Jaundice Profile

السلام عليكم ورحمة الله وبركاته

يارب تكونوا كلكم بخير دا اولا

يارب احفظ مصر واهلها من كل مكروه  دا ثانيا

وثالثا الموضوع اللى هنتكلم عنه النهاردة كتير مننا عارفين عنه معلومات كتيرة بس هحاول اطرح الموضوع بشكل مبسط وموضوعنا عن  (Jaundice Profile)

قبل منتكلم عن( Jaundice ) هنتكلم سريعا عن Bilirubin اللى بيتسبب فى وجود الصفرا

Formation of bilirubin

1-Bilirubin is one of bile pigment and formed from break down of RBCS in liver

and spleen  after  120day

2-.heme of hemoglobin is  oxidised by heme oxygenase into iron&porphyrin

which cleaved into biliverdin(green pigment) reduced into bilirubin.

3- This bilirubin(indirect) is slightly soluble in plasma  so is transported to liver

by binding to albumin

4-bilirubin dissociates from albumin and enters  hepatocyte

5- In hepatocyte  it conjugated with 2 molecule  of glucuronic acid

forming Bilirubin  diglucuronide (direct bilirubin).

6-direct bilirubin transported into bile then  into gut where it is hydrolysed by bacteria                forming   Urobilinogen

7- Urobilinogen is transported  to kidney and excreted  as Urobilin in urine.

Most of  urobilinogen of feces are oxidized into stercobilin                                              -8

Normal value :     Total serum bilirubin   up to 1.0 mg/dl

Direct bilirubin       up to 0.25  mg/dl

In direct bilirubin= total bilirubin – direct bilirubin

وبعد الكلام الكتير ده عندى ملحوظة صغيرة اوى

N/B: In healthy persons,  5% of total plasma bilirubin is conjugated & 95% is un conjugated

No bilirubin in urine .

ودلوقتى هندخل للموضوع الاساسى بتاعنا ان شاء الله هنركز مع بعض

اول سؤال ممكن تساله يعنى ايه Jaundice

Jaundice ( icterus) :  is yellowish pigmentation of skin &sclera(white of eye) and mucous membrane due to increased  bilirubin levels in blood  (Hyperbilirubinemia)

طيب ايه اسبابها  ؟ لها اسباب كتير هنحاول نوضحها من خلا ل التقسيمة دى

وعشان كده هنقسم Jaundice الى ثلاث انواع

Hemolytic Jaundice(Pre-hepatic Jaundice).                                                                     – 1

In this type, Over production of bilirubin is due to excessive breakdown of RBCS.

Example, in tropical countries : hemolysis is due mainly to Malaria.

genetic diseases(Sickle cell anemia,G6PD deficiency, Thalassemia,Spherocytosis

, Gilbert syndrome( genetic disorderof bilirubin metabolism)

ABo,Rh incompatibility

Hepatocellular Jaundice(Hepatic)                                                                                      – 2

Jaundice is due to liver damage Ex:( cirrhosis, hepatitis, ,

,brucellosis  ,alcoholic liver disease    ,biliary cirrhosis   )

Obstructive Jaundice(Post-hepatic)                                                                                  – 3

Called also(cholestatic Jaundice)     and results from obstruction of bile ducts

Ex:  Due to presence of gall stones, tumor,cholangitis( inflammation of bile ducts) ,

by some helminthes ex Fasciola   &Ascaris infections

 

ودلوقتى هنشوف جدول بيوضح الفرق بين  3 انواع

 

Obstructive

Hepatic

Hemolytic

Function Test

Increased

Increased

Increased

Total bilirubin

Increased

Increased

Normal

Conjugated bilirubin

Normal

Increased

Increased

Unconjugated    bilirubin

Decreased

Increased

Increased

Urobilinogen

Dark

Dark

Normal

Urine Color

Pale

Pale

Normal

Stool Color

Increased

Increased

Normal

Ast& Alt

Present

Present

Absent

Conjugated Bilirubin in Urine

Absent

Present

Present

spleenomegaly

 

