This document discusses jaundice, focusing on its relation to liver function and describing different types, causes, and effects. It outlines the physiological role of the liver, the enterohepatic circulation, and the pathophysiology of jaundice, including pre-hepatic, hepatic, and post-hepatic causes. Additionally, it details factors like liver impairment, excessive red blood cell breakdown, and biliary obstruction that can lead to jaundice, along with the impact of drug abuse and specific toxins.

1. JaundiceA Supplementary Report on the Gastrointestinal System (Liver)Chiu,Ribaya, & UrtulaIV-BSHScOctober 1, 2011

2. Part I: BackgroundThe LiverHepatic LobuleEnterohepatic Circulation (Bile & Blood)Bile ComponentsJaundice2 External, Physical Characteristics4 Types of Jaundice

3. The Liver (a summary)Some functions:Glycogen formation, storage, and break-downSynthesis & secretion of bileCholesterol synthesisDetoxifies by acting like a “sieve” for the hepatic portal systemVitamin, iron, and copper storage

4. Hepatic Lobule (liver unit)Hepatic Portal System / Triad:Portal artery for oxygenated blood from aorta)Portal vein for blood from SIBileduct

5. Enterohepatic CirculationBlood:Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries)Liver cells or hepatocytes get nutrients from sinusoids. Old/damaged erythrocytes are broken downBlood drained out via the central vein -> hepatic veins -> vena cavaBile:Hepatocytes, in turn, synthesize and secrete bile into bile canaliculiBile ducts constantly secrete bile into the duodenum of the small intestine.The rest is concentrated in the gallbladder.The most important components of bile, bile salts, are taken back via the PV.

6. Bile (4 parts)Bile Salts & Lecithin:Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries) [e.g.: used in bile soaps]Cholesterol & Trace Metals:Synthesized/stored material excreted for maintaining blood homeostatis. Cholesterol is a raw material for bile salts.HCO3- and related salts:Neutralizes acids in the duodenum of the intestine

7. Bile (4 parts)Bile Pigments:“left-over” material of broken down hemoglobin from the damaged erythrocytes sieved-out as old or damagedUrine (yellow)-reduced into urobilinFeces (brown)-processed by enzymes into stercobilinBILIRUBIN (cooked in pinapaitan)

8. JaundiceCHARACTERISTIC 1: IcterusYellowing of the skin– extreme increase of bilirubin levels in extracellular fluidHyperbilirubinemia: an excess of bilirubin in the blood

9. JaundiceCHARACTERISTIC 2: IctericscleraeThe yellowing of the conjuntival membranes of the sclera.Hyperbilirubinemia: an excess of bilirubin in the blood

10. Types of JaundicePre-Hepatic:Pathology occurs prior to the liver.[e.g.: malaria, caused by Plasmodium (protist parasites)][e.g.: Gilbert’s syndrome, genetic defect in bilirubin metabolism]Hepatic (or Hepatocellular):Pathology occurs within the liver (or hepatocytes).[e.g.: Cirrhosis, scarring of liver tissue][e.g.: Hepatitis, inflammation of the liver]Post-Hepatic:Pathology after formation of bilirubin in the liver.[e.g.: Obstructive jaundice by gallstones (cholesterol precipitation)][e.g.: Obstructive jaundice by liver fluke (trematode flatworm)]

11. Types of JaundiceNeo-Natal:Commonly known as “yellow baby”.-jaundice in neonates that is usually non-fatal-affects about50% of all babies during their first week of life outside the womb-usually caused by:the excessive breakdown of hemoglobin during this period in life as fetal hemoglobin is being replaced by adult hemoglobin

12. relatively immature liver still trying to cope up with the excretion of bilirubinPart II: Common CausesImpairment of Liver Cells[1] Parasitic Infection, [2] Viral Infection, [3] Liver Cancer, [4] Congenital Disorders, [5] Autoimmune HepatitisExcessive Breakdown of Erythrocytes[1] Hemolytic AnemiaBlockage/Narrowing of Biliary Ducts[1] Obstructive Jaundice (Stenosis / Stricture, Inflammation, Trauma, Gallstones), [2] Tumors, [3] Cirrhosis, [4] Pregnancy /CholestasisI. Impairment of Liver Cells

13. Parasitic Infections2 Common Parasitic Diseases:TrichinosisEating uncooked meat

14. Roundworm: Trichina worm

15. Parasites also block the bile ducts

16. Causes right-sided abdominal pain, fever, enlarged liver and jaundice

17. Treatment: Anti-parasitic drug therapyParasitic Infections2 Common Parasitic Diseases:2. Clonorchiasis - Eating raw fish - Liver fluke: Clonorchissinensis - Parasites also block the bile ducts - Mistaken for cancer of the bile ducts - Treatment: Bithionol

18. Viral InfectionsViral HepatitisInflammation of the liver Body will not be able to manufacture bileBilirubin accumulates in the blood and leaks to surrounding tissue

19. Causes:Hepatitis A – Ingestion of contaminated food and waterHepatitis B – Exposure to contaminated blood or needles, body fluidsHepatitis C – Exposure to contaminated bloodHepatitis D – Occurs only when Hepatitis B is present in personHepatitis E – Ingestion of contaminated food and water

