Jaundice

Question 1

Jaundice definition?

Answer 1

Also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels in blood

Jaundice manifest = > 2.5 mg/dL of bilirubin in blood

It can be a disorder of bilirubin formation, conjugation or elimination by the liver

Question 2

Bilirubin metabolism

Answer 2

1-2. Bilirubin comes from mature RBC degradation normally in spleen and liver by macrophages.

3-4. Unconjugated bilirubin binds to albumin and is taken up by the liver.

5. Bilirubin is conjugated with glucuronic acid in the liver and secreted into bile.
6. Intestinal bacteria remove glucuronic acid and transform it to urobilinogen.

7-10. Urobilinogen is partially eliminated in the intestine and gives feces its brown color. Other part is reabsorbed and could be taken up by the liver and eliminated by the kidney.

Question 3

Causes of hyperbilrubinemia and jaundice

Answer 3

1. increase in production of indirect bilirubin (unconjugated)
2. hepatocyte reuptake disorder
3. Bilirubin hepatic conjugation defect (Transient jaundice of the newborn = immaturity of UDP-glucoronyltransferase)
4. conjugated bilirubin elimination disorder at hepatocyte level (Dubin-johnson and Rotor syndromes)

Question 4

Most common cause of jaundice

Answer 4

Pre-hepatic: e.g. excessive red blood cell destruction (e.g.hematoma). Liver is overloaded

Intra-hepatic: either decreased reuptake or decreased conjugation of bilirubin.
Due to liver disease, cirrhosis, hepatitis, Gilbert’s (coluria= yes)

Post-hepatic: biliary obstruction, gallstone, rumor etc. Due to biliary flow (coluria=yes)

Question 5

2 types of bilirubin

Answer 5

Unconjugated (indirect) = Can cross BBB–> kernicterus newborns

Conjugated (direct) = dont cross BBB

Question 6

Cholestasis: bile dont reached intestine due to obstruction in bile flow in the liver!

Lithiasis= gallbladder obstruction!

Answer 6

Feces with reduced color: (acolia)

Dark colored urine: Coluria

Malabsorption of D,A,E,K vitamin because they need the bile fats and salts to be taken up = leads to steatorrhea

Question 7

Diagnosis of jaundice?

Answer 7

1. Blood test:

TB= IB(unconjugated) + DB(conjugated)

IB= related to newborns

DB= related to intra and extra hepatic cholestasis

2. Urine test: measure urobilinogen
3. Image tests: Cholestasis
   - Ultrasound
   - CT
   - MRI

Question 8

Cholestasis

Answer 8

Cholestasis is bile flow stop that avoids totally or partially bile enter to the duodenum.

intrahepatic
Extahepatic

Question 9

Cholestasis symptoms

Answer 9

Obstructive jaundice
Pruritus
Bradycardia
Malabsorption of DAEK vitamins
Steatorrhea

Question 10

Cholestasis diagnosis tests?

Answer 10

Lab tests:
Bilirubin
Alkaline phosphatase
Gamma-GT

Imaging:

MRI:
• Cholelithiasis = stone in bladder.
• Choledocholithiasis = stone in bile duct.

Question 11

Viral hepatitis

Answer 11

Intra-hepatic Mixed hyperbilirubinemia

Question 12

Symptoms hepatitis

Answer 12

• Viral hepatitis is frequently preceded by general malaise, anorexia, nausea or gastrointestinal discomfort, myalgias, headaches, fever and chills (HA and HE).
• Jaundice with coluria and acholia (lack of bile secretion).
• The most characteristic feature of viral hepatitis is the increase in transaminases (GOT and GPT)