> Cirrhosis (liver scarring and necrosis) <br />-> liver failure<br />
  49. 49. Jaundice & Amatoxin Poisoning<br />Amatoxinis found in deadly amounts among members of the genus Amanita – where the infamous “death caps” Amanita phalloidescome from.<br /><ul><li>Toxic hepatitis:
  50. 50. impairs hepatocytes to properly dispose of bile
  51. 51. precursor to jaundice (hyperbilirubinemia)
  52. 52. can further lead towards liver failure through centrolobular necrosis
  53. 53. ability to inhibit mRNA in protein synthesis</li></ul>Common victims:<br /><ul><li>Uninformed foragers who mistaken baby death caps for puff balls (an edible Amanita).
  54. 54. Many local drug abusers who mistaken adult death caps for a Psilocybe.</li></li></ul><li>References<br /><ul><li>http://www.drugs.com/health-guide/bile-duct-diseases.html
  55. 55. http://www.nlm.nih.gov/medlineplus/ency/article/000264.htm
  56. 56. http://www.nlm.nih.gov/medlineplus/ency/article/000263.htm
  57. 57. http://emedicine.medscape.com/article/187001-overview#showall
  58. 58. http://gallstoneflush.com/images/biliary%20tract.JPG
  59. 59. http://www.pharmaceutical-drug-manufacturers.com/articles/paracetamol-sideeffects.html</li></ul>http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010383/<br />http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001597/<br />http://emedicine.medscape.com/article/170539-overview<br />http://labtestsonline.org/understanding/conditions/liver-disease/<br />http://labtestsonline.org/understanding/conditions/hep?start=7<br />http://www.medicinenet.com/jaundice/article.htm<br />Widmaier et al., Vander’s Human Physiology<br />