JAUNDICE. for undergraduate pptx.pdf for

Jaundice

3. JAUNDICE

4. BY
Dr. SamyAli Hussein Aziza
Professor of Biochemistry and
Clinical Biochemistry
Faculty of Veterinary Medicine,
Moshtohor, BenhaUniversity,
Egypt.
E.Mail:[email protected]

5. JAUNDICE
Jaundice(alsocalledicterus)isacondition
characterizedbyayellowdiscolorationoftheskin,
sclera(whitesoftheeyes),andmucousmembranes.
Itcausedbydepositionofbilirubinsecondaryto
increasedbilirubinlevelsinthecirculation.

8. Itcanbecausedbyotheryellow
substancessuchascaroteneorcertain
drugs.
Conjugatedbilirubincausesmore
jaundicethanunconjugatedbilirubin
becauseofitseasierabsorptioninto
tissuesandhigherwatersolubility.

9. Types of jaundice
Jaundice can be classified into three major
forms:
A.Hemolytic jaundice (prehepatic).
B.Hepatocellular jaundice (Hepatic).
C.Obstructive jaundice (Posthepatic).
Inbothprehepaticandposthepatic
jaundice,thefunctionoftheliveritselfis
notimpaired.

12. a. Hemolytic jaundice
(Prehepatic)
Theliverhasthecapacitytoconjugateand
excreteover3000mgbilirubinperday,
whereasthenormalproductionofbilirubin
isonly300mg/day.Thisexcesscapacity
allowsthelivertorespondtoincreased
hemedegradationwithacorresponding
increaseinconjugationandsecretionof
bilirubindiglucuronide.

13. Prehepaticjaundiceiscausedbyan
increasedproductionofbilirubinbythe
body.
There are four general causes:
1.Excessivedestructionofcirculating
erythrocytes(hemolysis)
2.Ineffectiveerythropoiesis,resultinginan
increasedrateofdestructionofimmature
andmalformedredcells.
3.Increasedturnoverofnonhemoglobinheme
compoundsintheliverandotherorgans.
4.Phagocyticbreakdownofextravasatedred
bloodcells(hematoma).

14. •Increased hemolysis may be due to:
Hemolytic anemias.
Exposure to chemicals.
Hemolytic antigen-antibody reactions.
Disease states (some cancers).
Drugs coating red blood cells.
•Ineffectiveerythropoiesisisapathologic
processinwhichaverylowproportionof
redcellsformedinthebonemarrow
entersthecirculationandthoseremaining
inthebonemarrowareprematurely
destroyed.

15. Massivelysisofredbloodcells(for
example,inpatientswithsicklecell
anemiaormalaria)mayproducebilirubin
fasterthanthe,livercanconjugateit.
More bilirubinis excreted into the bile.
Theamountofurobilinogenenteringthe
enterohepaticcirculationisincreased
Urinary urobilinogenis increased.
Unconjugated bilirubinis elevated in
blood.

16. •In prehepatic jaundice, the production
of bilirubin is below the capacity of the
liver to conjugate and excrete it.
•Inprehepaticjaundicenobilirubin
foundintheurinebecausethe
increaseisinunconjugated
bilirubin(notfilteredthroughthe
glomerulus).

18. b.Hepatocellular jaundice
(Hepatic)
•Damage tolivercells(for
example,inpatientswithcirrhosis
orhepatitis)causesadecreasein
bothbilirubinuptakeand
productionofconjugatedbilirubin.

19. HepaticJaundice canbe
subdividedintotwotypes:
A.Retentionjaundice:defectinthe
transportofbilirubinintothe
hepatocyte.
B.Regurgitationjaundice:the
hepaticcellisdamagedordefective
ortheexcretionofproductsfromthe
hepatocyteisimpaired.

20. Inretentionjaundice,unconjugated
bilirubinisthepredominanttypefoundin
theplasma.
Inregurgitationjaundice,conjugated
bilirubinisfoundingreaterconcentrations.
Conjugationenzymedeficiencies,asin
Gilbert’sdiseaseandCrigler-Najjar
syndrome,areexamplesofretention
jaundice.
Dubin-Johnson syndrome, Rotor’s
syndrome,viralhepatitis,andtoxicand
neoplasticconditionsareexamplesof
regurgitationjaundice.

