JAUNDICE = icterus = yellow / greenish pigmentation of the skin that caused by hyperbilirubinemia ( total plasma bilirubin conc.

above 2.5 to 3 mg/dl) = can result from: 1) excessive hemolysis of RBC or 2) obstructive disorders of the bile ducts/ liver cells 3) also by metabolic defects that impair the uptake/ conjugation of unconjugated bilirubin in liver * gilbert dzs :cause an elevation of unconjugated bilirubin in the plasma but no other symptoms of liver dzs caused by an inherited def of glucoranyl transfrease enzyme ( required for the hepatic uptake of unconjugated bilirubin)

= jaundice in newborns is caused by impaired bilirubin uptake & conjugation PATHOPHYSIOLOGY 1) obstructive jaundice can result from extrahepatic/ intrahepatic obstruction extrahepatic obstruction jaundice dvlp if the common bile duct is occluded by a gallstone, tumor, or compression from edema of pancreatitis bcoz the bile duct is obstructed bilirubin is conjugated by the hepatocytes, but cannot flow into the duodenum (conjugated bilirubin is soluble in water & is then soluble in aqueous bile) it accumulates in the liver & enter the bloodstream HYPERBILIRUBINEMIA bcoz conjugated bilirubin is water soluble , it appears in the urine stools may be light colored/ clay colored bcoz they lack bile pigments lack urobilinogen bcoz bile is not available for conversion to urobilinogen intrahepatic obstructive jaundice involves disturbances in hepatocyte fx & obstruction of bile canaliculi the uptake, conjugation & excretion of bilirubin are affected with elevated levels of both conjugated & unconjugated bilirubin hepatocellular damage increases plasma conc. of unconjugated bilirubin obstruction of bile canaliculi (major disorder) diminishes flow of conjugated bilirubin into the common bile duct with elevation in the plasma in mild cases some of the bile canaliculi opes amount of bilirubin in intestinal tract may be only slightly decreased stool may appear normal/ light colored

2) excessive hemolysis (breakdown) of RBC / absorbtion of hematoma cause hemolytic jaundice (prehepatic jaundice) an increased amount of unconjugated bilirubin is formed tru metabolism of heme component of destroyed RBC extra amount of unconjugated bilirum exceeds the conjugation ability of the liver cause blood levels of unconjugated bilirubin to rise unconjugated bilirubinemia the major cause of hemolytic jaundice bcoz unconj bilirubin is not water soluble not excreted in urine reserve conjugation ability of the liver usually prevents long-term unconjugated hyperbilirubinemia greater than 4 to 5 mg/dl cause severe hemolytic crisis like sickle cell dzs if unconjugated hyperbilirubinemia exceeds 5 mg /dl both hemolytic & liver disorders r indicated CLINICAL MANIFESTATION vary & r related to underlying pathology conj. Hyperbilirubinemia cause urine to darken to darken several days b4 the onset of jaundice complete obstruction of bile flow from the liver to duodenum light-colored stools partial obstruction stools r normal in colour & bilirubin is present in the urine fever, chills & pain often accompany jaundice, resulting from viral / bact inflammation of liver manifestation of liver injury from any cause commonly : - anorexia, malaie & fatigue - yellow discoloration may first occur in the sclera of eye & then progress to skin pruritus commonly accompanies jaundice with an elevation of serum alkaline phosphatase & bilirubin accumulation in skin EVALUATION & TREATMENT lab evaluation of serum whether elevated plasma bilirubin is conj / unconj/ both unconjugated bilirubinemia results from hemolysis / hereditary disorders of bilirubin metabolism elevated in conj. Bilirubin indicate liver injury / extrahepatic obstruction history & physical exam identify the underlying disorder treatment : correcting the cause