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JAUNDICE


Definition=jaundice defined as yellowish pigmentatn of skin,mucous membrane nd sclera by bilirubin ,rusulting frm elevated levels of bilirubin in blood.
Clinical jaundice occurs when serum bilirun is more than 2.5 mg %.
Latent jaundice is when serum bilirubin is more than 1 mg % but than 2.5 mg %
Classification=
1..Based on underlying derangement of bilirubin metabolism
a..Predominantly unconjugated hyperbilirubinaemia
b..Predo conjugated hyperbilirubinaemia
2..Based on pathology
a..Haemolytic jaundice
b..Hepatocellular jaundice
c..Cholestatic jaundice
A..HEMOLYTIC jaundice=
it results frm increased distructn of red cells resulting in increased bilirubin production
Unconjugated bilirubin accumulates in plasma.
Causes=
1..Intraerythocytic-
spherocytosis,sickle cell disease ,thalassaemia ,g6pd defi
2..Extraerythocytic_
autoimmune haemolytic anemia ,malaria ,prosthetic valves ,PND..
Clinical feature=

.Pallor
.Mild jaundice
.Hepatosplenomegaly
.Dark stool
Investigatn=
.No bilirubin in urine
.Urobilinogen increased
.Serum bilirubin incr
.Unconjugated bilirubinemia
.Normal liver functn test
B..Hepatocellular jaundice
.Results frm inability of liver to transport bilirubin into bile leading to liver cell damage..
Here both conjugated nd unconjugated bilirubin level rises.
Causes=
.Viral hepatitis
.Alcoholic hepatitis
.Chr hepatitis
.Cirrhosis
C..Cholestatic jaundice
.Means failure of bile flow ,coz may lie anywhere btw hepatocytes nd duodenum
.It is usually a surgical jaundice.
Causes=
1.Small duct obstructn due to=
drugs ,alcohol ,viral hepatitis ,cirrhosis ,chr hepatitis ,hodgkins disease
2..Large duct obstructn duue to=
gall stone ,carcinoma head of pancrease ,ca of ampulla of vater ,stricture bile ducts ,ca of bile ducts
.C/F=
symptoms=
.Jaundice
.Pruritus
.Dark urine
.Fever with chils nd rigors
.Wt loss
.Haemorrhagic tendency
.Bone pains
.Signs=
.Deep jaundice
.Xanthelasmas on eyelids
.Xanthomas
.Palpable gall bladder
.Hepatomegaly
.Signs of liver cell failure
.Investigatn=
.Bilirubin in urine
.Urobilinogen absent in urine
.Ser bilirubin raised
.Conjugated hyperbilirubinemia
.Ser alkaline phosphates rised
.Ultrasonography
.Liver biopsy

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