4 DEFINITION OF FEVERFever is an elevation of body temperature that exceeds the normal daily variation, in conjunction with an increase in hypothalamic set point.θ in the anus ≥ ᵒCin the mouth ≥ 37.7 ᵒCaxillary/otic ≥ 37.2 ᵒCTemperature in the anus (rectum/rectal) is at or over 37.5–38.3 °C (99.5–100.9 °F)Temperature in the mouth (oral) is at or over 37.7 °C (99.9 °F)Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 °C (99.0 °F)
5 PATTERN OF FEVER Sustained (Continuous) Fever Intermittent Fever (Hectic Fever)Remittent FeverRelapsing Fever:Tertian FeverQuartan FeverDays of Fever Followed by a Several Days AfebrilePel Ebstein FeverFever Every 21 Day
7 Jaundice – is it a disease or a sign of a disease? Yellowish staining of the skin and scleraeHigh levels of bilirubin in bloodJaundice is a condition in which an excess of bilirubin builds up in the blood and causes the skin and eyes to turn a yellowish color. Bilirubin is a byproduct of the process by which the liver removes dead red blood cells. Excess bilirubin can be caused by a number of health problems, many of which are serious. Jaundice with fever can be a sign of malaria, acute pancreatitis or certain liver problems.If someone shows signs of jaundice, doctors will look to treat the condition that's causing it rather than jaundice itself.
8 Clinical Aspects of Jaundice Clinically detectable if SB is >2.0 mg%With edema and dark skin – Jaundice may be maskedWhat is special about the sclera ? – Rich ElastinSkin discoloration – Yellowish, - Carotinemia – Eyes NMucosa – hard palate (in dark skinned)Greenish hue of skin and sclera - due Biliverdin – indicates long standing jaundiceGeneralized Pruritus – Obstructive Jaundice – Why ?
9 Jaundice – Classification Normal Serum Bilirubin (SB) is 0.3 to 1.0 mg%Jaundice may be due to:Over production of Bilirubin (Hemolytic)From hemolysis of RBCLysis of RBC precursors – Ineffective erythropoesisImpaired hepatic function (Hepatitic)Hepatocellular dysfunction in handling bilirubinUptake, Metabolism and Excretion of bilirubinObstruction to bile flow (Obstructive)Intrahepatic cholestasisExtrahepatic Obstruction (Surgical Jaundice)
15 Hereditary, Familial, Genetic Disorders: Sickle cell anemiaCirrhosis/childhood Indian type
16 An Approach to Jaundice & fever Is it isolated elevation of serum bilirubin ?If so, is the↑unconjugated or conjugated fraction?Is it accompanied by other liver test abnormalities ?Is the disorder hepatocellular or cholestatic?If cholestatic, is it intra- or extrahepatic?These can be answered with :History and physical examinationInterpretation of laboratory tests andRadiological tests and procedures.
18 Clinical History – Imp clues Duration of jaundice – Acute / ChronicAbdominal pain v/s painless jaundicePruritus - obstructiveAffect appetite – Hepatocellular infection / MalignancyWeight loss – Malignancy – CAHColour of stools –chalky white –obstructiveFamily history – Hemolytic – Inherited dis.H/o transfusion, IDUAlcohol abuse, Medications.
19 Laboratory Tests Complete blood count Prothrombin time Bilirubin level in serum (total and direct)AminotransferaseAlkaline phosphataseU/A for bilirubin and urobilogenComplete blood countProthrombin timeOther laboratory tests pertinent to historyCoombs testElectrophoresis of hemoglobinViral hepatitis panel
20 First Step Estimate Serum Bilirubin Is it less than 1 mg % - Normal Is it more than 1 mg % - Elevated
21 Second Step : If SB > 1.0 mg Is it unconjugated bilirubin ?Haemolytic JaundiceIs it Conjugated Bilirubin ? (> 20%)Hepatocellular jaundiceObstructive jaundice
23 Third Step : If CSB is increased Do - AST and ALT (SGOT and SGPT)Elevated AST and ALTHepatocellular jaundiceAKP, 5N, GGT will be normalDo - Alkaline Phosphatase and GGTAKP, GGT ↑↑ in Obstructive JaundiceAST and ALT will be normal
24 Fourth Step : Hepatocellular Hepatocellular – Features and D.DConjugated SB is increasedAST and ALT are increasedAKP, 5NS, GGT are normalHepititis – A,B,C,D,E, CMV,EBVToxic Hepatitis – Drugs, AlcoholMalignancy – Primary CaCirrhosis – ALD, NAFLD
25 TreatmentTreatment requires a precise diagnosis of the specific cause and should be directed to the specific problem
26 PBL Members Alif Alia Syafiq Yasmin Malisa Deanna Fatimah Fadhillah MohamedShawameeraThank You!