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JAUNDICE

Jaundice is characterized by yellowish discoloration of the skin and mucous membranes due to elevated bilirubin levels in the blood, with clinical jaundice evident at levels above 3 mg/dl. It can be classified into pre-hepatic, hepatocellular, and obstructive types, each with distinct causes and associated symptoms. Diagnosis involves various investigations including blood tests and imaging to determine the underlying cause of jaundice.

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2 views16 pages

JAUNDICE

Jaundice is characterized by yellowish discoloration of the skin and mucous membranes due to elevated bilirubin levels in the blood, with clinical jaundice evident at levels above 3 mg/dl. It can be classified into pre-hepatic, hepatocellular, and obstructive types, each with distinct causes and associated symptoms. Diagnosis involves various investigations including blood tests and imaging to determine the underlying cause of jaundice.

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naimur.ammc
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We take content rights seriously. If you suspect this is your content, claim it here.
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JAUNDICE

Definition:
It is defined as yellowish discoloration of the skin and
mucous membrane due to excess amount of bilirubin
present in the blood.

Breakdown of HB in the spleen, liver and bone marrow to


unconjugated bilirubin ( water insoluble). This
unconjugated bilirubin bind to albumin and in the
hepatocyte it conjugates with glucuronic acid to become
conjugated bilirubin (water soluble). This bilirubin excreted
in the intestine as bile and by colonic bacteria metabolized
to urobilinogen then stercobilinogen and finally stercobilin.
Stercobilin makes brown coloration of stool. Some
Urobilinogen absorbed and passes to urine as urobilin.
What is latent jaundice ?

The normal serum bilirubin level is


0.3-1.0 mg/dl. Clinical jaundice is
evident when serum bilirubin
crosses 3 mg/dl.
Jaundice is latent, i.e., clinically non-
evident (only detected by serum
analysis) when the serum bilirubin
level is in between 1-3 mg/dl.
Sites to be examined in a patient
of jaundice
Jaundice is seen in bright natural daylight.
Upper bulbar conjunctiva (sclera is examined by
retracting the
upper eyelids upwards and asking the patient to
look downwards - both eyes at a time).
Undersurface of tongue (sublingual mucosa).
Palms of hand.
General skin surface.
Differential diagnosis of
jaundice
Carotenaemia (carotenoderma)
—Skin is yellow (mainly the
palms and soles) but the sclera
and mucous membrane are
unaffected. The stool and urine
are of normal color.
Carotenemia is a harmless
condition. It's usually caused by
eating too many foods that are
high in carotene, like carrots,
squash, and sweet
potatoes. Other causes are
hypothyroidism, familial,
Clinical classification of jaundice

Classification of Jaundice

Pre-hepatic jaundice: This is caused either by hemolysis


or congenital non hemolytic hyperbilirubinaemia.
Unconjugated: G+C
Gilbert syndrome: AD/AR . Mild jaundice in fasting due to
decrease glucoronyl activity.
Crigler- Najjar type 1, and 11: AR condition.

Conjugated: D+R
Dubin Johnson – AR: Decrease excretion of bilirubin.
Rotor – AR: Decrease bilirubin uptake by hepatocyte.

Hemolytic jaundice is mild, urine is normal color but high


color stool due to high stercobilinogen and stercobilin.
All hemolysis can cause jaundice.
Hepatocellular jaundice
Hepatocellular jaundice results from an inability of the
liver to transport bilirubin into the bile, occurring as a
consequence of parenchymal disease.

In hepatocellular jaundice, the concentrations of both


unconjugated and conjugated bilirubin in the blood
increase.
associated with increases in transaminases (AST,
ALT).

Acute jaundice in the presence of an ALT of > 1000


U/L is highly suggestive of an infectious cause (e.g.
hepatitis A or B), drugs (e.g. paracetamol) or hepatic
ischemia.
Obstructive (cholestatic) jaundice

Cholestatic jaundice may be caused by:


•Failure of hepatocytes to initiate bile flow.
•Obstruction of the bile ducts or portal tracts.
• Obstruction of bile flow in the extrahepatic bile
ducts
between the porta hepatis and the papilla of Vater.

Obstruction of the bile duct drainage due to blockage


of the extrahepatic biliary tree is characteristically
associated with pale stools and dark urine, pruritis,
deep jaundice.

Conjugated hyperbilirubinimia.
Medical causes of extrahepatic
obstruction
1. Sclerosing cholangitis in ulcerative colitis.
2. Obstruction by round worm in CBD.
3. Enlarged lymph nodes at porta hepatis in
lymphoma.
4. Gall bladder stone impacting the CBD.
Causes of Jaundice:

Acute onset: over days


Gall stone disease ( Choledocholithiasis)
Cholangitis.
Acute Hepatitis ( Viral hepatitis A, E,
paracetamol overdose, Anti TB medicine,
anti epileptic medicine))
Hemolysis
Acute Budd- chiari syndrome
Sub acute: Weeks to months
Right sided heart failure
Pancreatic and hepatobiliary malignancy.
Auto immune hepatitis, drugs.

Recurrent:
Gallstone ( Choledocholithiasis, cholangitis)
Disorder of bile transport ( Gilberts
syndrome)
Associated symptoms of jaundice:

Fever ( cholangitis, viral hepatitis.)


Right upper quadrant pain.
Back pain.
Dark urine, pale stool – obstructive
jaundice.
Pruritus – Cholestatic jaundice, Primary
biliary cirrhosis.
Investigations for Jaundice:
CBC, PBF, LDH, Heptaglobin, reticulocyte
count
AST,ALT, Gama GT, ALP, Bilirubin direct and
indirect, Albumin, Prothrombin time.
Viral serology Hbs Ag, Hepatitis C Ab,
Hepatitis A IgM, Hepatitis E IgM.
Ferritin, ceruloplasmin, Alpha fetoprotein,
Anti sm Ab, AMA.
USG of hepatobiliary system.

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