POWER POINT KESEHATAN ICTERI SEDERHANA.pptx

PENYAKIT KUNING

1. JAUNDICE AN INNER LOOk …,

2. OBJECTIVES Overview of jaundice Normal breakdown of RBC Jaundice – increase in bilirubin Hemolytic jaundice Neonatal jaundice Obstructive jaundice

3. Jaundice sign or symptom / disease ?

4. Some underlying conditions that may cause jaundice are: Acute inflammation of the liver Inflammation of the bile duct Obstruction of the bile duct Hemolytic anemia Gilbert's syndrome Cholestasis

5. Yellow discolorization

6. To save patients like me please listen to the ppt

7. Pathophysiology Accumulation of bilirubin in extracellular fluid - yellow-green pigment - degradation product of heme (iron-binding portion of hemoglobin)

8. Bilirubin production - 65% to 80% comes from Hb breakdown - maximum amount taken up by liver so, Normal plasma concentration - ∼0.5 mg/ dL or lower The skin or eyes may begin to appear yellow - 1.5 to 3 mg/ dL .

9. At 120 Days…. in RBC’s

10. RES

11. MACROPHAGE FEEDING rbc

12. RBCs after 120 days Fragile Membranes of RBC rupture Phagocytized by Reticulo endothelial system Tissue macrophages Kupffer cells Spleen

13. Hemoglobin split Heme Globin Amino acid pool- reuse Free Iron Transported in blood by transferrin Reused Happens Inside the macrophage

14. Formation of biliveridin

15. Formation of bilirubin

16. Straight chain of 4 pyrrole nuclei Biliverdin Free Bilirubin (released by Macrophages into plasma) Combination with plasma Albumin Blood u.b Liver Interstitial fluids HEME OXYGENASE BILIVERDIN REDUCTASE

17. destruction of red blood cells  rapid release of free unconjugated bilirubin into the circulation  Jaundice.

18. Glucaryl tansferase

19. Conjugated bilirubin more soluble and can be excreted into bile

20. neonates  increased production of heme  immature pathways for glucuronidation in the liver  Unconjugated hyperbilirubinemia in neonates.

21. Physiological jaundice - usually occurs after 2-3 days after the baby’s birth pathological jaundice - occurs within 1 st 24 hrs Rx Blue florescent light. Bilirubin (non polar)  polar  excreted in bile

22. Obstructive jaundice conjugated bilirubin imparts a dark yellow color to the urine. Measurement of free and conjugated bilirubin in serum serves as a sensitive test for detecting liver disease.

23. Obstruction of bile ducts /damage to the liver No excretion of conjugated bilirubin refluxes of bilirubin systemic circulation plasma with highly soluble conjugated bilirubin only small amount filtered by the kidneys Major form of bilirubin,bound to albumin Not excreted by the kidneys

24. Formation of uroblinin

25. Clinical dip stick test Urobilinogen detection in the urin

26. In obstructive jaundice, no bilirubin reaches the intestine for conversion into urobilinogen so no urobilinogen appears in the blood for excretion by the kidney. As a result, tests for urobilinogen in urine are negative in obstructive jaundice.

27. Clay stool

28. Because of the lack of stercobilin and other bile pigments in obstructive jaundice, the stool becomes clay colored.

29. Thank you