21. Unconjugated bilirubin occurs in the blood.
Increased urobilinogen in the urine.
Theurineisdarkincolorandstoolsarea
pale,claycolor.
PlasmalevelsofAST(SCOT)andALT
(SGPT)areelevatedandthepatient
experiencesnauseaandanorexia.

23. c. Obstructive jaundice
(Posthepatic)
•Posthepatic jaundice, or obstructive
jaundice, caused by a blockage of the flow
of bile from the liver.
•Bileproducedbythelivercannotbe
releasedintotheintestinesandoverflows.
•Jaundiceisnotduetooverproductionof
bilirubin,butresultsfromobstructionofthe
bileduct.

24. Forexample:
•Thepresenceofahepatictumorofbile
stonesmayblockthebileducts,
preventingpassageofbilirubinintothe
intestine.
•Patientswithobstructivejaundice
experienceGIpain,nausea,andproduce
stoolsthatareapale,claycolor.
•Theliver"regurgitates"conjugated
bilirubinintotheblood,whichisexcreted
intheurine.

25. Cause:
The most common obstructions are:
Stones within the common bile duct.
Neoplasm of the pancreas or other organ.
Strictures caused by congenital defects in
the ducts or by trauma to the ducts during
abdominal surgery.
•Note:Prolongedobstructionofthebile
ductcanleadtoliverdamageanda
subsequentriseinunconjugatedbilirubin.

27. Posthepatic jaundice characterized by:
Increase plasma conjugated bilirubin.
Thequantityofbilirubinreachingthe
intestinesisdecreasedresultinginthe
characteristicclay-coloredfeces.dueto
thedecreasedformationofurobilinogenin
theintestinesanditsdecreasedexcretion.
verylittleornourobiliogenbutlarge
quantitiesofbilirubinintheurine.
yellow-orangeurinecolorreflects
excretionofbilirubin.

30. d-Neonatal jaundice
•Neonataljaundiceisacondition
definedasthenewbornhavingtotal
serumbilirubinlevelsabove15mg/dL
inthefewdaysafterbirthorbilirubin
levelspersistingabove10mg/dLfor
morethan2weeks.
•Thenewbornhavehigherbilirubin
concentrationthanadultbecauseof
thehemolysisoccurringduringbirth
aswellastheinfant’simmatureliver.

31. •Newborninfants,particularlypremature
babies,oftenaccumulatebilirubinbecause
theactivityofhepaticbilirubinglucuronyl
transferaseislowatbirthandreaches
adultlevelsinabouttwoweeks.
•Elevatedbilirubin,inexcessofthebinding
capacityofalbumin,candiffuseintothe
basalgangliaandcausetoxic
encephalopathy.

32. •Cause:
Beforebirththefetusdependonthemother’s
livertoperformthenecessaryfunctions.
Theenzymesnecessaryformetabolismand
conjugationarenotpresentinsufficient
concentrationsatbirthanddonotfunction
efficientlyforafewdaysafterward.
Thesetwoconditions,aswellasanincreased
rateofabsorptionofunconjugatedbilirubinfrom
theinfant’sintestinaltract,oftencausebilirubin
levelstoriseto10mg/dL
Medicaltreatmenttoassisttheremovalof
excessbilirubinandtopreventthedevelopment
ofkernicterus.

33. •Kernicterusisthedepositionofunconjugated
bilirubininthecentralnervoussystemthatmay
causesevereneurologicdamage.
Several pathologic conditions cause these
symptoms to continue .
such as:
Biliaryatresia.
ABO.
Rhincompatibility.
Septicemia.
Neonatal hepatitis.
Inherited metabolic liver diseases

34. Treatment:
AdministrationofPhenobarbitaltoinduce
enzyme activityorphototherapywith
monochromaticbluelighttocausetheoxidation
ofbilirubintomoresolubleendproductsand
enhancetherenalexcretionofthebilirubin.
Thus,newbornswithmarkedlyelevatedbilirubin
levelsaretreatedwithbluefluorescentlight,
whichconvertsbilirubintomorepolarand,
hence, water-solubleisomers.These
photoisomerscanbeexcretedintothebile
withoutconjugationtoglucuronicacid.

35. Neonatal jaundice light treatment

37. Neonatal jaundice