Transcript JAUNDICE - ASHWINI

JAUNDICE
What is jaundice?
Jaundice is not a disease but
rather a sign that can occur in
many different diseases. Jaundice
is the yellowish staining of the skin
and sclerae (the whites of the
eyes) that is caused by high levels
in blood of the chemical bilirubin.
The color of the skin and sclerae
vary depending on the level of
bilirubin. When the bilirubin level is
mildly elevated, they are
yellowish. When the bilirubin level
is high, they tend to be brown.
PHYSIOLOGY OF JAUNDICE
Samson Wright
Bilirubin comes from red blood cells. When red blood cells get old, they are ingested and
destroyed by the RE system( certain phagocyctic cells found in the bone marrow, liver, lymph
nodes, spleen and subcutaneous tissue) Normally, about 1% of our red blood cells retire every
day, to be replaced by fresh red blood cells. Haemoglobin the chemical in red blood cells that
carries oxygen, contains haem attached to globin. In the RE cells the haem part of the molecule
is altered by the oxidation of the C of one of its methine (=CH) bridges. The tetrapyrrole ring
structure is thus broken and the four pyrrole groups become arranged a s straight chain. As a
result of this chemical change the green iron containing compound choleglobin is formed. As its
name implies the molecule still contains the original globin. Next both iron and globin are split off
and bilirubin is formed.
This compound is only soluble in lipid solvents but is extruded into the plasma in a colloid form
bound with α-globulin. It is this protein conjugation of bilirubin which is responsible for the solubility
of the bilirubin complex in the plasma and which prevents its excretion by the kidneys. On
reaching the liver the bilirubin- globulin complex enters the hepatic cells and therein undergo
conjugation with glucuronic acid to form water soluble . These compounds pass by the bile ducts
into the intestine., where by bacterial degradation, mainly in the colon, stercobilinogn( =
urobilinogen) is formed. is formed.
Some urobilinogen is reabsorbed and goes via the portal system to the liver, where some escapes
into the general circulation and some is re-excreted in the bile. Urobilinogen is water soluble and
is filtered off by the kidney and is excreted in the urine.If the urine is allowed to stand urobilinogen
is oxidised to urobilin which gives the yellow colour to the urine.
The stercobilinogen that is not reabsorbed from the intestine is in excreted in amounts of 20250mg/day in the faeces. Some of this stercobilinogen is oxidised to stercobilin which is
responsible for the yellow colour of the urine.
JAUNDICE- TYPES & CAUSES
Jaundice occurs when there is
1) Excessive breakdown of RBCs resulting in too much bilirubin being
produced for the liver to remove from the blood- hemolytic jaundice or
prehepatic. (For example, patients with hemolytic anaemia have an
abnormally rapid rate of destruction of their red blood cells that releases
large amounts of bilirubin into the blood). As bilirubin is not filtered by the
kidneys hemolytic jaundice is also called acholuric.
2)
a defect in the liver that prevents bilirubin from being removed from the
blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile,
due to toxic damage, infection of the liver or lack of the enzyme ( glucuronyl
transferase) – hepatocellular or hepatic jaundice
3)
blockage of the bile ducts that decreases the flow of bile and bilirubin from
the liver into the intestines - Obstructive jaundice or post hepatic. (For
example, the bile ducts can be blocked by cancers, gallstones, or
inflammation of the bile ducts). The decreased conjugation, secretion, or
flow of bile that can result in jaundice is referred to as cholestasis: however,
cholestasis does not always result in jaundice.
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BILE SALTS
These are synthesized by the hepatic cells.
Cholic acid is formed from cholesterol and is
conjugated with either taurine or glycine to form
the bile salts – glcyocholic and taurocholic
acids.At the pH of bile 7.3-7.7 taurocholate and
glycocholate exist as anions.
They are water soluble and are necessary for the
digestion of fats.
In obstructive jaundice they are regurgitated into
blood and are filtered by the kidneys and so are
present in urine
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Van den Burgh Test
• When a mixture of sulphanilic acid, HCl, and
sodium nitrite is added to sierum containing an
excess of bilirubin glucuronide a reddish violet
colour results max in 30secs. This is called the
Direct reaction
• When the reagents are mixed with serum
containing an excess of bilirubin no colour
develops until alcohol is added whereupon the
reddish-violet colour appears.
