JAUNDICE

Syn: ICTERUS

Clinical manifestation of defect in the metabolism or excretion of

bilirubin (yellow pigment)

Greater than normal amounts of

bilirubin in the blood (2-3mg/dl)

• Accumulates in plasma & other tissues

• Yellow discoloration of the

skin, mucous membranes, sclera etc.
 (b)

BILIRUBIN RE Cell

 Breakdown product of haeme

(enzymatic degradation)
 Sources of haeme
 Aged RBC (80%)
 Injured RBC
 Myoglobin
 Cytochromes
 Peroxidase
 Catalase
 Guanylate cyclase

 Formed in RE system
 HEME

BILIVERDIN

BILIRUBIN
OATP

BUGT

IN URINE AS
UROBILIN

IN FAECES AS
INTESTINE STERCOBILIN
 TYPES OF JAUNDICE
 PRE-HEPATIC JAUNDICE (Haemolytic jaundice)
 pathology is occurring prior to the liver
 If the RBCs die at a faster rate than usual, bilirubin can
accumulate in the blood and cause jaundice

 HEPATIC JAUNDICE ( toxic jaundice)

 The pathology is located within the liver
 Liver diseases of all kinds threaten the organ's ability to
keep up with bilirubin processing

 POST-HEPATIC JAUNDICE (Obstructive jaundice)

 pathology is located after the conjugation of bilirubin in the
liver
 Jaundices caused by failure of soluble bilirubin to reach the
intestines after it has left the liver
 Haemolytic jaundice
By anything which causes an increased rate of hemolysis
Cond…

LABORATORY FINDINGS
 HEPATIC JAUNDICE
Liver diseases of all kinds threaten the organ's ability to keep up
with bilirubin processing

CAUSES
 HEPATIC JAUNDICE

Impairment of all steps of bilirubin

metabolism
Uptake
Conjugation
Excretion
Presence of both conjugated &
unconjugated bilirubin in blood
Rate limiting step – excretion
So conjugated hyperbilirubinaemia
predominates
Cond…

LABORATORY FINDINGS
POST-HEPATIC JAUNDICE
Obstruction to the flow of bile
Cond…
Bilirubin is conjugated normally

reabsorbed into the blood

(water soluble)

circulates to kidneys

colouring urine dark yellowish brown

(stools remain pale)
Cond…
 TEST FOR TYPE OF JAUNDICE
Van den Bergh Reaction

BILIRUBIN
Diazotised sulfanilic acid
(Sulfanilic acid in HCl
& sod.nitrite)
AZOBILIRUBIN
 ICTERUS INDEX
• Calculation indicating the level of bilirubin in
serum
(the intensity of the color of a specimen is compared with
that of a standard solution using a colorimeter)

• Highly indicated for canine, feline & ovine

plasma
(water clear & free of yellow colour)
 FOUCHET’S TEST
TEST FOR PRESENCE OF BILIRUBIN IN URINE

10ml urine

10% BaCl2

Filter

Fouchet’s
reagent
 EHRLICH’S TEST
Test for urobilinogen in urine

1ml urine + 0.1ml 2% P- dimethyl aminobenzaldehyde

In 2N HCl

After 10 mts

RED COLOUR
Presence of urobilinogen
JAUNDICE IN ANIMALS
 HORSE
 Normally higher bilirubin
level (4mg/dl)
 Absence of gall bladder
 Bilirubin value increased
in
Colic constipation
Enteritis
Pneumonia
Fasting
Acute hepatic necrosis
Cirrhosis

 Value may upto 8mg/dl

 RUMINANTS

Clinical icterus is associated with

Anaplasmosis
Babesiosis
Cu poisoning in sheep
Severe fatty liver in cattle
 CANINES
• Normally small amount of bilirubin
in urine
(absence of tubular
reabsorption)
• Haemolysis – conjugated bilirubin
<25% of total
• Intra hepatic- conjugated bilirubin
40-50% of total
• Extra hepatic- conjugated bilirubin
>75% of total
• ALP(Alkaline Phosphatase) also
elevated with cholestasis.
 FELINES

Bilirubinuria in cat is abnormal

Common causes of feline jaundice

Hepatic lipidosis
Cholangiohepatitis
Feline infectious peritonitis