1. This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Jaundice By Saad AL-Robaiea Medical Student

3. Definition: Jaundice or icterus is yellowish discoloration of skin, mucous membranes and sclera result of rise in serum bilirubin Normal range of plasma bilirubin 3-17 mcmol/L (0.5 – 1 mg/dl) Clinically obvious     50 mcmol/L (3mg/dl)

4. NORMAL BILIRUBIN METABOLISM
Bilirubin is derived mainly from breakdown of hemoglobin
Unconjugated bilirubin is conjugated in the liver by glucuronyl transferase
Conjugated bilirubin is water soluble and is secreted by the hepatocytes into the biliary canaliculi
Converted to urobilinogen (colorless) by bacteria in the gut wich may reabsorbed and excreted by the kidneys or converted to stercobilin and excreted in faeces (colored)

5. Types hyperbilirubinemia
Unconjugated hyperbilirubinaemia (Indirect)
Conjugated hyperbilirubinaemia (Direct)

6. Causes of jaundice

7. Prehepatic (hemolytic) jaundice
Results from overproduction of bilirubin (beyond the livers ability to conjugate it) following hemolysis
Impaired hepatic uptake (Rifampine , Gilbert’s syndrom)
Impaired conjugation (Chloramphenicol , Criglar-Najjar syndrom)
Increased plasma unconjugated bilirubin
Increased urobilinogen in urine
ALP, ALT, AST - normal

8. Intrahepatic jaundice
Impaired uptake, conjugation, or secretion of bilirubin
Reflects a generalized liver (hepatocyte) dysfunction
Excess bilirubin mixture unconjugated +conjugated
Increased ALT/AST
Slightly increased or Normal ALP

9. Posthepatic (Obstructive) jaundice
Caused by an obstruction of the biliary tree
Increased plasma conjugated bilirubin
Characterized by pale colored stools (absence of fecal stercobilin), and dark urine (increased conjugated bilirubin) and urobilinogen is absent from the urine
Increased ALP
Slightly increased or Normal ALT,AST

12. History : Onset Fever abdominal pain
Pruritus , dark urin , pale stools
Travel
Drugs
Blood transfusion
Family history
Surgical history

13. Physical examination General examination Vital signs Murphy's sign
Hepatomegaly , Splenomegaly
Signs of chronic liver disease

14. Lab evaluation CBC , reticulocyte count , LFT , prothrmobine and INR
Iron profile
Viral serology
Autoantibodies

15. U.S C.T ERCP MRCP Liver biopsy : - Cirrhosis - Chronic hepatitis
- Undiagnosed hepatomegaly
- Cholestasis of unknown cause

17. 1- In obstructive jaundice:
a. Urinary conjugated bilirubin is increased
b. Serum unconjugated bilirubin is increased
c. Urinary urobilinogen is increased
d. Serum conjugated bilirubin is reduced
e. Faecal stercobilin is increased

18. THANK YOU