消化科彭昭黄疸.ppt

JAUNDICE,Teacher : Zhao Peng Date:10/5/2019,Definition,YELLOW,Definition,Jaundice is the yellow discoloration of the sclera , skin and mucus membrane resulting from an increase bilirubin concentration in the body fluid (more than 17.1 mol/L) Clinical jaundice: 34.2 mol/L Jaundice occult: 17.1-34.2 mol/L,1,Liver diseases,2,Congenital hypebilirubinemia,3,Hemolytic anemia,4,Recurrent jaundice,Annotation Hb: hemoglobin UCB: unconjugated bilirubin CB: conjugated bilirubin UGT: UDP-glucuronyl transferase,UGT,Bilinogen enterohepatic circulation,Over production,Decreased hepatic conjugation,Decreased hepatic uptake,Disturbance of excretion,Types,UGT,CB,Hepatocellular,Obstructive,CB,1.Extra-erythrocytic abnormalities Malaria Autoimmune Physical trauma (e.g. burns ,prosthetic heart valve) Chemical trauma (drugs e.g. dapsone ) Metabolic (e.g. urmia) 2. Intra-erythrocytic defects Spherocytosis Thallassemia Enzyme Glucose-6-phophonate dehydrogenase deficiency Vitamin B12 and folic acid deficiency,Jaundice :mild , if bilirubin is more than 6 mg/dL then there is concomitant hepatic injury Pallor :due to the anemia Splenomegaly Stool:dark in color due to excessive stercobilinogen which is producted by bilirubin Urine: dark due to increased urobilinogen,Viral hepatitis Liver cirrhosis Leptospira Septicemia,Jaundice :mild , pruritus fatigue ;anorexia; hemorrhagic tendency ;ascites Except for jaundice and pruritus, the other symptoms were all manifestations of primary liver disease,1.Extra-hepatic cholestasis Common duct stones Carcinoma of -head of pancreas -ampulla -bile duct(cholangiocarcinoma) Traumatic biliary stricture Crystic fibrosis 2. Intra-hepatic cholestasis Pregnancy Recurrent idiopathic cholestasis Drugs such as oral contraceptive, anabolic steroids,Early feature :Jaundice ; pruritua ; dark urine ; Pale stool Late feature: Xanthelasma and xanthomata ; Malabsorption ; Weight-loss ; Steatorrhoea ; Osteomalacia ; Bleeding tendency. The combination of jaundice , fever and rigor is called Charcots triad and it indicates acute cholangitis,1.Unconjugated hyperbilirubinemia Gilberts Syndrome Crigler-Najjar Syndrome 2. Conjugated hyperbilirubinemia Dubin-Johnson Sdydrome Rotor Syndrome,Gilberts syndrome : it is asymptomatic and usually dedected incidental finding of slightly raise bilirubin on a routime check .no signs of liver disease are seen . there is a family history of jaundice in 5-15% of patients Crigler-najjars syndrome : Death occurs usually in first year of life due to kernicterus,Jau