Jaundice

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    • Jaundice
      • Conjugated bilirubin (direct) is easily excreted because it is soluble in water.
      • Unconjugated bilirubin (indirect) is not soluble in water.
      • Jaundice is clinically apparent when the serum total bilirubin is above 3 mg/dL (MCQ)
      • Hemolysis causes elevated indirect bilirubin. (MCQ)
      • Impaired conjugation is caused by
        • reduced hepatic uptake resulting from liver disease (eg, hepatitis) (MCQ)
        • conjugation enzyme deficiencies.
      • Conjugated hyperbilirubinemia is caused by
        • reduced hepatic excretion
        • impaired bile flow (eg, bile duct obstruction)
    • Neonatal jaundice
      • occurs during the first week of life.
      • There is a mild and transient rise in unconjugated bilirubin with a benign clinical course.
      • It is caused by inadequate production of glucuronyl transferase by the immature liver. (MCQ)
      • It is treated by UV exposure. (MCQ)
    • Hemolytic disease of the newborn
      • caused by maternal-fetal Rh incompatibility (MCQ)
      • more clinically ominous
      • usually has higher bilirubin levels than benign neonatal jaundice. (MCQ)
    • Breast milk jaundice
      • occurs in some breastfed newborns
      • usually after the first week(MCQ)
      • lasts longer than physiologic jaundice. (MCQ)
    • Gilbert syndrome
      • a common cause of slightly increased unconjugated bilirubin
      • it  is usually discovered by (MCQ)
        • family history
        • an incidental finding in routine laboratory testing.
      • There is no hepatic impairment or clinical symptoms(MCQ)
      • If the patient becomes stressed, or febrile it may lead to jaundice.
    • Crigler-Najjar syndrome
      • is a severe familial glucoronyl transferase enzyme deficiency
      • very high unconjugated bilirubin levels.
      • Type I
        • causes kernicterus
        • uniformly fatal.
      • Type II
        • less severe
        • responds to phenobarbital treatment(MCQ)
        • reduces the unconjugated bilirubin levels.
    • Dubin-Johnson syndrome
      • an autosomal recessive disease (MCQ)
      • defective protein carrier in the bile canalicular membrane
      • leads to impaired bile excretion
      • black pigmentation of the liver (MCQ)
      • elevated conjugated bilirubin levels.


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    Jaundice is a condition that causes yellowing of the skin and mucus membranes around the eyes. Patients who display these symptoms usually have some underlying medical condition that is causing their bile ducts, gallbladder, liver or pancreas to malfunction.
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