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Face
Acne
Actinic Keratosis
Herpes Zoster (trigeminal nerve distribution)
Secondary Syphilis
Variola
acne herpes zoster syphilis
Small pox
Erythema Multiforme
CLINICAL OCCURRENCE:
Increased Production: Hemolysis of normal red cells autoimmune hemolytic anemia,
transfusion hemolysis, hemolysis from chemicals, drugs, or infections; Red cell defects sickle
cell disease, thalassemia, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, pyruvate
kinase deficiency, paroxysmal nocturnal hemoglobinuria;
Ineffective erythropoiesis thalassemia major, folate, and vitamin B12 deficiency;
Miscellaneous absorption of hematoma, pulmonary infarction.
Deficient Hepatic Uptake: sepsis, fasting, hypotension, and drugs. DeficientHepatic
Conjugation: Congenital Gilbert syndrome,Crigler-Najjar syndromes; Acquired: advanced
hepatocellular
Conjugated hyperbilirubinemia. This results from impaired excretion of conjugated
bilirubin from the hepatocyte into the bile canaliculi or obstruction of the biliary
flowthrough the canaliculi, intrahepatic, and extrahepatic bile ducts to the duodenum.
The feces may be acholic in which case the urine lacks urobilinogen but contains
bilirubin. The serum alkaline phosphatase is elevated out of proportion to the
transaminases. Clinically, it is important to distinguish mechanical extrahepatic
obstruction from intrahepatic obstruction that results from either mechanical
obstruction or altered hepatocyte and canalicular function (cholestasis). In most cases
of extrahepatic obstructive jaundice, dilatation of the bile ducts can be detected by
ultrasonography.
CLINICAL OCCURRENCE:
Intrahepatic Cholestasis: Congenital Dubin-Johnson syndrome, Rotor syndrome;
Acquired hepatocellular disease, drugs (especially sex steroids), sepsis,
hypotension, primary biliary cirrhosis.
Extrahepatic Obstruction: Intrinsic gallstones, biliary sludge, biliary carcinoma,
sclerosing cholangitis, stricture, parasites; Extrinsic pancreatic carcinoma,
portahepatis lymphadenopathy, pancreatitis, pancreatic pseudocyst.