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

3. 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.

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

6. 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.

7. 12/26/2018

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

10. 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

11. Types of Jaundice

12. 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.

13. 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.

14. 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.

15. 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.

16. مقطع فيديو راح يتم عرضه من الملف الأصلي

17. 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.

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

21. 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

22. 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

23. 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

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

25. History and Examination

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

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

28. Abdominal Examination
Abdominal mass
Caput medusa
Peripheral oedema
Ascites

29. Laboratory Tests

30. 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

33. References Clinical Biochemistry illustrated colour text
Essential Hematology