APPROACH TO JAUNDICE_f8e70f56-7425-40da-908a-829fb2f6c215.pptx

gfufutfu

1. APPROACH TO JAUNDICE Mentor : Prof . Dr. Dinesh Kumar Lamsal Presented By: Dr. Chudamani Neupane MD( GP &EM )Resident Rapti Academy Of Health Sciences

2. CONTENTS Introduction Bilirubin Production and Metabolism Approach Isolated elevation of serum bilirubin Elevation of serum bilirubin with other liver test abnormalities Special considerations with jaundice Summary

3. Introduction

4. Pathophysiology

5. Approach

6. Isolated hyperbilirubinemia

7. FEATURE CRIGGLER NAJJAR 1 CRIGGLER NAJJER 2 GILBERT’S SYNDROME UDPGT 0% 10% 33% MODE OF INHERITANCE AR AR AR,AD TOTAL BILIRUBIN >20 mg/ dL 6-20 mg/ dL <6 mg/ dL KERNICTERUS common rare absent MORTALITY < 1yr adulthood N LIVER BIOPSY N N Black brown TREATMENT Liver transplantation phenobarbitone No

8. FEATURE DUBLIN JOHNSON SYNDROME ROTOR SYNDROME CAUSE MRP-2 OATP1B1, 1B3 MODE OF INHERITANCE AR AR SERUM BILIRUBIN < 5mg/ dL < 5mg/ dL KERNICTERUS - - MORTALITY N N INVESTIGATION No clearance of dye Liver biopsy-black Delayed N TREATMENT Not required Not required

9. Increased S. Bilirubin with other tests abnormal

10. Hepatocellular conditons

11. Cholestasis - Intrahepatic

12. Cholestasis - Extrahepatic

13. Features of prehepatic jaundice Triad of anemia , Jaundice , spleenomegaly According to hemolytic anemia – malaria, autoimmune hemolytic anemia

14. Features of hepatocellular jaundice Anorexia, nausea , vomiting, weakness Stool is yellow( but may be dark,clay colored in later stages due to intrahepatic cholestasis ) Liver is enlarged , tender

15. Features of obstructive jaundice Pale, dark/clay colored stool Itching of whole body May be abdominal pain , mass in epigastrium Other features depend upon ( xanthelasma / xanthoma in PBC) Bleeding tendency Bone pain

16. Special considerations

17. Fluctuating jaundice Choledocholithiasis Choledochal cyst Hemolytic jaundice Wilson’s disease Gilbert’s syndrome Benign recurrent intrahepatic cholestasis Recurrent pancreatitis Primary sclerosing cholangitis

18. Progressive jaundce Acute viral hepatitis Carcinoma of head of pancreas Cholangiocarcinoma Primary biliary cirrhosis Primary sclerosing cholangitis

19. Recurrent Jaundice Congenital Hyperbilirubinemia Recurrent benign cholestasis

20. Palpable gall bladder with jaundice Carcinoma of head of pancreas Carcinoma of ampulla of vater Stone in common bile duct Pressure from outside on bile duct Cholangiocarcinoma Sclerosing cholangitis

21. Painless progressive jaundice with palpable gall bladder Carcinoma of head of pancreas

22. Abdominal pain with fluctuating jaundice Stone in CBD or stricture pancreatitis

23. Jaundice with itching Obstructive jaundice Primary biliary cirrhosis

24. SUMMARY

25. References Murtagh’s General Practice , 8 Th edition Harrison’s textbook of Medicine , 21 st edition