Curr Health Sci J, vol. 37, no. 2, 2011

TIRZIU C.⁽¹⁾

⁽¹⁾University of Medicine and Pharmacy of Craiova

Abstract:

Jaundice is a yellowish  pigmentation of the skin, the conjunctival membranes over the sclerae and other mucous membranes caused by hyperbilirubinemia and subsequently causes increased levels of bilirubin in extracellular fluids. The concentration of bilirubin must exceed 1,5 mg/dl, that means three times the usual value. Tipes of jaundice. The jaundice is classified into three catergories , depending on wich part of physiological mechanism the phatology affects: prehepatic : The pathology is occurring prior to the liver. Jaundice is caused by incresed rate of hemolysis . Malaria, leptospirosis, hemolytic uremic syndrome, sickle cell anemia, spherocitosis, , thalasemia and G-6-PDH deficiency can lead to increase red cell lysis. Laboratory findings: Urine  - no bilirubin, urobilirubin >2 units, Serum : incresd unconjugated bilirubin. hepatic: The pathololy is located within thw liver. Jaundice is caused by acute hepatitis, hepatotoxicity, Gilbert’s syndrome, Crigler-Najjar syndrome and alcoholic liver disease,  wereby cell necrosis reduce the liver’s ability to metabolize and excrete bilirubin. Other causes include neonatal jaundice ( is usually harmless, lasting until dsy 8 to 14 in premature births caused by metabolic and physiological adjustments after birth) and primary biliary cirrhosis. Laboratory findings are: Urine : conjugated bilirubin present, urobilirubin > 2 units . posthepatic: The pathology is located after the conjugation of bilirubin in the liver. This jaundice, also called obstructive jaundiced, is caused by an interruption to drenage af bile in the biliary system . The most common causes are gallstones in the common bile duct, cancer in the head of the pancreas. Other causes include : parasites, biliary atresia, ductal carcinoma, pancreatitis, pancreatic pseudocysts, Mirizzi’s syndrome. Laboratory fidings : pale stools and dark urine, elevated serum cholesterol. No test can differentiate the type of jaundice. There are a combination of function tests to arrive at the diagnosis. Phatophisiology of jaudice. Jaundice itself is not a disease, but rather a sign af one many possible underlying pathological processes that occure at some poit along af normal pathological pathway of metabolism of bilirubin. When red cell have completed their live span (aprox. 120 days) traverses throuthout the reticuloendothelial system and are destroid. The  hemoglobin  are phagocytosed by macrophages, and split into hem and globine portions. Two reactions then place whit the hem molecule:an  oxcydation reaction  and results biliverdin (green color pigment),  the next step is reduction of biliverdin to bilirubin (yellow color pigment). This bilirubin is unconjugated or indirect bilirubin. Other sourses of bilirubin  (20%) are represented by ineffective erytropoesisand , breakedown of myoglobine and cytocromes. Once it arrives to the liver, indirect bilirubin is conjugated  whit gucuronic acid and forms direct bilirubin by the enzyme UDP-transferase . Th

Keywords: Jaundice, bilirubin

Corresponding: Constantin Tirziu, MD. PhD student, University of Medicine and Pharmacy of Craiova, Str Petru Rares nr. 4, 200456, Craiova, Dolj, RomAnia

DOI 10.12865/CHSJ.37.02.08 - Download PDF Jaundice Obstructive Syndrom PDF