jaundice by anup kumar Dash

2. • Jaundice is a condition in which a person’s skin and the whites of the
eyes are discoloured yellow due to an abnormally increased level of bile
pigments, bilirubin in the blood and body tissue resulting from liver
diseases such as cirrhosis, hepatitis or gallstones
• Some bilirubin is bound to a certain protein (albumin) in the blood. This
type of bilirubin is called unconjugated, or indirect, bilirubin. In the liver,
bilirubin is changed into a form that your body can get rid of. This is
called conjugated bilirubin or direct bilirubin.

6. • Uridine diphosphate glucuronosyltransferase (UDP-
glucuronosyltransferase, UDPGT) convert water soluble compounds

7. TYPES
1.Pre-hepatic jaundice:
• If an infection or medical condition makes the red blood cells break down
sooner than usual, bilirubin levels rise. This is known as pre-hepatic
jaundice.
• Conditions which may trigger this include malaria, sickle cell anaemia,
thalassaemia, Gilbert’s syndrome, hereditary spherocytosis and Crigler
Najjar syndrome.
• Gilbert syndrome is a common, harmless liver condition in which the
liver doesn’t properly process bilirubin. Bilirubin is produced by the
breakdown of red blood cells. Gilbert syndrome is an inherited genetic
condition.
• Crigler-Najjar syndrome is a severe condition characterized by high levels
of a toxic substance called bilirubin in the blood (hyperbilirubinemia).
Bilirubin is produced when red blood cells are broken down

9. 2.Intra-hepaticjaundice
: If the liver is damaged, it may be less able to process bilirubin and reduces
UDPGT activity and the liver’s ability to metabolize and excrete bilirubin
leading to a build-up of unconjugated bilirubin in the blood which causes
intra-hepatic jaundice.
• The liver damage may be a result of causes that include hepatitis, alcoholic
liver disease, glandular fever, liver cancer, illegal drug use, and paracetamol
overdose.
• Obesity and liver disease can be a cause of cirrhosis of the liver and
jaundice.

10. 3.Post-hepaticjaundice:
• Gallstones, pancreatitis, pancreatic cancer and cancers of the gallbladder or
bile duct may also disrupt the bilirubin removal process leading to jaundice.
• This is called post-hepatic jaundice.
• Eating a high-fat diet can raise cholesterol levels and increase the risk of
gallstones.
Complications
• sepsis especially cholangitis, (infection of the bile ducts,) biliary cirrhosis,
• pancreatitis, renal and liver failure.
• coagulopathy, (in abilities to clot blood)

11. Urine Test:
• Urine can be tested for urobilinogen, which is produced when bilirubin is
broken down.
• Finding high or low levels can help pinpoint the type of jaundice.
Endoscopic retrograde cholangiopancreatography (ERCP):
• ERCP is a procedure that involves the introduction of an endoscope (a
tube with a camera at the end) through the mouth and into the small
intestine.
• A dye is then injected into the bile ducts while X-rays are taken. It can be
useful for identifying stones, tumors or narrowing of the bile ducts
.

12. Laparoscopy (peritoneoscopy):
It allows direct inspection of the liver and gallbladder, without the
trauma of a full laparotomy.
Unexplained cholestasis jaundice warrants laparoscopy occasionally
and diagnostic laparotomy rarely.
IMAGING
• MRI
• CT
• ULTRASOUND

13. • In Pre-hepaticjaundice infections, such as malaria, the use of medication
to treat the underlying infection is usually recommended.
• For genetic blood disorders, such as sickle cell anaemia or thalassaemia,
blood transfusions may be required to replace the red blood cells.
• In intra hepatic jaundice the liver damage is caused by exposure to
harmful substances such as alcohol or chemicals, avoiding any further
exposure to the substance is recommended.
• In severe cases of liver disease, a liver transplant is another possible option
• In most cases of post-hepatic jaundice, surgery is recommended to
unblock the bile duct system.