اللى هنلاحظه ا ن فى حالةic   hemolyt   بيزيد   Unconjugated    bilirubin

وفى حالة   Hepatic  بيزيد   Conjugated bilirubin و  Unconjugated

وفى حالة     Obstructive  بيزيد  Conjugated bilirubin

 

ودلوقتى هنتكلم عن نوع من Jaundice  بيحصل فى كتير من الاطفال وهو

Neonatal Jaundice :

– Is yellow discoloration of skin &sclera&mucous membrane  of newborn infant  due to increased bilirubin level

it is observed in newborn s when total serum bilirubin reaches( 5 -7 mg/dl)                  -1

2 – Tt is usually harmless, it is seen in newborn  around 2nd day after birth until 8 day in     normal birthes

Causes of Neonatal Jaundic e

1-Unconjugated hyper  bilirubinemia

conjugated hyper bilirubinemia                                                                                                -2

وممكن تفسير الاسباب دى من خلال تقسيم هذا النوع من الصفرا الى

 

Early onset jaundice                                                                                                                          -1

Persistence  jaundice                                                                                                                         -2

 

Early onset jaundice                                                                                                                       

Is classified into 2 types

hemolytic jaundice:                                                                                                  – 1

Jaundicr appears in the first 24 hr

Dueto hemolysis of RBCS

(EX:   ABO& RH incompatibility )                                                                                                        ِ

وفى الحالة دى عدم توافق RH factor   بيكون اخطر من عدم توافق الفصيلة وممكن نكشف عن عدم التوافق ده بعمل (coombs test & reticulocytic count)

 

EX :  G6PD  deficiency:  cause also hemolysis of red cells                                                             -ُْ

2- Physiological jaundice

*-This is the most  common cause of jaundice in newborn . it occur in 60%  of newborn infants, & rpremature

Causes :

Bilirubin load on liver.                                                                                                           -1

Uptake of bilirubin by liver                                                                                                    -2

3- Conjugation of bilirubin by liver(immaturity of glucoronyl transferase&

its activity is low ,reaches adult level in 2 weeks )

Manifestations:

Jaundice usually appears in 2nd Or 3 rd day.                                                                          -1

level of bilirubin is less than 5 mg/dl.                                                                                     -2

3-Peak level is less than 12-15 mg/dl

4-it usually donot persist after 5-7 days.

No anemia.                                                                                                                                  -5

Urine and stool are normal       -6

it is of unconjugated type.                                                                                                       -7

8 -Isnot severe.

Persistence  jaundice:

it is seen during 1st week and can persist 2-3 weeks.                                                                 

Causes:

1- Hypothyrodism : where thyroxin is needed for maturation of enzymes.

2-Breast milk jaundice in breast fed babies:

Milk contains some substances inhibit  bilirubin Conjugation.

3- Severe hemolytic anemia (EX: sickle cell anemia, spherocytosis)

4-Biliary atresia

5- some drugs,infection with TORCH agents.

Treatment:

1-  Phototherapy:

Newborn are treated with blue fluorescent light which converts bilirubin into more polar and soluble isomers excreted in bile without conjugation.

2-Exchange transfusion : used when bilirubin reaches  level  that places infant at risk for bilirubin induced brain injury

ملحوظة صغيرة :

High level of Bilirubin is dangerous in  infants why?

Because   elevated bilirubin in presence of binding capacity of albumin leads to diffusion of bilirubin  through blood brain barrier(BBB) espically (basal ganglia) causing Toxic encephalopathy and brain damage . brain damage condition called  Kernicterus

اما بالنسبة للجزء العملى ففى بعض الاحتياطات  precautions واهمها

عدم تعرض العينة للضوء المباشر لان الضوء بيكسر البليروبين بسرعة

لازم العينه تكون خالية من hemolysis لان     hemolysis   بتزود من نسبته

يارب اكون قدرت اشرح الموضوع بشكل مبسط

كان معكم من الاستوديو التحليلى لجروب تحاليل طبية

د/ ايمان فتحى

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