Jaundice

12,910 views

Published on

Published in: Health & Medicine
3 Comments
29 Likes
Statistics
Notes
No Downloads
Views
Total views
12,910
On SlideShare
0
From Embeds
0
Number of Embeds
410
Actions
Shares
0
Downloads
662
Comments
3
Likes
29
Embeds 0
No embeds

No notes for slide

Jaundice

  1. 1. Jaundice Dr E M Said
  2. 2. objectives <ul><li>About jaundice </li></ul><ul><li>History taking </li></ul><ul><li>Discussion </li></ul>
  3. 4. definition <ul><li>Jaundice (or icterus) is a term used to describe the yellow pigmentation of a patient's skin and sclerae caused by excess bilirubin in the blood. </li></ul><ul><li>Jaundice become visible at >35umole/L </li></ul><ul><li>Jaundice is not itself a diagnosis and the cause should always be sought. </li></ul><ul><li>Many diseases cause jaundice through a variety of different mechanisms. </li></ul>
  4. 5. Classification & causes
  5. 6. Pre-hepatic hepatic post-hepatic <ul><li>haemoglobin bile duct </li></ul><ul><li>breakdown </li></ul><ul><li> Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  6. 7. Prehepatic jaundice: <ul><li>excess production or failure of uptake into liver </li></ul><ul><li>Haemolysis, eg G6PD deficiency </li></ul><ul><li>Autoimmune </li></ul><ul><li>Congentital hyperbilirubinaemia eg Gilberts, </li></ul><ul><li>Crigler Najar </li></ul>
  7. 8. Pre-hepatic hepatic post-hepatic <ul><li>haemolysis bile duct </li></ul><ul><li>haem breakdown Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  8. 9. Hepatocellular jaundice <ul><li>Hepatocyte failure / damage (ALT>ALP) </li></ul><ul><li>Alcohol </li></ul><ul><li>Viral Hepatitis A, B and C , EBV </li></ul><ul><li>Cirrhosis </li></ul><ul><li>Drugs </li></ul><ul><li>Auto immune </li></ul><ul><li>Hepatoma </li></ul><ul><li>Metastases </li></ul><ul><li>Wilsons </li></ul><ul><li>Hepatic congestion from cardiac failure </li></ul>
  9. 10. Pre-hepatic hepatic post-hepatic <ul><li>blood bile duct </li></ul><ul><li>haem Hepatocyte damage </li></ul><ul><li>Unconjugated </li></ul><ul><li>bilirubin conjugation </li></ul><ul><li>Liver uptake conjugated </li></ul><ul><li>bilirubin </li></ul>
  10. 11. Chronic liver disease <ul><li>Alcohol & viral hepatitis are the most common causes of chronic liver disease and cirrhosis. </li></ul><ul><li>Develop when the functional capacity of the liver can no longer maintain normal physiological conditions </li></ul><ul><li>Jaundice is a feature of chronic liver disease </li></ul>
  11. 14. Cholestatic jaundice <ul><li>impaired excretion of bile (ALP>ALT) </li></ul><ul><li>Gallstones </li></ul><ul><li>Head of pancreas cancer </li></ul><ul><li>Porta hepatis lymph nodes </li></ul><ul><li>PBC </li></ul><ul><li>Sclerosisng Cholangitis </li></ul>
  12. 15. Pre-hepatic hepatic post-hepatic <ul><li>blood bile duct </li></ul><ul><li>haem Hepatocyte </li></ul><ul><li>Unconjugated </li></ul><ul><li>Bilirubin conjugation </li></ul><ul><li>Liver uptake </li></ul><ul><li>obstruction </li></ul><ul><li>conjugated bilirubin </li></ul>
  13. 18. History <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>
  14. 19. History <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>Painful jaundice Alcoholic,infective,biliary colic,pancreatitis,cholecystitis,metastasis.
  15. 20. <ul><li>When the patient first noticed it? </li></ul><ul><li>Was it gradually deepening? </li></ul><ul><li>Any prev episodes of jaundice? </li></ul><ul><li>Any family Hx of jaundice? </li></ul><ul><li>Pruritis? </li></ul><ul><li>Dark urine /pale stool? </li></ul><ul><li>Any abd pain and its nature? </li></ul>History Painless jaundice Haemolysis,PBS pancreatic/ biliary malignancy,cirrhosis Heamochromatosis,
