1. Jaundice- Icterus
Accumulation of bilirubin,
a product of heme metabolism,
in body tissues- sclera & skin

2. Pathophysiology
 Old RBC in reticuloendothelial system
 HemeBiliverdinBilirubin (indirect)
 Bound to albumin, travels to liver
 Conjugation with glucuronic acid
 Excreted from liver into bile
 Intestinal bacteria convert bilirubin to
urobilinogen
 Converted to stercobilin & passed in feces
or reabsorbed & excreted in urine

3. Classification
 Unconjugated/Indirect
Overproduction-
 Hemolysis
 Ineffective erythropoiesis
Reduced uptake-
 Sepsis
 Prolonged fasting
Reduced conjugation-
 Gilbert’s/Crigler-Najjar syn.
 Neonatal
 Sepsis
 Conjugated/Direct
Faulty excretion-
 Dubin-Johnson/Rotor syn.
 Cholestasis of pregnancy
Hepatocyte dysfunction-
 Hepatitis/Cirrhosis
 Drug-induced cholestasis-
OC, anabolic steroids
 Sepsis
Extrahepatic obstruction-
 Stones
 Stricture
 Tumor

4. Evaluation
 History
 Examination-
 Splenomegaly
 e/o CLD, tender hepatomegaly
 e/o pruritis, clay colored stool, deep icterus
 Investigation-
 Hemoglobin
 Bilirubin- indirect & direct
 SGPT/ALP, alkaline phosphatase, GGT
 Albumin, PT/INR
 US, CT scan, MRCP, ERCP
 Liver biopsy

5. Stigmata of CLD
 Muscle wasting
 Pallor, jaundice
 Clubbing
 Palmar erythema
 Dupuytren’s contracture
 Spider nevi
 Gynecomastia
 Testicular atrophy
 Caput medusae
 Ascites

6. Treatment
Underlying cause

7. Ascites
Accumulation of fluid in
peritoneal cavity
80% due to portal HT/CLD

8. Evaluation
 History- abdominal distension,
associated symptoms- fever, wt. loss
alcohol, IVDU, BT/surgery
Fat, Flatus, Fetus, Fluid
 Examination- e/o CLD, SCLN, JVP
tenderness, fluid thrill, shifting dullness
 Investigation- LFT, HBsAg/anti-HCV Ab,
serum &
ascitic fluid albumin, US/CT

9. Causes- based on SAAG
 High SAAG- >1.1
gm./dl.- Transudate
 Cirrhosis
 CHF, TR
 Constrictive pericarditis
 Budd-Chiari syndrome-
hepatic vein thrombosis
 Portal vein occlusion
 Myxedema
 Low SAAG- <1.1
gm./dl.- Exudate
 Cancer
 TB, SBP
 NS, PLE
 Pancreatic

10. Treatment
 Low SAAG- treat cause
 High SAAG-
 Salt restriction
 Diuretics- spironolactoneloop diuretocs
 LVP- >5 lits. in one go
 TIPS
 Liver transplantation