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    Icterus

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    nikita134
    Jaundice, or icterus, is caused by the deposition of bilirubin resulting in a yellowish discoloration of the skin and eyes. It can be a sign of either liver disease or a hemolytic disorder. There are three main types of jaundice: prehepatic, which involves excessive bilirubin production; hepatocellular, which affects the liver's ability to transport bilirubin; and obstructive, which is a blockage of bile flow in the bile ducts. The causes, characteristics, and distinguishing laboratory findings of each type are described.

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    Icterus

    Uploaded by

    nikita134
    263 views11 pages
    Jaundice, or icterus, is caused by the deposition of bilirubin resulting in a yellowish discoloration of the skin and eyes. It can be a sign of either liver disease or a hemolytic disorder. There are three main types of jaundice: prehepatic, which involves excessive bilirubin production; hepatocellular, which affects the liver's ability to transport bilirubin; and obstructive, which is a blockage of bile flow in the bile ducts. The causes, characteristics, and distinguishing laboratory findings of each type are described.

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    Jaundice, or icterus, is caused by the deposition of bilirubin resulting in a yellowish discoloration of the skin and eyes. It can be a sign of either liver disease or a hemolytic disorder. There are three main types of jaundice: prehepatic, which involves excessive bilirubin production; hepatocellular, which affects the liver's ability to transport bilirubin; and obstructive, which is a blockage of bile flow in the bile ducts. The causes, characteristics, and distinguishing laboratory findings of each type are described.

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    263 views11 pages

    Icterus

    Uploaded by

    nikita134
    Jaundice, or icterus, is caused by the deposition of bilirubin resulting in a yellowish discoloration of the skin and eyes. It can be a sign of either liver disease or a hemolytic disorder. There are three main types of jaundice: prehepatic, which involves excessive bilirubin production; hepatocellular, which affects the liver's ability to transport bilirubin; and obstructive, which is a blockage of bile flow in the bile ducts. The causes, characteristics, and distinguishing laboratory findings of each type are described.

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    © All Rights Reserved
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    of 11

    Icterus

    Nikita Garg

    Icterus / Jaundice
    Jaundice, or icterus, is a yellowish discoloration of tissue resulting from the
    deposition of bilirubin.
    -Serum hyperbilirubinemia and is a sign of either liver disease or, less often, a hemolytic
    disorder.

    The presence of scleral icterus indicates a


    serum bilirubin of at least 3 mg/dL.
    The second place to check for icterus is to examine underneath the Tongue.

    Physiology
    Bilirubin metabolism and elimination.
    (1) Normal bilirubin production from heme (0.20.3
    gm/day) is derived primarily from the breakdown of
    senescent circulating erythrocytes.
    (2) Extrahepatic bilirubin is bound to serum albumin and
    delivered to the liver.
    (3) Hepatocellular uptake
    (4) Glucuronidation in the endoplasmic reticulum generate
    bilirubin monoglucuronides and diglucuronides, which are
    water soluble and readily excreted into bile.
    -The conjugation of glucuronic acid to bilirubin is
    catalyzed by bilirubin uridine diphosphateglucuronosyl transferase (UDPGT).

    (5) Gut bacteria deconjugate the bilirubin and degrade it to


    colorless urobilinogens.
    The urobilinogens and the residue of intact pigments are
    excreted in the feces, with some reabsorption and
    excretion into urine.

    Pathophysiology
    Hyperbilirubinemia may result
    from
    1. Excessive extrahepatic production
    of bilirubin
    2. Reduced hepatocyte uptake

    An increase in unconjugated bilirubin


    in serum results from either
    Overproduction
    Impairment of uptake
    Impaired Conjugation of bilirubin

    3. Impaired conjugation
    4. Decreased hepatocellular excretion
    5. Impaired bile flow.

    An increase in conjugated bilirubin is


    due to
    Decreased excretion into the bile ductules
    Backward leakage of the pigment.

    Types
    1. Prehepatic Jaundice
    2. Hepatocellular Jaundice
    3. Obstructive Jaundice

    Prehepatic Jaundice - Unconjugated


    Bilirubin overproduction may result from excessive breakdown of heme
    derived from hemoglobin
    Hemolysis
    Inherited disorders include spherocytosis, sickle cell anemia, thalassemia, and deficiency
    of red cell enzymes such as pyruvate kinase and glucose-6-phosphate dehydrogenase.
    Acquired hemolytic disorders include microangiopathic hemolytic anemia (e.g.,
    hemolytic-uremic syndrome), paroxysmal nocturnal hemoglobinuria, immune hemolysis
    and parasitic infections including malaria.
    In these conditions, the serum bilirubin rarely exceeds 86 mol/L (5 mg/dL).
    Higher levels may occur when there is coexistent renal or hepatocellular dysfunction or in
    acute hemolysis such as a sickle cell crisis.

    Hepatocellular Jaundice
    Unconjugated and Conjugated Jaundice
    Most liver diseases affect canalicular excretion, resulting in the accumulation of both
    conjugated and unconjugated bilirubin in hepatocytes
    Inability of liver to transport bilirubin across the hepatocytes due to liver disease
    Usually associated with increased levels of transaminases AST> 1000 U/L
    Increase in AST and ALT more than increase in ALP
    This type of jaundice is usually caused by liver failure, cirrhosis, hepatitis or taking certain
    drugs.
    Ethanol, Paracetamol, Halothane, Methyldopa, Barbiturates
    It may also be caused by a tumour in the liver.
    Imaging
    Liver biopsy

    Obstructive Jaundice Conjugated


    Obstruction of bile flow in the
    Extrahepatic Bile ducts between Porta
    Hepatis and the Papilla of Vater

    The most common cause of


    obstructive jaundice is the presence
    of gallstones in the ducts of the biliary
    system
    Other Causes:

    Biliary stricture (narrowing of the bile duct)


    Cancer of the gallbladder or pancreas
    Cholangitis (infection or inflammation of
    the common bile duct)
    Congenital structural defects
    Cysts of the bile duct
    Lymph node enlargement
    Pancreatitis
    Parasitic infection
    Trauma, including surgical complications

    Characterstically associated with dark urine


    and pale stools
    Prurutis and skin excoriations
    CHARCOTs TRIAD
    Jaundice
    Right upper quadrant pain
    Fever

    Increase in ALP more than increase in ALT


    and AST

    Thank You

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