  16. 21. <ul><li>Associated symptoms? </li></ul>Continue history…
  17. 22. Continue history… <ul><li>Associated symptoms? </li></ul><ul><li>N/V </li></ul><ul><li>Haematamesis </li></ul><ul><li>Fatigue </li></ul><ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Loss of apetite/Wt </li></ul><ul><li>Rash/arthritis </li></ul><ul><li>Abd swelling </li></ul><ul><li>Confusion </li></ul><ul><li>Sleep pattern </li></ul>
  18. 23. Continue history… <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul>
  19. 24. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx. </li></ul>Continue history…
  20. 25. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx </li></ul>Continue history… <ul><li>CAGE questionnaire </li></ul><ul><li>Drinking at work </li></ul><ul><li>Driving offences </li></ul><ul><li>Psychological/social problems </li></ul>
  21. 26. <ul><li>Associated symptoms? </li></ul><ul><li>Any cardiac/respiratory symptoms? </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul>Continue history…
  22. 27. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul>Continue history… Liver & gall stone disorder Malignancy,recent anaesthesia,blood transfusion,autoimmune disorders
  23. 28. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul>Continue history…
  24. 29. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul>Continue history… Antibiotics,antirhuematic,etc
  25. 30. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul><ul><li>Risk factors for viral hepatitis </li></ul>Continue history…
  26. 31. <ul><li>Associated symptoms </li></ul><ul><li>Any cardiac/respiratory symptoms </li></ul><ul><li>Full alcohol Hx </li></ul><ul><li>Relevant PMHx </li></ul><ul><li>Full drug Hx </li></ul><ul><li>Risk factors for viral hepatitis </li></ul>Continue history…
  27. 32. examination <ul><li>Temp, pulse, BP </li></ul><ul><li>Anaemia, lymph nodes </li></ul><ul><li>Features of cirrhosis </li></ul><ul><li>Encephalopathy </li></ul><ul><li>Nutritional status </li></ul><ul><li>Hepato / splenomegaly </li></ul><ul><li>Tattoos </li></ul>
  28. 33. Investigations
  29. 34. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul>
  30. 35. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul>
  31. 36. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul>blood film, reticulocytes, low haptoglobin, high LDH, DCT
  32. 37. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul>
  33. 38. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Immunoglobulins, </li></ul><ul><li>Auto antibodies (smoth muscle, ANA, AMA, LKM) </li></ul><ul><li>Viral hepatitis serology </li></ul><ul><li>ferritin, </li></ul><ul><li>caeruloplasmin </li></ul><ul><li>alpha 1 anti-trypsin </li></ul>
  34. 39. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Radiology USS </li></ul><ul><li>MRCP </li></ul>
  35. 40. Continue Investigations… <ul><li>Routine Bloods - LFT, GGT, UE, FBC </li></ul><ul><li>Haemolysis Screen </li></ul><ul><li>Non Invasive Liver Screen </li></ul><ul><li>Radiology USS </li></ul><ul><li>MRCP </li></ul><ul><li>Invasive Tests </li></ul><ul><li>ERCP </li></ul><ul><li>Liver biopsy </li></ul>
  36. 41. Treatment <ul><li>Remove toxin </li></ul><ul><li>Antibiotics </li></ul><ul><li>Fluids </li></ul><ul><li>Relieve obstruction – ERCP, Percutaneous drainage (PTC) </li></ul><ul><li>Ursodeoxycholic acid </li></ul><ul><li>Steroids / immunosupressants </li></ul><ul><li>Liver transplant </li></ul>
  37. 42. Any Question?

×