Jaundice (Icterus)

7,307 views

Published on

0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,307
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
332
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Jaundice (Icterus)

  1. 1. JAUNDICE (ICTERUS) <ul><li>YELLOWISH DISCOLORATION OF SKIN & MUCOUS MEMBRANES </li></ul><ul><li>EXCESS BILIRUBIN IN PLASMA. </li></ul><ul><li>NORMAL RANGE 5-17 micromol/L </li></ul><ul><li>(0.3 – 1.0mg/dl) </li></ul><ul><li>LEVEL ABOUT 50 micromol/L (3mg/dl) </li></ul><ul><li>-> CLINICAL JAUNDICE </li></ul><ul><li>(SCLERA,SKIN,PALATAL MUCOSA) </li></ul>
  2. 2. CONTD <ul><li>DIAZO REAGENT(DIAZOTISED </li></ul><ul><li>SULPHANILIC ACID)->DEMONSTRATES </li></ul><ul><li>+ BILIRUBIN </li></ul><ul><li>SODIUM NITRITE </li></ul><ul><li>+ </li></ul><ul><li>HCL ->A RED COMPD. AZOBILIRUBIN </li></ul><ul><li>CONJUGATED BILIRUBIN ->IMMEDIATE </li></ul><ul><li>(POLAR MOLECULE) REACTION </li></ul><ul><li>DIRECT van den Berg reaction </li></ul><ul><li>UNCONJ.BILIRUBIN ->NO REACTION until alc.is added </li></ul><ul><li>(NONPOLAR) ->INDIRECT van den Berg reaction </li></ul>
  3. 4. contd <ul><li>UROBILINOGEN-CONSISTS OF </li></ul><ul><li>UROBILINOGEN, </li></ul><ul><li>MESOBILINOGEN, </li></ul><ul><li>& STERCOBILINOGEN. </li></ul><ul><li>Conj. B. (soluble in water)- excreted in </li></ul><ul><li>urine. </li></ul><ul><li>Unconj.B.(bound to albumin)- lipid soluble (does not enter gl.filtrate) </li></ul><ul><li>DANGER- binding capacity of albumin exhausted--- absorbed by lipid rich areas in Brain. </li></ul><ul><li>Plasma level 340 micromol/l (20mg/dl) </li></ul><ul><li>Basal ganglia deeply bile stained- irreparable damage to neurons </li></ul><ul><li>KERNICTERUS </li></ul>
  4. 5. TYPES OF JAUNDICE <ul><li>HAEMOLYTIC. </li></ul><ul><li>OBSTRUCTIVE.& </li></ul><ul><li>HEPATOCELLULAR. </li></ul>
  5. 6. HAEMOLYTIC JAUNDICE <ul><li>↑ BILIRUBIN LOAD DUE TO- EXCESSIVE </li></ul><ul><li>BREAKDOWN OF RBCs. </li></ul><ul><li>-INEFFECTIVE </li></ul><ul><li>ERRYTHROPOIESIS (↑IN </li></ul><ul><li>THALASSEMIA,PERNICIOUS ANAEMIA) </li></ul><ul><li>CONDITIONS ARE THOSE ASSOC. WITH HAEMOLYTIC ANAEMIA. </li></ul><ul><li>UNCONJ. HYPERBILIRUBINAEMIA +HEPATIC DYSFUNCTION DUE TO ANAEMIA </li></ul>
  6. 7. CONTD. <ul><li>BIOCHEM. MANIFESTATIONS </li></ul><ul><li>↑ INDIRECTLY REACTING BILIRUBIN IN PLASMA. </li></ul><ul><li>↑ STERCOBILINOGEN IN FAECES </li></ul><ul><li>↑ UROBILINOGEN IN URINE. </li></ul><ul><li>ABSENCE OF BILIRUBIN IN URINE. </li></ul><ul><li>Jaundice not severe. seldom↑85micromol/l(5mg/dl) except </li></ul><ul><li>Rh haemolytic disease of newborn. </li></ul>
  7. 8. OBSTRUCTIVE JAUNDICE <ul><li>OBSTRUCTION TO PASSAGE OF CONJ. BILIRUBIN FROM LIVER CELLS ->INTESTINE. </li></ul><ul><li>CHOLESTASIS – EXTRAHEPATIC </li></ul><ul><li>INTRAHEPATIC </li></ul><ul><li>EXTRAHEPATIC CHOLESTASIS( surgical jaundice) </li></ul><ul><li>1.Blockage of CBD by Gallstones. </li></ul><ul><li>2.Occlusion of Duct by Ca head of Pancrease </li></ul><ul><li>3.Pressure by enlarged L.nodes in Porta hepatis. </li></ul><ul><li>4.Ca. of Duct itself either at Ampulla of Vater or higher </li></ul><ul><li>up. </li></ul>
