JAUNDICE

 Is the condition associated with high

serum bilirubin concentration in the
blood , all the body tissues including
the sclerae and the skin.
TYPES OF JAUNDICE:

1- Hemolytic.
2- Hepatocellular.
3-Obstructive .
4- Hereditary hyperbilirubinemia.
 Hepatocellular and obstructive jaundice are

the two types commonly associated with

liver disease.
HEMOLYTIC JAUNDICE:-

 Due to increased destruction of the red blood

cells the effect of which is to flood the plasma
with bilirubin so that the liver functioning
normally but cannot able excrete the bilirubin as
quickly as it is formed .
 Patients with this type of jaundice, unless
their hyperbilirubinemia is extreme, do not
experience symptoms or complications as a
result of the jaundice .
 www.drsarma.in

FIRST STEP
Estimate Serum Bilirubin

Is it less than 1 mg % - Normal

Is it more than 1 mg % - Elevated

6
HEPATOCELLULAR JAUNDICE:-
 Is caused by the inability of damaged liver
cells to clear normal amounts of bilirubin
from the blood.
 The cellular damage may be from infection,
such as in viral hepatitis (eg, hepatitis A, B,
C, D, or E)
 Or duo to other viruses that affect the liver
(eg, yellow fever virus, Epstein-Barr virus),
from medication
 Or chemical toxicity (eg, carbon
tetrachloride, chloroform, phosphorus,
arsenicals, certain medications), or from
alcohol.
S&S
 lack of appetite, nausea, malaise, fatigue,
weakness, and possible weight loss.
 Headache, chills, and fever if the cause is
infectious.
DIAGNOSTIC EVALUATIONS :-

-The serum bilirubin concentration and urine

urobilinogen level may be elevated.
- AST and ALT levels may be increased indicating
cellular necrosis
OBSTRUCTIVE JAUNDICE :-
 It is extrahepatic type may be caused by
occlusion of the bile duct by a gallstone, an
inflammatory process, tumor or pressure
from an enlarged organ.
 The obstruction may also involve the small bile
ducts within the liver( intrahepatic
obstruction).
 Intrahepatic obstruction resulting from stasis and

inspissation (thickening) of bile within the

canaliculi may occur after the ingestion of certain
medications .
 Whether the obstruction is intrahepatic or
extrahepatic and whatever its cause may be,
bile cannot flow normally into the intestine
but is backed up into the liver substance.
 It is then reabsorbed into the blood and
carried throughout the entire body, staining
the skin, mucous membranes, and sclera.
 It is excreted in the urine which becomes
deep orange and foamy.
 Because of the decreased amount of bile in
the intestinal tract, the stools become light
or clay-colored.
 -The skin may itch intensely requiring repeated
soothing baths.
- Dyspepsia and intolerance to fatty foods may
develop because of impaired fat digestion in the
absence of intestinal bile.
DIAGNOSTIC EVALUATIONS:-
 AST, ALT, and GGT levels generally rise
only moderately, but bilirubin and alkaline
phosphatase levels are elevated