1. Jaundice: Causes and Etiopathogenesis
INTEGRATED TEACHING
Jaundice: Causes and Etiopathogenesis
Dr. Ashok Singh
Assistant Professor
Dept. of Pathology

2. Jaundice “ Jaune” : Yellow पीलिया Icterus Latin
Sighting the bird was thought to cure jaundice
Deposition of bilirubin

3. IMBALANCE between production and clearance
Overproduction: hemolysis
Prehepatic
Impaired uptake/conjugation/excretion:
hepatocytes
Hepatic
Regurgitation:
Hepatocyte/bileduct
Posthepatic

4. What are the different etiopathogenic patterns?
Haemolysis
Disorder of uptake and conjugation
Hepatocellular injury
Cholestasis
Role of pathology in establishing diagnosis?
Peripheral Smear examination
Liver biopsy

5. Serum Bilirubin rarely >5 mg/dL
Haemolysis
Inherited Vs Acquired
Spherocytosis
Sickle cell
Thalassemia
Pyruvate kinase deficiency
G6PD deficiency
Microangiopathic haemolytic anemia (HUS)
Paroxysmal Nocturnal Haemoglobinuria
Immune hemolysis
Parasitic infections (Malaria)
Ineffective erythropoiesis (B12, folate deficiency)
Serum Bilirubin rarely >5 mg/dL
Intravascular Vs Extravascular
Pigmented gall stones

6. Schistocytes
Nucleated RBCs

7. Spherocytes: No central pallor
Coombs positive Autoimmune haemolytic anemia

8. Hereditary Spherocytosis Microspherocytes in C.perfringens sepsis

9. Osmotic Fragility testing

10. Bite cells
Blister cells
G6PD deficiency, Unstable Hb

11. Irregularly contracted cells
Heinz bodies:
Crystal Violet stain
Unstable Hb

12. Microangiopathic Hemolytic anemia Pyruvate Kinase def.
Spiculated spheroid cells

13. INTRAVASCULAR HEMOLYSIS
Hemolysis, serum
Jaundice
Hemoglobinuria

14. Paroxysmal Nocturnal Hemoglobinuria

16. Sickle cell anemia

17. Disorders of uptake and conjugation

18. INHERITED JAUNDICE

19. Lipofuscin like pigment in Zone 3 Positive on Fontana Mason stain
Dubin Johson syndrome
Lipofuscin like pigment in Zone 3
Positive on Fontana Mason stain

20. Hepatocellular Injury
Alcohol
Viruses
Autoimmune
Drugs B C E
EBV
CMV
Combination of reduced conjugation and cholestasis
CIRRHOSIS

21. Hepatitis C

22. Hepatitis B

23. Autoimmune hepatitis

24. Fibrosis
Cirrhosis

25. Normal liver
Cirrhotic liver

26. Cholestasis

27. BENIGN
MALIGNANT

28. Feathery degeneration
Cholestasis pattern
Feathery degeneration

29. Cholestasis

30. SUMMARY IMBALANCE between production and clearance
Overproduction: hemolysis
Prehepatic
Impaired uptake/conjugation/excretion:
hepatocytes
Hepatic
Regurgitation:
Hepatocyte/bileduct
Posthepatic

31. Thank You for listening…