Pre-hepatic jaundice

by:Jehad abdullah

Pre-hepatic

Due to excess production of unconjugated bilirubin after hemolysis which exceeds the capacity of liver to conjugate it

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Characterized by the following

High levels of

indirect

(unconjugated)

bilirubin in plasma

Dark urine caused

by high levels of

urobilinogen in

urine

Dark stool caused

by high levels of

Fecal urobilin

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Unconjugated bilirubin (Indirect

bilirubin)

A. Main bilirubin present in plasma

normally

B. Water insoluble

C. Transported in blood as Bilirubin-

albumin complex

D. Not excreted in urine

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Etiology

Increased bilirubin production can result from the following:

• Hemolysis

- hereditary internal factors

• Defects in cytoskeleton (e.g., hereditary spherocytosis).

• Structurally abnormal hemoglobin (e.g., sickle cell

anemia, thalassemias).

• Enzyme deficiencies (e.g., glucose-6-phosphate

dehydroge- nase [G6PD] deficiency).

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- external factors

1- Antibody mediated

2- Drugs e.g. ribavirin

3-Infections ( Malaria - Babesiosis )

4- Any of the causes of hypersplenism (increased activity of the spleen), such as portal hypertension.

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Etiology

Neonatal Jaundice

• is a condition marked by high levels of bilirubin in the blood.

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Special characteristic in

neonates

• 1.More billirubin produced• Much more Hemolysis

• The life-length of hemolysis(70~80)

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• 2.The low capability of albumin on unconjugated billirubin transportation

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• 3.The low capability of heptatocyte

• Less Y protein and Z protein

• The primary development of Hepato-enzyme system

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Kernicterus

• Kernicterus is damage to the brain centers of infants caused by increased levels of unconjugated-indirect bilirubin

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