Jaundice
-
- Jaundice
- Conjugated bilirubin (direct) is easily excreted because it is soluble in water.
- Unconjugated bilirubin (indirect) is not soluble in water.
- Jaundice is clinically apparent when the serum total bilirubin is above 3 mg/dL (MCQ)
-
- Hemolysis causes elevated indirect bilirubin. (MCQ)
- Impaired conjugation is caused by
- reduced hepatic uptake resulting from liver disease (eg, hepatitis) (MCQ)
- conjugation enzyme deficiencies.
- Conjugated hyperbilirubinemia is caused by
- reduced hepatic excretion
- impaired bile flow (eg, bile duct obstruction)
- Neonatal jaundice
-
-
- occurs during the first week of life.
- There is a mild and transient rise in unconjugated bilirubin with a benign clinical course.
- It is caused by inadequate production of glucuronyl transferase by the immature liver. (MCQ)
- It is treated by UV exposure. (MCQ)
-
- Hemolytic disease of the newborn
-
-
- caused by maternal-fetal Rh incompatibility (MCQ)
- more clinically ominous
- usually has higher bilirubin levels than benign neonatal jaundice. (MCQ)
- Breast milk jaundice
- occurs in some breastfed newborns
- usually after the first week(MCQ)
- lasts longer than physiologic jaundice. (MCQ)
- Gilbert syndrome
- a common cause of slightly increased unconjugated bilirubin
- it is usually discovered by (MCQ)
-
- family history
-
-
-
- an incidental finding in routine laboratory testing.
- There is no hepatic impairment or clinical symptoms(MCQ)
- If the patient becomes stressed, or febrile it may lead to jaundice.
-
- Crigler-Najjar syndrome
- is a severe familial glucoronyl transferase enzyme deficiency
- very high unconjugated bilirubin levels.
-
- Type I
-
-
-
- causes kernicterus
- uniformly fatal.
-
-
- Type II
-
-
- less severe
- responds to phenobarbital treatment(MCQ)
- reduces the unconjugated bilirubin levels.
-
- Dubin-Johnson syndrome
- an autosomal recessive disease (MCQ)
- defective protein carrier in the bile canalicular membrane
- leads to impaired bile excretion
- black pigmentation of the liver (MCQ)
- elevated conjugated bilirubin levels.