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1、Jaundice,Gastroenterology Department, First Affiliated Hospital of Chongqing Medical University,Bingqiang Zhang,Aims and Demands 1. Grasp the concept of jaundice, clinical manifestation and points of inquisition 2. Familiar the etiology and mechanism of jaundice 3. Realize normal bilirubin metabolis
2、m,Definition：jaundice,or icterus refers to the yellow appearance of the skin,scleral and mucous membranes resulting from an increased bilirubin concentration in the body fluids. Total bilirubin: 1.7-17.1mol/L Conjugated bilirubin:0-3.42mol/l， Unconjugated bilirubin:1.7-13.68mol/l.,Normal bilirubin m
3、etabolism,Classification,1. Depending on Etiology Hemolytic Jaundice Hepatocellular Jaundice Cholestatic Jaundice Congenital jaundice,2. Depending on bilirubin Unconjungated bilirubing increased jaundice Conjungated bilirubing increased jaundice,Etiology 1.Congenital hemolytic anemia (thalassemia,he
4、reditary spherocytosis). 2.Posteriority acquired hemolytic anemia (autoimmunity hemolytic anemia, hemolytic disease of newborn, posttransfusion hemolytic, Favism). Mechanism A large number of erythrocyte destroyed rapidly Anemia,hypoxia and toxity of erythocyte metabolism products,1.Hemolytic Jaundi
5、ce,Haemolytic Jaundice mechanism,Clinical Manifestation Mild jaundice,light lemon,no skin itch. Acute hemolytis: fever,chill,headache,vomit,backache,anemia, hemoglobinuria( dark sauce or tea), acute renal failure. Chronic hemolysis:anemia and splenomegaly.,Laboratory Examination 1.Serum TB,UCB,CB no
6、rmal. 2.UCBintestinal CBfaecal color deepen. 3.Intestinal Urobilinogenurinary Urobilinogen. 4.Acute hemolytis, occult blood test (+). 5.Blood test:anemia, reticulocyte,erythacyte proliferation.,2.Hepatocellular Jaundice,Etiology Hepatocyte damage. Mechanism Impair hepatocyte uptakeing,conjugating an
7、d excreting bilirubin, UCB CB reflux into blood, serum CBjaundice.,Hepatocellular Jaundice mechanism,Clinical Manifestation Skin and mucosa:light to deep yellow, mild skin itch Tired,loss of appetite hemorrhagic tendency,ascites,coma. Primary disease manifestation,Laboratory Examination CB, UCB Icte
8、ric hepatitis:CB UCB Urine:CB(+),urobilinogen Blood test:liver demaged,3.Cholestatic Jaundice,Etiology Obstruction in liver:virus hepatitis,drug caused,drug hepatitis, primary biliary cirrhosis. Obstruction of Extrahepatic bile duct:narrow, obstruction,stone, inflammtory,tumor. Mechanism Obstruction
9、 causes small bile duct and bile capillary broken, conjugated bilirubin reflux to blood. Failure of hepatocyte excreting CB,bilirubin deposit and bile thrombus formation.,Cholestatic Jaundice mechanism,Clinical features Skin dark yellow,yellow green. Skin itch, bradycardia,dark yellow of urine,facal
10、 light yellow or clay color. Courvoisiers sign.,Laboratory Examination Serum CB Urine bilirubin (+) Urobilinogen , stercobilin or absence Serum alkaline phosphatase and Cholesterol,Three kinds of jaundice laborotory examination indentification,Class Haemolytic Hepatocellular Cholestatic TB increased
11、(UCB) increased increased CB normal increased markedly increased CB/TB 15一20 30一40 50一60 urine bilirubin 十 十十 urobilinogen increased slight increased decreased or absence ALT、AST normal markedly increased may increased ALP normal increased markedly increased r-GT normal increased markedly increased
12、PT normal delayed delayed Vit K respond no poor good Cholesterol normal slight increased or decreased markedly increased Serum protein normal Alb decreased,Glob increased normal,4.Congenital Nonhemolytic Jaundice,Due to the deficiency of the hepatocyte in uptakeing,conjugating and excreting bilirubi
13、n Uncommon,1.Gilber syndrome:hepatocyte uptaking UCB abnormal, deficiency of glucuronyl transferase, UCB jaundice (no symptom,liver function normal). 2.Dubin-Johnsons syndrome:abnormal of Hepatocyte excreting CB and some anion to bile capillary CB jaundice. 3.Crigler-Najjars syndrome:absence of gluc
14、uronyl transferase in hepatocyte, UCB cant be transfered to CB，serum UCBjaundice,UCBnuclear jaundic, newborn,poor prediction. 4.Rotors syndrome:deficiency of Hepatocyte uptaking UCB and excreting CB,bilirubinjaundice.,Accessory Examination,1.Ultrosound 2.X ray 3.ERCP(Endoscopic retrograde cholangiop
15、ancreatography) 4.PTC(Percutaneous transheptic cholangiography) 5.CT(Computed tomography) 6.MRI(Magnetic resonance cholangiopancreatography) 7.Radio Nuclide Examination 8.Liver Biopsy and LC(Laparoscopy),Accompanying Symptoms,Fever:acute cholangitis,liver abscess, leptospirosis, septicemia, lobar pneumonia.Fever then jaundice:virus hepatitis,acute hemolysis. Upper abdominal sharp pain:biliary calculi,liver
