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Jaundice

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Topic updated on 07/04/17 8:41pm

Overview
  • Hyperbilirubinemia leading to yellowing of skin and eyes 
    • classified by ratio of conjugated bilirubin:total bilirubin
      • CB < 20%
        • Gilbert's/Crigler Najjar syndromes
        • physiologic jaundice of newborn
        • hemolysis
      • CB 20-50%
        • viral hepititis
      • CB > 50%
        • drugs (e.g. OCP)
        • Dubin-Johnson/Rotor syndromes
        • primary biliary cirrhosis
        • obstruction (e.g. stone)
  • Pathophysiology
    • hepatocytes convert unconjugated (indirect) bilirubin into conjugated (direct) bilirubin
      • performed by glucuronyl transferase enzyme to make bilirubin water soluble
        • see Heme metabolism topic for normophysiology
    • bilirubin is not toxic at moderate levels
    • high increases can result in kernicterus and death
      • deposition of bilirubin in the brain
  • Types
    • hemolytic 
      • destruction of RBCs than conjugation/excretion system can handle
      • can result from
        • hereditary hemolytic anemias, Rh incompatibility, ect.
    • obstructive
      • intrahepatic or bile duct block does not allow body to excrete bilirubin
      • can result from
        • oral contraceptives
        • gallbladder stone
        • carcinoma of the head of the pancreas
    • hepatocellular
      • damage to liver (i.e. hepatitis, cirrhosis) ↓ ability of conjugation/excretion system to handle normal bilirubin load
Jaundice Type
Hyperbilirubinemia
Urine Bilirubin
Urine Urobilinogen
Hepatocellular Conjugated/unconjugated Normal/↓
Obstructive Conjugated
Hemolytic Unconjugated Absent

 

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