• 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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