1. Jaundice
BY - YOONUS IMRAN
NO – 509101447
SCHOOL OF SCIENCE

2. Contents
Introduction
Anatomy
Etiology
Pathophysiology
Signs & Symptoms
Prevention & Home remedies
Treatments

3. Introduction
 Known as icterus
 Elevation of bilirubin in urine and serum associate with
jaundice
 Bilirubin is derived from haemoglobin metabolism
 Normal bilirubin level – 2.5 to 3 mg/dL
 Depends on disruption of removal of bilirubin there are
3 types of jaundice
Pre-hepatic Hepatic Post hepatic
The disorder cause
before the
transportation of
bilirubin to the liver
from circulation
The disorder cause
inside the liver due to
the hepatic cell
damages
The disruption
blocks the pathway
of bilirubin in to
digestive systems
Figure1: Jaundice patient

4. Anatomy of Liver
Figure 2: Biliary ducts anatomy (cancer.gov, 2015)
Figure 3: Liver conditions (Glauberman, 2008)

5. Pre-hepatic Hepatic Post hepatic
Gall stones
Pancreatic malignancy
Cholangitis
Chronic Pancreatitis
Malaria
Sickle cell anemia
Thalassemia
G6PD deficiency
Hepatitis
Cirrhosis
Liver cancer
Causes of jaundice

6. Pathophysiology of Jaundice
Biliverdin reductase
Heme
Biliverdin
Bilirubin
O2
Fe3+
2 NADPH
2 NADP
CO
NADPH
NADP
Heme
oxygenase
Figure 5: Bilirubin pathway (Kumar and Robbins, 2007).

7. Bilirubin Conjugation
Bilirubin Bilirubin
monoglucuronide
UDP- glucuronyl – transferase
UDP-glucuronic acid UDP
Bilirubin
monoglucuronide
Bilirubin
diglucuronide
UDP- glucuronyl – transferase
UDP-glucuronic acid UDP

8. Signs & Symptoms
 Yellow colour of skin and eyes
 Pruritis (itchiness)
 Fatigue
 Abdominal pain
 Fever
 Paler than usual stools
 Dark urine

9. Diagnosis Tests
 Van den Burgh Test
 Bilirubin tests
 Full blood count (FBC)
 Hepatitis A, B, and C tests
 Abdominal ultrasonography (ultrasound)

10. Prevention & Home Remedies
 Balanced diet
 Maintain healthy cholesterol level
 Exercising
 Avoid alcohol consumption
 Get vaccines for hepatitis A, B and C
 For infants high breast feeding each day

11. Treatments
Hemolytic Jaundice Hepatic Jaundice Obstructive Jaundice
Blood transfusion Stop alcohol Surgery
Bone marrow
transplantation
Liver transplant Remove gallbladder
Iron chelation therapy Remove bile ducts
Folic acid Remove damaged area of
pancreas
Phototherapy
Intravenous immunoglobulin
Exchange transfusion
Infants

12. Summary
 Normal skin colour change to yellow
 Clearly visible when plasma bilirubin exceeds 2.5 – 3 mg/dL
 Needs to differentiate from hypercarotenaemia
 Can be identify by symptoms
 The treatment depends on the underlying cause

13. Reference
cancer.gov, (2015). Anatomy of the extrahepatic bile ducts. [Online] Available at:
http://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq (Accessed: 21 January 2016).
Glauberman, A. (2008). Livers. [Onine] Available at: http://www.sciencephoto.com/media/252896/view
(Accessed 21 January 2016).
Kobos, S. (2004). ‘Jaundice in the Adult Patient’, American Family Physician, pp.299-304. [Online] Aafp.org.
Available at: http://www.aafp.org/afp/2004/0115/p299.html (Accessed: 17 January 2016).
Kruger, and Danielle, (2011). ‘The Assessment of Jaundice in Adults’, Journal of the American Academy of
Physician Assistants. [Online] LWW. Available at:
http://journals.lww.com/jaapa/Fulltext/2011/06000/The_assessment_of_jaundice_in_adults__Tests,.9.aspx
(Accessed: 17 January 2016).
Kumar, V. and Robbins, S. (2007). Robbins basic pathology. Bilirubin Metabolism [Online] Available at:
http://www.us.elsevierhealth.com/robbins-pathology/robbins-basic-pathology-hardcover/9781416029731/
(Accessed: 22 January 2016).
Sherlock, S. and Dooley, J. (2002). Diseases of the Liver and Biliary System. 11th ed. Milan: Black Well
Publishing, pp.54-84. Google Books [Online] Available at: https://books.google.lk/books?id=-TD1_-
SiqvcC&pg=PA3&dq=biliary+system+anatomy&hl=en&sa=X&ved=0ahUKEwiT55X0s7vKAhXGGo4KHY6HD
CUQ6AEIIzAB#v=onepage&q=jaundice&f=false (Accessed: 21 January 2016).
Winslow, T. (2010). Liver. [Online] Available at: http://www.cancer.gov/images/cdr/live/CDR658899.jpg
(Accessed: 17 Jan. 2016).