JAUNDICE

Dr. Smrithi Shetty C.

Professor
Dept of Physiology
AJIMS & RC
PY2.5 Describe different types of
anemias & Jaundice
 • List the RBC indices and describe the
variations in disease
 • Define and classify jaundice.
 • Differentiate the different types of jaundice.
 • Describe Physiological jaundice
Jaundice : Yellowish discoloration of skin, Sclera
and mucous membrane due to increase
Bilirubin >2mg%
(N 0.2- 0.8mg%)
1 – 2mg- latent Jaundice
 Bilirubin metabolism
RBC

HB

Globin Haem
(Enters amino acid pool) Microsomal oxygenase
system
Remaining part Fe+2(combines with
Apoferritin)
Oxidized
Biliverdin Ferritin( stored in liver)
Reduced biliverdin reductase
Bilirubin ( unconjugated)
 Unconjugated bilirubin + Albumin
Albumin
Bilirubin + Ligandin General
UDPGA circulation
Conjugated Bilirubin
Excreted in bile
Reduced by colonic bacteria
Stercobilinogen 20% enters Filtered &
portal circulation excreted
80% excreted in feces
Oxidized Urobilinogen
Stercobilin ( brown color to feces)
 Pre hepatic jaundice

 Results from excess

production of bilirubin
(beyond the livers
ability to conjugate it)
following hemolysis
 High plasma
concentrations of
unconjugated bilirubin
(normal concentration
~0.5 mg/dL
 Hepatic jaundice
 Impaired uptake,
conjugation, or
secretion of bilirubin
 Post hepatic jaundice

 Caused by an
obstruction of the
biliary tree
 Jaundice - types
Tests Pre hepatic Hepatic Post hepatic
Haemolysis Infective Obstruction
or toxic of bile ducts
damage
1)Van Den Indirect +ve Biphasic direct +ve
Bergh test
2) Blood anemia, Normal Normal
Examination reticulcytosis,
abn RBC
 Jaundice - types
Tests Pre hepatic Hepatic Post hepatic
3) A/G ratio N decreased usually N
4) Thymol Nil Markedly ↑ slight
turbidity
5) Serum Alkaline N slight ↑ markedly ↑
phosphatase
6)Urine bilirubin absent + +
7)Urine ++/ ↑ + /↓ absent
urobilinogen
 Jaundice - types
Tests Pre hepatic Hepatic Post hepatic
8) Fecal markedly ↑, reduced, absent,
stercobilinogen dark brown pale clay colored
colored stools feces feces
9)Fecal fat N ↑, ↑
steatorrhoea
10) LFT N impaired N/ mildly
impaired
Physiological jaundice
-mild jaundice in newborn on 2nd or 3rd day of
life
- excessive destruction of RBC at birth
- hepatic immaturity
R Phototherapy
Thank you