This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration.
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Presentation on theme: "This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration."— Presentation transcript:
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.
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 hemoglobinUnconjugated bilirubin is conjugated in the liver by glucuronyl transferaseConjugated bilirubin is water soluble and is secreted by the hepatocytes into the biliary canaliculiConverted 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)
7 Prehepatic (hemolytic) jaundice Results from overproduction of bilirubin (beyond the livers ability to conjugate it) following hemolysisImpaired hepatic uptake (Rifampine , Gilbert’s syndrom)Impaired conjugation (Chloramphenicol , Criglar-Najjar syndrom)Increased plasma unconjugated bilirubinIncreased urobilinogen in urineALP, ALT, AST - normal
8 Intrahepatic jaundice Impaired uptake, conjugation, or secretion of bilirubinReflects a generalized liver (hepatocyte) dysfunctionExcess bilirubin mixture unconjugated +conjugatedIncreased ALT/ASTSlightly increased or Normal ALP
9 Posthepatic (Obstructive) jaundice Caused by an obstruction of the biliary treeIncreased plasma conjugated bilirubinCharacterized by pale colored stools (absence of fecal stercobilin), and dark urine (increased conjugated bilirubin) and urobilinogen is absent from the urineIncreased ALPSlightly increased or Normal ALT,AST
17 1- In obstructive jaundice: a. Urinary conjugated bilirubin is increasedb. Serum unconjugated bilirubin is increasedc. Urinary urobilinogen is increasedd. Serum conjugated bilirubin is reducede. Faecal stercobilin is increased