  8. 9. Contd. <ul><li>INTRAHEPATIC CHOLESTASIS </li></ul><ul><li>LESS OBVIOUSLY ASSOC. WITH MECH. OBSTRUCTION. </li></ul><ul><li>1.Sclerosing cholangitis </li></ul><ul><li>cholangiography -> multiple areas of stenosis& dilatations of intra & extra hepatic ducts. </li></ul><ul><li>Pr.– 85% assoc.with U. Colitis. </li></ul><ul><li>Sec.– in pts.with AIDS &in those with untreated bile duct stenosis </li></ul><ul><li>All varieties of sec. cholangitis progress to Cirrhosis. </li></ul><ul><li>2.Pr. Biliary cirrhosis </li></ul>
  9. 10. contd <ul><li>3.Rare compln.of last trimester of pregnancy </li></ul><ul><li>(effect of oestrogen),oral contraceptives. </li></ul><ul><li>4. Drugs(cholestatic drug jaundice) </li></ul><ul><li>Chlorpromazine & other phenothiazines. </li></ul><ul><li>Halothane,Steroids. </li></ul><ul><li>BIOCHEMICAL MANIFESTATIONS </li></ul><ul><li>1. ↑ Conjugated bilirubin in plasma. </li></ul><ul><li>2.↓ stercobilinogen in faeces. (pale, bulky, offensive) </li></ul><ul><li>Bile salts excluded from bowel(absorption of fat) </li></ul><ul><li>Long standing cases—Malabsorption syndrome, </li></ul><ul><li>Fat soluble vitamins.↓Vit. K->bleeding </li></ul><ul><li>Hypovitaminosis D -Osteomalacia </li></ul>
  10. 11. Contd <ul><li>3.Absence of urobilinogen in urine. </li></ul><ul><li>4.Presence of bilirubin & bile salts in urine. </li></ul><ul><li>5.↑ levels of Pl. alk.PO4ase& ץ glutamyl transferase. </li></ul><ul><li>-- Pruritis (pl. bile salt concn.&unconj. bile salts in skin) </li></ul><ul><li>-- Hypercholesterolaemia->cut. Xanthomas. </li></ul><ul><li>-- ↑ in LDLs & ↓ in HDLs </li></ul><ul><li>Abn.LDL-LipoproteinX(high proportion of </li></ul><ul><li>unesterified cholesterol& phospholipid) </li></ul><ul><li>--Hepatocellular damage </li></ul><ul><li>--Cirrhosis </li></ul>
  11. 12. HEPATOCELLULAR JAUNDICE <ul><li>DIRECT & INDIRECT reacting BILIRUBIN </li></ul><ul><li>---Failure of conjugating mechanism </li></ul><ul><li>---Obstruction to escape of cong. bilirubin </li></ul><ul><li>(from cells to canaliculi &from canaliculi) </li></ul><ul><li>intrahepatic cholestasis </li></ul>
  12. 13. contd <ul><li>1.Enzyme deficiency. </li></ul><ul><li>2.Intrahepatic cholestasis complicating liver cell damage. </li></ul><ul><li>a)Acute fatty liver-obstruction-pr. </li></ul><ul><li>b)Severe neonatal jaundice –obstruction- </li></ul><ul><li>inspissated bile in canaliculi. </li></ul><ul><li>3.Cirrhosis-ac.exacerbation &terminally. </li></ul><ul><li>4.Postop. Jaundice—hepatic necrosis(shock) </li></ul><ul><li>----hepatitis(drugs) </li></ul><ul><li>----red cell destruction(site, haemolysis of transfused cells) </li></ul>
  13. 15. STEPS IN DIAGNOSIS OF JAUNDICED PATIENT <ul><li>CLINICAL HISTORY &EXAMINATION. </li></ul><ul><li>URINE,STOOL </li></ul><ul><li>SERUM BIOCHEMICAL TESTS </li></ul><ul><li>BILIRUBIN </li></ul><ul><li>TRANSAMINASE(AST,SGOT) </li></ul><ul><li>ALKALINE PHOSPHATASE, </li></ul><ul><li>GAMMA GT. </li></ul><ul><li>ALBUMIN </li></ul><ul><li>QUANTITATIVE IMMUNOGLOBULINS. </li></ul><ul><li>HAEMATOLOGY-Hb,WBC,PLATELETS </li></ul><ul><li>BLOOD FILM </li></ul><ul><li>PROTHROMBIN TIME(before & after IM Vit.K) </li></ul><ul><li>X’RAY CHEST </li></ul>

×