University of Hail College of Medicine Laboratory Medicine Module 2015 Team Work ID Number Name 201104036 Raed Dawood AlMansour 201111909 Rakan Fraih Al-Muazzi 201316234 Haytham Samer Abdulaziz Alanazi 201316583 Bassam ahmed abdalazez almutlaq 201006175 Abdullah Abdelaziz Al-gherimeel

Jaundice – is it a disease? Yellowish staining of the skin and sclerae High levels of bilirubin in blood Clinical marker of defect in metabolism &/or excretion of bilirubin.

Pathophysiology Yellow discoloration of sclera, skin, mucous membranes due to deposition of bile pigment. Clinically detected with serum bilirubin 2 - 2.5 mcg/dL or  (2 times nl)

What is bilirubin? The breakdown product of Hgb from injured RBCs and other heme containing proteins. Produced by reticuloendothelial system. Released to plasma bound to albumin. Hepatocytes conjugate it and extrete through bile channels into small intest.

12/26/2018

What causes  bilirubin? Overproduction by reticuloendothelial system. Failure of hepatocyte uptake. Failure to conjugate or excrete. Obstruction of biliary excretion into intestine.

Unconjugated Conjugated  production exceeds ability of liver to conjugate. Ex. Hemolytic anemias, hemoglobinopathies, in-born errors of metabolism, transfusion rxn. Can produce but not excrete. ex. Intra- or extrahepatic obstruction

Types of Jaundice

Types of Jaundice 1. Hemolytic or prehepatic jaundice (Pathology occurs prior to the liver) 2. Hepato-cellular or intra-hepatic jaundice (Pathology located within the liver) 3. Obstructive or post-hepatic jaundice (Pathology located after the conjugation of bilirubin in the liver) 4. Congenital non-hemolytic jaundice.

1. Hemolytic or prehepatic jaundice If an infection or medical condition makes the red blood cells break down sooner than usual, bilirubin levels rise. This is known as pre-hepatic jaundice. Conditions which may trigger this include: malaria, sickle cell anaemia, thalassaemia, Gilbert's syndrome, hereditary spherocytosis and Crigler-Najjar syndrome.

2- Hepatic Jaundice If the liver is damaged, it may be less able to process bilirubin. This is known as intra-hepatic jaundice. The liver damage may be a result of causes that include: hepatitis, alcoholic liver disease, glandular fever, liver cancer, illegal drug use including ecstasy, and paracetamol overdose.

3- Obstructive Jaundice Gallstones, pancreatitis, pancreatic cancer and cancers of the gallbladder or bile duct may also disrupt the bilirubin removal process leading to jaundice. This is called post-hepatic jaundice. Eating a high-fat diet can raise your cholesterol levels and increase the risk of having gallstones.

مقطع فيديو راح يتم عرضه من الملف الأصلي

4- Congenital Neonatal Hyperbilirubinaemia is clinically detectable in the newborn when the serum bilirubin levels are greater than 85 μmol/L. This occurs in approximately 60% of term infants and 80% of preterm infants. Hyperbilirubinaemia is either unconjugated (which is potentially toxic but may be physiological or pathological) or conjugated (not toxic but always pathological). Without treatment, high levels of unconjugated bilirubin may lead to kernicterus.

Skin and sclerae yellow Signs & Symptoms Skin and sclerae yellow Dark urine Pain in abdomen Itching Headache Mental confusion

Signs & Symptoms Stool - light or clay coloured Trouble with sleeping Fatigue Swollen liver region Coma Diarrhea Vomiting and Nausea Constipation Loss of Appetite Bad Taste in the Mouth Ascites

Risk Factors Having siblings who have had neonatal jaundice Preterm babies Newborns with feeding difficulties/poor feeding Mother with diabetes Newborns with bruising/cephalohematoma Blood type incompatibility Congenital infection

Causes of Jaundice Increased production of bilirubin Acute liver inflammation Infiltrative liver diseases Bile duct inflammation Blockage of bile ducts Drugs (Corticosteroids, Penicillins, Amphotericin B) Genetic disorders Developmental abnormalities of bile ducts Jaundice of pregnancy

Complications of Jaundice Complications of jaundice include: Sepsis especially cholangitis, Biliary cirrhosis, Pancreatitis, Coagulopathy, Renal and liver failure.

History and Examination

Jaundice History Alcohol. Drugs. Blood Transfusion. Past History. IV Drug Use. Weight loss. Appetite loss. Abdominal pain. Fever. Family History of haemolytic anaemia.

Dupuytren’s Contracture Jaundice Examination Jaundice Clubbing Leuconychia Pallor Dupuytren’s Contracture Palmar erythema Spider Naevi

Abdominal Examination Abdominal mass Caput medusa Peripheral oedema Ascites

Laboratory Tests

Laboratory Tests CBC Prothrombin (PT) Serum bilirubin level (total and direct). Liver. aminotransferase. levels Alkaline Phosphatase Urine/A for bilirubin and urobilogen. Alanine Transaminase (ALT) and Aspartate Transaminase (AST) CBC Prothrombin (PT) - Other labs pertinent to history: Coombs test Hgb electrophoresis Viral hepatitis panel U/S Gallbladder

References Clinical Biochemistry illustrated colour text Essential Hematology www.Medscape.com