临床诊断学黄疸

Jaundice,Introduction,Jaundiceresultsfromtheaccumulationofbilirubin(areddishpigmentproductofhememetabolism)inthebodytissues;Hyperbilirubinemiamaybeduetoabnormalitiesintheformation,uptake,conjugation,andexcretionofbilirubin.,Outline,Thenormalmetabolismofbilirubin,Pathophysiologicclassificationofjaundice,Manifestationsofdiseasesassociatedwithjaundice,Normaltotalserumbilirubinlevel:0.1-1.0mg/dlConjugatedbilirubinlevel:0-0.2mg/dlUnconjugatedbilirubinlevel:0.1-0.8mg/dl,Thenormalmetabolismofbilirubin,Outline,Thenormalmetabolismofbilirubin,Pathophysiologicclassificationofjaundice,Manifestationsofdiseasesassociatedwithjaundice,Pathophysiologicclassificationofjaundice,UnconjugatedHyperbilirubinemia,ConjugatedHyperbilirubinemia,UnconjugatedHyperbilirubinemia,Increasedbilirubinproduction,Impairedbilirubinuptake,Impairedbilirubinconjugation,Pathophysiologicclassificationofjaundice,Increasedbilirubinproduction,a.Hemolysisb.Ineffectiveerythropoiesisc.Neonataljaundice,Pathophysiologicclassificationofjaundice,UnconjugatedHyperbilirubinemia,a.Gilbertsyndrome:b.Congestiveheartfailure,Pathophysiologicclassificationofjaundice,UnconjugatedHyperbilirubinemia,Impairedbilirubinuptake,Pathophysiologicclassificationofjaundice,UnconjugatedHyperbilirubinemia,a.Gilbertsyndromeb.Crigler-Najjarsyndrome,Impairedbilirubinconjugation,ConjugatedHyperbilirubinemia,Impairedcanalicularexcretion,Obstructionoftheintrahepaticbileducts,Obstructionoftheextrahepaticbileducts,Pathophysiologicclassificationofjaundice,ConjugatedHyperbilirubinemia,Impairedcanalicularexcretion,Hepatocellularinjury(viralhepatitis,alcoholichepatitis,cirrhosis)b.Intrahepaticcholestasis(eg.Intrahepaticcholestasisofpregnancy,totalparenteralnutrition-inducedjaundice,primarybiliarycirrhosis)c.Familialdisordersofconjugatedbilirubintransporta)Dubin-Johnsonsyndromeb)Rotorsyndrome,Pathophysiologicclassificationofjaundice,ConjugatedHyperbilirubinemia,Impairedcanalicularexcretion,Pathophysiologicclassificationofjaundice,Totalparenteralnutrition(TPN),HepatitisBvirus,Pathophysiologicclassificationofjaundice,ConjugatedHyperbilirubinemia,Impairedcanalicularexcretion,ConjugatedHyperbilirubinemia,Obstructionoftheintrahepaticbileducts,a.Hepatolithiasis(肝内胆管结石病)b.Clonorchiasissinensis(华支睾吸虫病)c.Neoplasms,Pathophysiologicclassificationofjaundice,ConjugatedHyperbilirubinemia,a.Choledocholithiasisb.Neoplasmsc.Biliarystrictures,Pathophysiologicclassificationofjaundice,Obstructionoftheextrahepaticbileducts,Outline,Thenormalmetabolismofbilirubin,Pathophysiologicclassificationofjaundice,Manifestationsofdiseasesassociatedwithjaundice,Manifestationsofdiseasesassociatedwithjaundice,UnconjugatedHyperbilirubinemia,ConjugatedHyperbilirubinemia,UnconjugatedHyperbilirubinemia,a.Stoolandurinescolorbecomedark(尿、便颜色变深)b.Mildjaundice(轻度黄疸)c.Splenomegaly（脾大）(Occursinhemolyticdisordersexceptinsicklecellanemia)d.Weaknessorabdominalorbackpain(acutehemolyticcrisis)(急性溶血危象),Manifestationsofdiseasesassociatedwithjaundice,Manifestationsofdiseasesassociatedwithjaundice,UnconjugatedHyperbilirubinemia,Splenomegaly,Conjugatedhyperbilirubinemia,Hereditarycholestaticsyndromeorintrahepaticcholestasisb.Hepatocellulardiseasec.Biliaryobstruction,Manifestationsofdiseasesassociatedwithjaundice,Conjugatedhyperbilirubinemia,Hereditarycholestaticsyndromeorintrahepaticcholestasis,a.Pruritusb.Light-coloredstoolsc.Malaise,Manifestationsofdiseasesassociatedwithjaundice,Conjugatedhyperbilirubinemia,b.Hepatocellulardisease,a).Malaiseb).Anorexiac).Low-gradefeverd).Rightupperquadrantdiscomforte).Jaundicef).Enlarged,tenderliverg).Vascularspiders,palmarerythemah).Ascites,Manifestationsofdiseasesassociatedwithjaundice,Conjugatedhyperbilirubinemia,c.Biliaryobstruction,a).Rightupperquadrantpainb).Weightloss(suggestingcarcinoma)c).Jaundiced).Light-coloredstoolse).Fever,chills(suggestingcholangitis),Manifestationsofdiseasesassociatedwithjaundice,SUMMARY,Thenormalmetabolismofbilirubin,Unconjugatedbilirubin,Erythrocytes,Marcrophages,Kidney,Livercell,Liver,BileDuct,Conjugatedbilirubin,Liver,Intestine,Urine,Unconjugatedhyperbilirubinemia,Increasedbilirubinproduction,Impairedbilirubinuptake,Impairedbilirubinconjugation,Co