Jaundice is caused by high levels of bilirubin in the blood which can discolor the skin and eyes. Bilirubin is produced from the breakdown of red blood cells and normally processed and excreted by the liver. Jaundice can be categorized as pre-hepatic, hepatic, or post-hepatic depending on where the underlying pathology is located. Common causes include liver inflammation, blocked bile ducts, and genetic disorders. Diagnosis involves medical history, physical exam, blood tests of liver enzymes and bilirubin levels, and imaging tests. Treatment depends on the specific cause but aims to address the underlying problem leading to elevated bilirubin.

1. In the name of Allah, the Entirely Merciful, the
Especially Merciful.(Sahih International)
Jaundice
Prepared and presented by
Groupe (H)
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2. E V Pathway for RBC Scavanging
 Liver, Spleen &
 Bone marrow
Hemoglobin
Globin Heme Bilirubin
Amino acids Fe2+ Through Liver
Amino acid pool Excreted
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3. Bilirubin is a yellow pigment which causes discoloration
of the skin and when serum levels exceed 35-40 μmol/L.
Concentrations may increase for three reasons:
- the production rate of bilirubin is increased, exceeding
the excretory capacity of the liver (prehepatic jaundice);
- conjugating and / or excretory functions are reduced, (hepatic
or hepatocellular jaundice);
- biliary obstruction interferes with the flow of bile and thus
bilirubin excretion (posthepatic, obstructive or
cholestatic jaundice).
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4. Jaundice – is it a disease?
Yellowish staining of the skin and sclerae
High levels of bilirubin in blood
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5. normal
jaundice
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6. What causes jaundice?
Category Definition
Pre-hepatic Pathology occurs
prior to the liver
Hepatic Pathology located
within the liver
Post-hepatic
Pathology located after
the conjugation of bilirubin in the liver
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7. 
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8. Neonatal jaundice
 Yellowish staining of the skin and whites of the newborn's
eyes (sclerae) by pigment of bile (bilirubin)
 Breakdown of red blood cells (which release bilirubin into
the blood) and immaturity of the newborn's liver (which
cannot effectively metabolize bilirubin and prepare it for
excretion into urine)
 Normal neonatal jaundice appears between the 2nd and
5th days of life and clears with time
 Kernicterus – brain damage - lifelong disability
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9. What problems does jaundice
cause?
 Skin and sclerae - yellow
 Stool - light colour, clay coloured
 Dark urine
 Pain in abdomen
 Itching
 Trouble with sleeping
 Fatigue
 Swelling
 Ascites
 Mental confusion
 Coma
 Bleeding
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10. Which diseases cause jaundice?
 Increased production of bilirubin
 Acute liver inflammation
 Infiltrative liver diseases
 Bile duct inflammation
 Blockage of bile ducts
 Drugs
 Genetic disorders
 Developmental abnormalities of bile ducts
 Jaundice of pregnancy
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11.  History
 Physical examination
 Blood tests - laboratory
 Ultrasonography
 CT
 MRI
 Liver biopsy
 ERCP
 Endoscopic ultrasound
Diagnosis
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12. Laboratory Tests
Bilirubin level in
serum (total and
direct)
Aminotransferase
Alkaline
phosphatase
U/A for bilirubin and
urobilogen
 Complete blood
count
 Prothrombin time
 Other laboratory
tests pertinent to
history
 Coombs test
 Electrophoresis of
hemoglobin
 Viral hepatitis panel
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13. Treatment
Treatment requires a precise diagnosis
of the specific cause and should be
directed to the specific problem
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14. Summary in liver function tests in the
differential diagnosis of jaundice
Test Prehepatic Hepatic Cholestatic
Serum bilirubin Uncojugated Mixed
Conjugated
Urine bilirubin Absent//Present Present Present
Urine Urobilinogen Increased Increased Decreased
ALT & AST Normal Marked Slight
increase increase
ALP Normal Slight Marked
increase increase
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15. Recognizing and Treating Jaundice
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16. 16

17. The End
http://en.wikipedia.org/wiki/Jaundice#Ne
onatal_jaundice
http://www.medicinenet.com/jaundice/arti
cle.htm
http://www.nlm.nih.gov/medlineplus/ency
/article/003243.htm
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