2. JAUNDICE
• Yellowish discoloration of skin, sclera
and mucous membrane resulting from
deposition of bilirubin .
• It is a sign of liver disease or less often a
hemolytic disorder or disorder of
bilirubin metabolism
3. SEQUENTIAL SITES OF JAUNDICE
1st STAGE
Frenulum of tongue(>1.5mgdl)
2nd STAGE
Sclera of eye (>2.5mgdl)
3rd stage
Skin(>3.5 mg/dl)
4. Differential diagnosis of Yellowing of
skin
• Carotenoderma-yellow color imparted to the
skin because of carotenes prsent in Carrots,
green leafy vegetable, squash, peaches and
oranges.
• Palms, soles, forehead and nasolabial folds.
• Spares the sclera(differentiated from
jaundice)
• Quinacrine an ANTIMALARIAL DRUG- 4-37%
yellowish discoloration of skin, also sclera.
6. Production of bilirubin
• Tetrapyrrole pigment
• Break down product of Heme
• 80-85%- Breadown of Old RBCS
• Rest- Premature destruction of erythroid
cells in the bone marrow and from turnover
of hemoproteins myoglobin and
cytochromes.
• Formation- RE Cells in liver and spleen
10. MEASUREMENT OF URINE BILIRUBIN
• Unconjuated bilirubin always bound to
albumin - not found in urine
• Conjugated bilirubin filtered by the
glomerulus and majority is reabsorbed by the
prox tubules.
• Urine dipstick test- ICTOTEST
• False negative in prolonged cholestasis due to
conjugated BR bound to albumin.
17. A-Unconjugated hyperbilirubinemia
• Increased bilirubin production-Due to
hemolysis and ineffective erythropoeisis
• Decreased hepatocellular uptake-Drugs like
Rifampicin
• Decreased conjugation- Gilberts syndrome
,Criggler –Najjar syndrome
18. B. Conjugated or mixed hyperbilirubinemia
• Dubin johnson syndrome
• Rotors syndrome
19.
20. LIVER DISEASE
A. Hepatocellular dysfunction
• Acute or subacute hepatocellular injury seen
in viral hepatitis , hepatotoxins,, ischaemia
• Chronic hepatocellular disease autoimmune
hepatitis, celiac disease, wilsons disease
21. B-Hepatic disorders with prominent cholestasis
• Infiltrative disease such as sarcoidosis,
mycobacterial infections
• Cholangiocyte injury due to primary biliary
Cirrhosis
23. TAKE HOME MESSAGE
• Jaundice is a hallmark of liver disease
• Through clinical examination and history
becomes vital in all cases
• Classified as pre hepatic, hepatocellular and
cholestatis although overlaps do occur
• Biochemical and radiological evaluation helps
in making a diagnosis.
• This is just a overview.
24. PATIENT A
42YEAR OLD FEMALE WITH HISTORY OF GENERAL
WEAKNESS OF4 MONTHS . SHE WAS FOUND TO
HAVE MODERATE ANEMIA , JAUNDICE AND
MILDSPLENOMEGALY .
28. PatientC
• 35YR OLD MALE WITH COMPLAINTS OF PAIN
ABDOMEN , JAUNDICE , ITCHING AND
PASSING CLAY COLORED STOOLS .
• PREVIOUSLY HE WAS DIAGNOSED WITH GALL
BLADDER STONES BUT HAS NOT TAKEN
TREATMENT .
• GALL BLADDER IS NOT PALPABLE .
