Jaundice
Protocols
Definitions of Jaundice :
It is a clinical condition characterised by yellow coloration of skin, Sclerae & Mucous membranes due to excessive bilirubin concentration in the body fluids.
Level of Jaundice : (bilirubin)
- Normal level :. 0.3-1 mg/dl
- Latent jaundice : below 3 mg/dl
- Clinical jaundice : > 3 mg/dl
Site where jaundice seen:
- 1) upper Sclerae
- 2) Ventral surface of tongue (Between lingual vein & frenulum)
- 3) Nail bed
- 4) palm of hands
Don’t miss
💢💢Must need Day light for jaundice examination 💢💢
Definitions of Jaundice :
It is a clinical condition characterised by yellow coloration of skin, Sclerae & Mucous membranes due to excessive bilirubin concentration in the body fluids.
Level of Jaundice : (bilirubin)
- Normal level :. 0.3-1 mg/dl
- Latent jaundice : below 3 mg/dl
- Clinical jaundice : > 3 mg/dl
Site where jaundice seen:
- 1) upper Sclerae
- 2) Ventral surface of tongue (Between lingual vein & frenulum)
- 3) Nail bed
- 4) palm of hands
Don’t miss
💢💢Must need Day light for jaundice examination 💢💢
Types of jaundice :
- 1) pre hepatic or Haemolytic jaundice
- 2) Hepatocellular jaundice
- 3) post hepatic or Obstructive or Cholestatic jaundice
Mechanism of Jaundice :
- 1)Hemolysis
- 2) impaired hepatic bilirubin transport
- 3)Hepatocellular damage
- 4)Impaired bile flow
Haemolytic Jaundice
This result from increased destruction of R.B.C. or there precursors in the marrow causing increase bilirubin production. Jaundice ts Usually mild because _a healthy liver can excrete a bilirubin load 6 times greater than normal before unconjugated bilirubin accumulates in the plasma. Exceptions in newborn and in patients with liver disease
[Ref. Davidson’s medicine 23"
Causes of haemolytic Jaundice :
1) Hereditary - Spherocytosis, Elliptocytosis
2) Sickle cell anaemia
3)Thalasaemia
4) Snake venom
5)Autoimmune destruction
6)G-6-phosphate (G6PD) deficiency
7) malaria
Q: What is jaundice? Why upper sclera is seen in jaundice?
A: It is a clinical condition characterized by yellow discolouration of skin and mucous membrane due to excess bilirubin in the blood. Clinically, jaundice is seen when serum bilirubin is .3 mg/dL.
If it is ,2.5 mg/dL, called subclinical (or anicteric hepatitis).
Jaundice should be seen in natural daylight.
Bilirubin has strong affinity for elastic tissue, sclera contains plenty of elastic tissue (also
in the skin). So, it is seen in sclera.
Causes of Hepatocellular jaundice:
1. Viral hepatitis due to A, B, C, D, E, other virus such as EBV, CMV, Yellow fever, dengue,
(Nonviral infections e.g., leptospirosis, Q fever).
2. Drugs—Antitubercular drugs (rifampicin, pyrazinamide, INH), Phenothiazines
(chlorpromazine, haloperidol), Cyclosporine, Alcohol.
3. Metabolic—Wilson’s disease, haemochromatosis.
4. Autoimmune hepatitis.
Causes of Posthepatic or Obstructive jaundice:
1. Extrahepatic:
• Choledocholithiasis.
• Carcinoma of head of pancreas.
• Cholangiocarcinoma.
• Periampullary carcinoma.
• Extrahepatic biliary atresia.
• Round worm in common bile duct.
• Biliary stricture (due to trauma, sclerosing cholangitis).
2. Intrahepatic:
• Primary biliary cirrhosis (PBC).
• Primary sclerosing cholangitis.
• Viral hepatitis (causes transient intrahepatic cholestasis).
5. Inherited disorders (Dubin–Johnson syndrome, Rotor syndrome).