Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Approach to a patient with JAUNDICE

2,102 views

Published on

Approach to a patient with JAUNDICE

Published in: Health & Medicine

Approach to a patient with JAUNDICE

  1. 1. Clinical Management of Patient with Jaundice
  2. 2. JAUNDICE Yellow pigmentation of skin, sclera and mucosa due to elevated bilirubin level Visible at 3mg/dL Imbalance between production and clearance of bilirubin. Sclera- high affinity because of elastin content- 3mg/dl
  3. 3. Bilirubin Metabolism:
  4. 4. Classified by: Type of Circulating Bilirubin: 1.Conjugated 2.Unconjugated Site of the Problem: 1.Prehepatic 2.Hepatocellular 3.Cholestatic/ Obstructive
  5. 5. Pre-hepatic Jaundice: - Excess Bilirubin production 1.hemolysis 2.inadequately liver uptake 3.deficient hepatic conjugation - Unconjugated Bilirubin enters the blood - Unconjugated Bilirubin is water insoluble  not excreted in the urine - Resulting in Unconjugated (Indirect) Hyperbilirubinemia
  6. 6. Hepatocellular Jaundice: - With hepatocellular damage +/- cholestasis - Causes: - Viruses: Hep, CMV, EBV - Drugs - Alcoholic Hep, cirrhosis, liver mets/abscess, hemochromatosis - AIH - sepsis, leptospirosis - a1 antitrypsin deficiency - Budd Chiari Syndrome, Wilsons Disease - Failure to Excrete Bilirubin (Dubin – Johnson & Rotor Syndrome) - Right Heart Failure - Toxins( Carbon Tetrachloride) - Fungi (Amanita phaloides)
  7. 7. Cholestatic/Obstructive Jaundice: - Blockage of the Common Bile Duct  Conjugated Hyperbilirubinemia - Conjugated Bilirubin is water soluble  easily excreted in the urine - Pt usually c/o dark, tea-colored urine - Clay-colored stool  due to lack of conjugated bilirubin reaching the GUT - Causes: 1.Choledocholithiasis 2.Pancreatic cancer 3.Porta-hepatis LN 4.Drugs 5.Cholangiocarcinoma 6.Sclerosing Cholangitis 7.PBC 8.Choledochal cyst 9.Biliary atresia
  8. 8. Clinical Manifestations: Ask about: 1.Previous blood transfusion 2.IVDU 3.Body Piercing 4.Tattoos 5.Sexual Activities 6.Travel Hx 7.In Contact with person with Jaundice 8.Family Hx 9.Alcohol Consumption 10.Medications
  9. 9. Physical Exam: 1.Look for signs of chronic liver disease 2.Hepatic Encephalopathy 3.LAD 4.Hepatomegaly 5.Splenomegaly 6.Palpable GB 7.Ascites 8.Pale stools and dark urine
  10. 10. Lab test: Bilirubin (-) in pre-hepatic causes Urobilinogen (-) in Obstructive Jaundice Signs of Hemolysis: Anemia • Elevated LDH • Low Haptoglobin • High Reticulocytes • (+) Coombs test LFT Virology: EBV, CMV, HAV, HBV, HCV Hemochromatosis: elev ferritin & iron:TIBC ratio  high serum iron sat(>50-60) A1-antitrypsin Deficiency – genetic analysis Wilson’s Disease – low serum & high Urine Copper Level, low serum Ceruloplasmin PBC – high anti-mitochondrial ab, AMA AIH – high anti-nuclear & anti-smooth muscle ab US – to check for CBD obstruction MRCP/ERCP – if CBD are dilated Liver Biopsy – if Bile ducts are normal MRI/CT
  11. 11. http://crisbertcualteros.page.tl

×