TESTS
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Urine – bile salts
Urine – bile pigments-( bilirubin)
Faecal urobilinogen
Faecal fat
LFT
Alkaline phosphatase
Van den Burgh
ANATOMY
SICKLE CELL DISEASE
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Sickle cell anemia is an inherited blood
disease in which the red blood cells
produce abnormal pigment
(hemoglobin). The abnormal
hemoglobin causes deformity of the
red blood cells into crescent or sickleshapes, as seen in this
photomicrograph
WHEN DO YOU SUSPECT SCD
AND WHAT SHOULD YOU DO
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JAUNDICE
BODY PAIN/JOINT PAIN
PAINFUL SWELLINGS
TIRED/NOT WORKING
POOR GROWTH
RECURRENT RESP
INFECTION
• STROKE
BLOOD TEST AT GAH
WHAT TO DO FOR PATIENT WITH
SCD
• PROTECT AGAINST
DIARRHOEA
• GIVE PENICILLIN
TILL AGE 5
• HYDROXYUREA
• GENETIC ADVISE
Diseases from contaminated water
HEPATIC JAUNDICE
Dysentery, Amebic dysentery, Cholera, Giardia
Entamoeba histolytica
Hepatitis A,
Leptospirosis
Typhoid fever,
Cercarial dermatitis, Cryptosporiosis,
Cyclosporiasis, Cysticercosis, Dracunculiasis,
Hookworm,, Melioidosis, Neurocysticercosis,
Polio, Relapsing fever, Toxocariasis, Trachoma,
Traveler's diarrhea,
CONTAMINATING!
HEPATATIS A
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Hepatitis A is transmitted by contaminated
food or water, or contact with a person who
is currently ill with the disease. The hepatitis
A virus is shed in the stools of an infected
person during the incubation period of 15 to
45 days before symptoms occur and during
the first week of illness. Blood and other
bodily secretions may also be infectious.
The virus does not remain in the body after
the infection has resolved, and there is no
carrier state (a person or animal that
spreads the disease to others but does not
become ill).
The symptoms associated with hepatitis A
are fever, poor appetite, nausea & vomiting,
abd pain ,jaundice & yellow urine. This is
because the liver is not able to filter bilirubin
from the blood.
Risk factors include having a family member
who recently had hepatitis A,
DRINK ONLY BOILED WATER
HEPATATIS B
Causes, incidence, and risk factors
• Hepatitis B is transmitted via blood and other body fluids.
Infection can occur through:
• Contact with blood in healthcare settings -- this puts
physicians, nurses, dentists, and other healthcare
personnel at risk
• Unsafe sex with an infected person
• Blood transfusions
• Sharing needles during drug use
• Receiving a tattoo or acupuncture with contaminated
instruments
• Birth -- an infected mother can transmit the virus to
the baby during delivery or shortly thereafter
HEPATATIS B
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Hepatitis B is also known as
serum hepatitis and is spread
through blood and sexual contact.
It is seen with increased frequency
among intravenous drug users
who share needles and among the
homosexual population. This
photograph is an
electronmicroscopic image of
hepatitis B virus particles. (Image
courtesy of the Centers for
Disease Control and Prevention.)
HEPATATIS B
• In acute hepatitis, it takes about 1-6 months from the
time of infection until symptoms appear. Early symptoms
may include nausea and vomiting, loss of appetite,
fatigue, and muscle and joint aches. Jaundice, together
with dark urine and light stools, follows.
• About 1% of patients infected with hepatitis B die due to
liver damage in this early stage.
• The risk of becoming chronically infected, carrier,
depends on the person's age at the time of infection.
More than 90% of newborns, about 50% of children,
and less than 5% of adults infected with hepatitis B
develop chronic hepatitis
UNSAFE INJECTIONS
HEPATITIS B VACCINE
• The hepatitis B vaccine is
recommended for healthcare
workers, people who live with
someone with hepatitis B, and
others at higher risk. The
hepatitis B virus can damage
liver cells. Immunization is also
recommended for all infants
and unvaccinated children &
adults
LEPTOSPIROSIS
Jaundice in Newborn
CONCLUSION-CAUSES OF
JAUNDICE
Sickle cell disease
VIRUS/Leptospirosisin water A
in blood B
water containing rat urine /faeces
ALCOHOL/DRUGS
Gallstones