消化科彭昭黃疸

1、JAUNDICE,Teacher : Zhao Peng Date:3/21/2024,Definition,YELLOW,Definition,Jaundice is the yellow discoloration of the sclera , skin and mucus membrane resulting from an increase bilirubin concentration in the bo

2、dy fluid (more than 17.1 μmol/L) Clinical jaundice: > 34.2 μmol/L Jaundice occult: 17.1-34.2 μmol/L,1,Liver diseases,2,Congenital hypebilirubinemia,3,Hemolytic anemia,4,Recurrent jaundice,AnnotationHb: hem

3、oglobinUCB: unconjugated bilirubinCB: conjugated bilirubinUGT: UDP-glucuronyl transferase,,,UGT,,Bilinogen enterohepatic circulation,Over production,,Decreased hepatic conjugation,,Decreased hepatic uptake,,Distu

4、rbance of excretion,,Types,,,,,UGT,,,CB,Hepatocellular,,,,Obstructive,,CB,,1.Extra-erythrocytic abnormalities Malaria Autoimmune Physical trauma (e.g. burns ,prosthetic heart valve) Chemical trauma

5、 (drugs e.g. dapsone ) Metabolic (e.g. urmia)2. Intra-erythrocytic defects Spherocytosis Thallassemia Enzyme Glucose-6-phophonate dehydrogenase deficiency Vitamin B12 and folic acid defic

6、iency,Jaundice :mild , if bilirubin is more than 6 mg/dL then there is concomitant hepatic injury Pallor :due to the anemia Splenomegaly Stool:dark in color due to excessive stercobilinogen which is product

7、ed by bilirubin Urine: dark due to increased urobilinogen,Viral hepatitis Liver cirrhosis Leptospira Septicemia,Jaundice :mild ,  pruritus fatigue ;anorexia; hemorrhagic tendency

8、 ;ascitesExcept for jaundice and pruritus, the other symptoms were all manifestations of primary liver disease,1.Extra-hepatic cholestasis Common duct stones Carcinoma of -head of pancreas -ampulla -bil

9、e duct(cholangiocarcinoma) Traumatic biliary stricture Crystic fibrosis2. Intra-hepatic cholestasis Pregnancy Recurrent idiopathic cholestasis Drugs such as oral contraceptive, anabolic steroids,Ea

10、rly feature :Jaundice ; pruritua ; dark urine ; Pale stoolLate feature: Xanthelasma and xanthomata ; Malabsorption ; Weight-loss ; Steatorrhoea ; Osteomalacia ; Bleeding tendency.The combination of jaundice

11、, fever and rigor is called Charcot’s triad and it indicates acute cholangitis,1.Unconjugated hyperbilirubinemia Gilbert’s Syndrome Crigler-Najjar Syndrome2. Conjugated hyperbilirubinemia Dubin-Johnson Sdyd

12、rome Rotor Syndrome,Gilbert’s syndrome : it is asymptomatic and usually dedected incidental finding of slightly raise bilirubin on a routime check .no signs of liver disease are seen . there is a family history of ja

13、undice in 5-15% of patientsCrigler-najjar’s syndrome : Death occurs usually in first year of life due to kernicterus,Jaundice FeverPruritus HepatomegalySplenomegalySigns of chronic liver diseaseLate featurePalpa