20. Liver CancerOriginates in the liverMalignant tumors inside or on the surface of the liverTumors form in the liverDestruction of liver cells around the tumorBody will not be able to manufacture bileBilirubin accumulates in the blood and leaks to surrounding tissue

21. Congenital DisordersThese are disorders present since birth that makes it hard for the body to process bilirubin.Common Disorder:Gilbert’s SyndromeHarmless, genetic condition

22. Abnormality in the enzyme glucoronyltransferase

23. Disposal of bilirubin

24. Results in mild elevations of bilirubin in the bloodstreamAutoimmune HepatitisChronic form of hepatitis Leads to the progressive damage of the liverImmune system attacks the liverMore common in women than in menSigns and SymptomsSame as those of hepatitis in generalTreatmentImmune system suppressors Prednisone

25. 2 Types:Type IAffects young women

26. Associated with other autoimmune disorders

27. Type 1 Diabetes2. Type II- Less common - Affects girls between ages 2 to 14

28. II. Excessive Breakdown of Red Blood Cells

29. Hemolytic AnemiaNot enough red blood cells in the bloodTypes -> reason for destruction of RBCCould be w/in RBC itself (Intrinsic factors) or outside the RBC (Extrinsic factors)Intrinsic FactorsDefects in hemoglobin productionSickle-cell diseaseDefects of red blood cell membrane productionHereditary spherocytosis

30. Intrinsic Factors (Continued)Defective red cell metabolismPyruvatekinase deficiencyExtrinsic FactorsAbnormal immune system responsesBlood clots in small blood vesselsCertain infections and diseasesMalariaSide effects from medications

31. III. Blockage/Narrowing of Biliary Ducts

32. Obstructive JaundiceStenosis or Stricture of the biliary duct

33. Narrowing or constriction

34. Due to various reasons

35. Inflammation

36. Trauma

37. Gallstones

38. Tumors

39. Cirrhosis

40. Pregnancy

41. Accumulation of bilirubin in the blood and tissuesTraumaInflammation Caused by bile duct diseasesInflammed organs/glands exert pressure that narrows the ductsCauses narrowingMay lead to scarringSurgeryInjuries to abdominal areaDiseaseLeads to scarringGallstonesMost common cause of obstructive jaundiceCrystallized cholesterol from bileCholesterol concentration is higher than other bile contentsObstruction of bileGallbladder openingCommon bile ductSphincter of Oddi

43. TumorsTumors/cysts that block or narrow the bile ductsCan be caused by cancers of LiverBile duct (rare)Pancreas (more common)Mass exerts pressure on the ducts

44. CirrhosisScarring in the liverFinal phase of chronic liver diseaseCauses poor liver functionAccumulation of toxins in liver

45. PregnancyPressureCauses the narrowing of biliary ductsImpedes the flow of bileAKA cholestasis of pregnancy

46. IV. In Focus: Drug Abuse & Jaudice(a) Acetaminophen(b) Alcohol Hepatitis (c) Amatoxin

47. Part III: Other CasesAcetaminophen OverdoseJaundice from the abuse of paracetamolAlcohol Hepatitis / Alcohol Liver DiseaseJaundice from the abuse of alcoholic beveragesAmatoxin PoisoningJaundice from the ingestion of the fungal toxin amatoxinAcetaminophen OverdoseAKA Paracetamol ToxicityJaundice is a sign of liver failureOverdose causes liver damage & failureLow blood sugarLow blood pHEasy bleedingHepatic encephalopathy (worsening of brain function due to toxins)

48. Alcohol HepatitisEarliest stage of alcoholic liver diseaseExcessive intake of alcoholLeads to jaundiceSign of liver failureInflammation of liver Impediment of function When alcohol is still consumed chronically-> Cirrhosis (liver scarring and necrosis) -> liver failure

49. Jaundice & Amatoxin PoisoningAmatoxinis found in deadly amounts among members of the genus Amanita – where the infamous “death caps” Amanita phalloidescome from.Toxic hepatitis:

50. impairs hepatocytes to properly dispose of bile

51. precursor to jaundice (hyperbilirubinemia)

52. can further lead towards liver failure through centrolobular necrosis

53. ability to inhibit mRNA in protein synthesisCommon victims:Uninformed foragers who mistaken baby death caps for puff balls (an edible Amanita).

54. Many local drug abusers who mistaken adult death caps for a Psilocybe.Referenceshttp://www.drugs.com/health-guide/bile-duct-diseases.html

55. http://www.nlm.nih.gov/medlineplus/ency/article/000264.htm

56. http://www.nlm.nih.gov/medlineplus/ency/article/000263.htm

57. http://emedicine.medscape.com/article/187001-overview#showall

58. http://gallstoneflush.com/images/biliary%20tract.JPG

59. http://www.pharmaceutical-drug-manufacturers.com/articles/paracetamol-sideeffects.htmlhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010383/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001597/http://emedicine.medscape.com/article/170539-overviewhttp://labtestsonline.org/understanding/conditions/liver-disease/http://labtestsonline.org/understanding/conditions/hep?start=7http://www.medicinenet.com/jaundice/article.htmWidmaier et al., Vander’s Human Physiology