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Jaundice
{
Clinical round
By
Dr. Ehab M. Oraby
Yellowish discoloration of:
Tissues ex. Sclera and palate except brain.
Body fluids urine and stool except CSF, tears
and saliva.
Definition
Destruction of RBCs release of HB Haeme
+ Globin
Haeme iron + bilirubin (in unconjugated
form = water insoluble).
Conjugation occurs in liver (bilirubin becomes
water soluble).
Pathophysiology:
Secretion of conjugated form of bilirubin to
biliary tract then to GIT stool coloration.
Some of conjugated bilirubin absorbed from
GIT to circulation renal excretion.
Pathophysiology:
Hemolytic Anemia:
Young age.
Congenital or Acquired.
Attacks of “crisis” ++ Hemolysis ++
unconjugated bilirubin, ++ conjugation, ++
conjugated bilirubin dark stool & normal
urine.
Pathophysiology:
Hemolytic Jaundice:
Anemia (chronic with periodic exacerbations).
During attacks diffuse abdominal pain + bony
pains + fever with rigors.
Splenomegaly.
Gall stones “pigment stones”.
Leg ulcers.
Pathophysiology:
Hepatocellular Jaundice:
Any age.
Mostly viral hepatitis cirrhosis. Others: drug
induced hepatitis.
Pathophysiology:
Hepatocellular Jaundice:
Liver fail to conjugate bilirubin + fail to properly
secrete conjugated fraction to biliary tree ++
blood level of conjugated bilirubin and bile salts.
Conjugated bilirubin jaundice + excreted in
urine dark urine.
Bile salts in blood pruritus.
Stool is normal.
Pathophysiology:
Hepatocellular Jaundice:
Other stigmata of LCF: gynecomastia, spider
naevi, palmar erythema, ascites and lower limb
edema
Pathophysiology:
Obstructive Jaundice:
Failure of bile drainage ++ blood level of
conjugated bilirubin and bile salts jaundice,
dark urine, pale clay stool and pruritus.
Obstruction is either calcular or malignant.
Pathophysiology:
Calcular obstruction:
Females, Middle age.
By gall stone impacted in ampulla of vater.
Pathophysiology:
Calcular obstruction:
Intermittent
jaundice + pain “biliary” + fever.
Pathophysiology:
Calcular obstruction:
Gall Bladder is non-palpable
except in cases with:
double impaction or
strategic impaction.
Pathophysiology:
Re Calcular obstruction:
Females, Middle age.
By gall stone impacted in ampulla of vater.
Intermittent
jaundice + pain “biliary” + fever.
Gall Bladder is non-palpable
except in cases with double impaction or
strategic impaction.
Pathophysiology:
Malignant Obstruction:
Males, old age.
By:
Pancreatic head tumors
Malignant LN in porta hepatis
Bile duct cancer”cholangiocarcinoma”.
Pathophysiology:
Malignant Obstruction:
Painless except late.
Epigastric pain referred to back patient position
is leaning forward.
Pathophysiology:
Malignant Obstruction:
Jaundice is progressive except:
in cases with peri-ampullary carcinoma.
Pathophysiology:
Malignant Obstruction:
Gall Bladder is palpable “courvoiser law” except
in cases with:
double pathology “cancer + gall stone” or
malignant LN ???coming from cancer Gall Bladder.
Pathophysiology:
ReMalignant Obstruction:
Males, old age.
By:
Pancreatic head tumors
Malignant LN in porta hepatis
Bile duct cancer”cholangiocarcinoma”.
Painless except late. Epigastric pain referred to back
patient position is leaning forward.
Jaundice is progressive except in cases with periampullary carcinoma.
Gall Bladder is palpable “courvoiser law” except in
cases with double pathology “cancer + gall stone” or
malignant LN ??? coming from cancer Gall Bladder.
Pathophysiology:
General examination
Look
Fascies
Complexion
Body built and position
Vital signs
Regional survey
Examination
Local abdominal examination:
Inspection:
General look:
Movement with respiration
Contour
Scars
Dilated veins
Pigmentation
Specific look:
Subcostal angle
Linea alba
Umbilicus
Hair distribution
Hernial orifices
Examination
Palpation:
Superficial palpation
Deep palpation:
Liver
Gall Bladder
Spleen
Lymph Nodes
swelling
Examination
Percussion:
Liver
Gall Bladder
Spleen
Ascites
Swelling
Auscultation:
Venous hum with portal hypertension
Examination
Anatomical
Pathophysilogical
Functional
Diagnosis
