Family Medicine - Jaundice in Adults

"Yellow Skin" related to Hyperbilirubinemia

A.Heme product degradation yields Hemoglobin
B.Hemoglobin transported to reticuloendothelial system, a.Heme is oxidized to bilverdin
C.Bilverdin converted to Unconjugated Bilirubin
D.Unconjugated Bilirubin circulates
1.Tightly bound to albumin and fat soluble
2.Unconjugated Bilirubin is insoluble in water
3.Concentrates in high albumin containing tissues skin and sclera jaundice
Unconjugated bilirubin converts to conjugated bilirubin by glucuronosyltransferase enzyme - only conjuagted bilirubin can be excreted

4 mg/kg/day

1.Tightly bound to albumin and fat solublea.Displaced Bilirubin causesi.Albumin saturated with Bilirubin or
ii.Medications (e.g. Sulfisoxazole, Streptomycin, Vitamin K)

b.Displaced Unconjugated Bilirubin crosses blood-brain barrier and placentai.Results in toxicity (e.g. Hepatic Encephalopathy, Kernicterus)


2.Unconjugated Bilirubin is insoluble in watera.Not found in tears or Saliva
b.Unconjugated Bilirubin can not be excreted

3.Concentrates in high albumin containing tissuesa.Skin (especially face and trunk): Jaundice
b.Sclera: Scleral Icterus

Indirect
A.Normal: <1.0 mg/dl

A.Hemolysis1.Hemolytic Anemia (mild Hyperbilirubinemia)

B.Large heme load (e.g. large hematoma reabsorption)
C.Liver disease1.Hepatitis
2.Cirrhosis
3.Neoplasm

D.Hepatic congestion
E.Hereditary1.Gilbert's disease
2.Crigler-Najjar syndrome

A.<0.2 mg/dl

A.Intrahepatic Causes1.Hepatocellular diseasea.Viral Hepatitis
b.Alcoholic Liver Disease

2.Biliary Tract Obstruction
3.Drug induced cholestasis
4.Prolonged Total Parenteral Nutrition
5.Sarcoidosis
6.Pregnancy
7.Primary Biliary Cirrhosis
8.Primary Sclerosing Cholangitis

B.Extrahepatic Causes1.Cholelithiasis
2.Pancreatitis
3.Cryptosporidium infection (immunocompromised patient)
4.Cytomegalovirus infection
5.Cholangiocarcinoma
6.Cancer involving liver
7.Pancreatic Cancer
8.Lymphoma

Ictotest

A.Hepatitis
B.Liver disease1.Cirrhosis
2.Liver Metastases
3.Liver infarction

C.Hemolytic Jaundice

Substance formed when red blood cells are broken down. Bilirubin is part of the bile, which is made in the liver and is stored in the gallbladder. The abnormal buildup of bilirubin causes jaundice

pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice.