What is jaundice?What is jaundice?O It is yellowish
discoloration of Skin, mucous membranes, sclera.. Due to excess plasma bilirubin.
Signs and symptoms Signs and symptoms O Skin and sclerae - yellowO Stool - light colour, clay colouredO Dark urineO Pain in abdomenO ItchingO Trouble with sleepingO Fatigue, swellingO AscitesO Mental confusion, comaO Bleeding
O The differential diagnosis for yellowing of the skin is limited. In addition to jaundice, it includes Carotenoderma.
O In carotenoderma the pigment is concentrated on the palms, soles, forehead, and nasolabial folds. Carotenoderma can be distinguished from jaundice by the sparing of the sclerae.
Is it disease?Is it disease?O Is not a disease but rather a sign that
can occur in many different diseases.O Normal plasma bilirubin range 5-17 m
mol/l O Clinically obvious 50 mmol/l (2.5mg/dl)
Types of jaundiceTypes of jaundicecategory definit ion
Pre-hepatic/ hemolytic The pathology is occurring prior to the liver.
Hepatic/ hepatocellular The pathology is located within the liver.
Post-Hepatic/ cholestatic
The pathology is located after the conjugation of bilirubin in the liver.
Prehepatic jaundicePrehepatic jaundiceO Pre-hepatic jaundice is caused by
anything which causes an increased rate of hemolysis.
O In jaundice secondary to hemolysis, the increased production of bilirubin, leads to the increased production of urine-urobilinogen. Bilirubin is not usually found in the urine because unconjugated bilirubin is not water-soluble.
Hepatocellular jaundiceHepatocellular jaundiceO Cell necrosis reduces the liver's ability
to metabolize and excrete bilirubin leading to a buildup of unconjugated bilirubin in the blood.
O Other causes include primary biliary cirrhosis leading to an increase in plasma conjugated bilirubin because there is impairment of excretion of conjugated bilirubin into the bile.
Posthepatic jaundicePosthepatic jaundiceO is caused by an interruption to the
drainage of bile in the biliary systemO In complete obstruction of the bile
duct, no urobilinogen is found in the urine, since bilirubin has no access to the intestine and it is in the intestine that bilirubin gets converted to urobilinogen to be later released into the general circulation.
Neonatal jaundiceNeonatal jaundiceO Yellowish staining of the skin and whites of
the newborn's eyes (sclerae) by pigment of bile (bilirubin)
O Breakdown of red blood cells (which release bilirubin into the blood) and immaturity of the newborn's liver (which cannot effectively metabolize bilirubin and prepare it for excretion into urine)
O Normal neonatal jaundice appears between the 2nd and 5th days of life and clears with time
O Kernicterus – brain damage - lifelong disability.
Diagnosis Diagnosis O HistoryO Physical examinationO Blood tests - laboratoryO UltrasonographyO CTO MRIO Liver biopsyO ERCP (Endoscopic retrograde
cholangiopancreatography) O Endoscopic ultrasound
Treatment Treatment O Treatment requires a precise diagnosis of the
specific cause and should be directed to the specific problem.
O Complications of jaundice include sepsis especially cholangitis, biliary cirrhosis, pancreatitis , coagulopathy, renal and liver failure.
O Cholangitis, especially the suppurative type (Charcot’s triad or Reynolds' pentad), is usually secondary to choledocholithiasis. It may also complicate procedures like ERCP.
O Treatment should include correction of coagulopathy, fluid/electrolyte anomaly, antibiotics and biliary drainage with ERCP where available or trans-hepatic drainage or surgery.