What is the clinical appearance of jaundice?
- Yellow appearance
- Deposition of bilirubin in the skin, mucous membranes, and sclera
- Tea-colored urine
- Acholic (tan-colored) stools
- Clinically apparent when serum bilirubin levels reach 2-3 mg/dL
Jaundice indicates an excess of bilirubin in the body.
What are the general mechanisms of increased bilirubin?
- Pre-hepatic Jaundice
- Hepatic Jaundice
- Post-hepatic Jaundice
Each type has distinct causes and characteristics.
What characterizes Pre-hepatic Jaundice?
- Excessive bilirubin presented to the liver for metabolism
- Increased UNCONJUGATED bilirubin (Indirect Bilirubin)
Common causes include hemolytic anemia and newborn jaundice.
What are the possible mechanisms of Hepatic Jaundice?
- Impaired CELLULAR UPTAKE
- Defective CONJUGATION
- Abnormal EXCRETION by Hepatocytes
This is the most common type of jaundice.
What laboratory finding is associated with Hepatic Jaundice?
- Unconjugated and/or conjugated hyperbilirubinemia
This indicates issues with bilirubin metabolism in the liver.
What is Gilbert’s Syndrome?
- Impaired cellular uptake of bilirubin
- Increased unconjugated bilirubin; usually <3 mg/dL
It is a common genetic condition.
What is Dubin-Johnson Syndrome?
- Rare, genetic condition
- Defective excretion of bilirubin into the bile duct
- Increased total serum bilirubin (2-5mg/dL)
- Predominant form is conjugated bilirubin
This syndrome affects bilirubin processing in the liver.
What is the difference between Type I and Type II Crigler-Najjar Syndrome?
- Type I: Complete absence of UDPG-T; no conjugated bilirubin formed
- Type II: Less severe; deficiency of UDPG-T; increased unconjugated bilirubin; usually < 20 mg/dL
Both types are rare genetic disorders affecting bilirubin metabolism.
What causes Post-Hepatic Jaundice?
- Mechanical blockade (e.g., gallstone or tumor)
This leads to increased total bilirubin, primarily conjugated.
What are the possible etiologies of Hepatitis?
- Viruses (A, B, C, D)
- Drugs (e.g., Acetaminophen, ecstasy)
- Chemical (e.g., halothane)
- Toxins (e.g., Amanita phalloides)
Hepatitis can result from various sources leading to liver inflammation.
What are the markers of Hepatitis?
- Marked increase in ALT & AST
- Increase in ALP & GGT
- Increase in Total Bilirubin & Direct Bilirubin
These markers indicate liver damage and inflammation.
What are the clinico-pathological syndromes of viral hepatitis?
- Carrier state
- Asymptomatic infection
- Acute hepatitis (anicteric or icteric)
- Chronic hepatitis (without or with progression to cirrhosis)
- Fulminant hepatitis
These syndromes reflect the varying presentations of viral hepatitis.
What is Drug-Induced Liver Disease?
- Structural and functional changes to the liver
- Failure of bile secretory capacity
It is important to inquire about drug ingestion in suspected cases.
What are common lab findings in hepatic tumors?
- Increased ALP and GGT
- Normal ALT and AST
- > 2-fold increase in total LD
- Increased alpha-fetoprotein
These findings help differentiate between metastatic and primary liver tumors.
Name the three inherited disorders of bilirubin metabolism.
1) Gilbert’s syndrome 2) Crigler-Najjar syndrome 3) Dubin-Johnson syndrome
What causes Gilbert’s syndrome?
Decreased hepatic uptake of unconjugated bilirubin.
What causes Crigler-Najjar syndrome?
Deficiency or absence of UDP-glucuronyl transferase (impaired conjugation).
What causes Dubin-Johnson syndrome?
Defective excretion of conjugated bilirubin into bile ducts.
What are the lab findings in Gilbert’s syndrome?
Mild unconjugated hyperbilirubinemia (< 3 mg/dL); other liver tests normal.
What are the lab findings in Crigler-Najjar syndrome?
Markedly high unconjugated bilirubin (up to 50 mg/dL); normal liver enzymes.
What are the lab findings in Dubin-Johnson syndrome?
Moderate conjugated bilirubin (2–5 mg/dL); darkly pigmented liver on biopsy.
Define jaundice.
Yellow discoloration of skin and sclera caused by elevated bilirubin (> 2–3 mg/dL).
Classify this patient’s jaundice as pre-hepatic, hepatic, or post-hepatic.
Post-hepatic (obstructive) jaundice.
List four findings that support a post-hepatic classification.
Markedly high ALP (cholestatic pattern) High direct (conjugated) bilirubin Pale stool (lack of stercobilin) Decreased urine urobilinogen with bilirubin-positive urine
