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Jaundice

Jaundice is caused by hyperbilirubinemia, which can be either unconjugated or conjugated. Unconjugated hyperbilirubinemia occurs in hemolytic jaundice due to increased red blood cell destruction. Conjugated hyperbilirubinemia occurs in obstructive jaundice due to a blockage preventing bile from leaving the liver. The type of hyperbilirubinemia determines whether bilirubin is present in the urine. Physiological jaundice sometimes occurs in newborns due to immature liver function.

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137 views18 pages

Jaundice

Jaundice is caused by hyperbilirubinemia, which can be either unconjugated or conjugated. Unconjugated hyperbilirubinemia occurs in hemolytic jaundice due to increased red blood cell destruction. Conjugated hyperbilirubinemia occurs in obstructive jaundice due to a blockage preventing bile from leaving the liver. The type of hyperbilirubinemia determines whether bilirubin is present in the urine. Physiological jaundice sometimes occurs in newborns due to immature liver function.

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PATHOPHYSIOLOGY OF JAUNDICE

JAUNDICE
• Jaundice is the yellowish discoloration of
sclera, skin and mucus membrane due to the
deposition of bilirubin.
•Normal bilirubin level 0.2 to 0.8 mg/dL
•Jaundice: when bilirubin level exceeds 2 mg/dl
• Latent or subclinical jaundice: 0.8 – 2 mg%
• First appears in sclera because bilirubin has
high affinity for scleral protein elastin
BILIRUBIN METABOLISM
Bilirubin metabolism
• Jaundice is due to hyperbilirubinemia
1. Unconjugated hyperbilirubinemia: in
Hemolytic jaundice
2. Conjugated hyperbilirubinemia: in
obstructive jaundice
HEMOLYTIC JAUNDICE OR PREHEPATIC
JAUNDICE
• Occurs from increased destruction of RBCs
• This leads to increased bilirubin production
• Usually mild (except in the newborns)
• Bilirubin in plasma forms complex with
albumin  Unconjugated bilirubin
• Since Unconjugated bilirubin increases, more
amount of unconjugated bilirubin enters the
liver and more conjugated bilirubin is formed.
• More quantity of conjugated bilirubin is
delivered to intestine
• Increased amount of stercobilinogen is formed
• Increased excretion of: fecal stercobilinogen
urinary urobilinogen
• Unconjugated bilirubin level increases in
serum. This cannot be excreted in urine since
albumin molecule is large enough not to get
filtered in renal glomeruli
• Therefore, Urinary bilirubin is absent
• Note: urinary urobilinogen increases, urinary
bilirubin is absent
HEPATIC JAUNDICE
• Cause: viral hepatitis, glucuronyl transferase dysfunctioning
• Uptake, conjugation and excretion of bilirubin is affected
• Conjugation of bilirubin is impaired. Due to this liver may not
be able to conjugate all the load of bilirubin. Thus blood
contains Unconjugated bilirubin
• Also some amount of conjugated bilirubin is not excreted in
bile due to:
• Intrahepatic obstruction: narrowing of biliary canaliculus
• due to this the conjugated bilirubin accumulates in liver cells
diffusions across the cell membrane into the bloodstream
• Consequently conjugated bilirubin is excreted in the urine this
makes urine yellow due to the presence of urinary bilirubin
• It is not excreted in the bile hence fecal stercobilinogen and
urinary urobilinogen are reduced
OBSTRUCTIVE JAUNDICE/ POST HEPATIC
JAUNDICE
• Causes: Gallstones
• Occurs due to obstruction to bile secretion
into intestine
• No bile reaches intestine
• Therefore, no fecal stercobilinogen is formed
and stool becomes clay coloured
• Also urinary urobilinogen is absent
• The conjugated bilirubin is regurgitated by the
liver cells into the bloodstream
• Therefore level of conjugated bilirubin in the
blood is high which is excreted in urine and
causes deep yellow urine
• As bile salt is reduced in intestine, there is
increased fecal excretion of fat (steatorrhea)
CLINICAL ASPECT:
• Physiological jaundice:
• Seen in some newborns and therefore it is
also known as neonatal jaundice
• the jaundice usually appears on the second or
third day of life
• It occurs due to subnormal activity of
glucuronyl transferase that impairs
conjugation of bilirubin in hepatocyte.

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