Jaundice part 3 [ bilirubin metabolism ]

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Hyperbilirubinemia leading to yellowing of skin and eyes
1..classified by ratio of conjugated bilirubin:total bilirubin
CB LES THAN 20%
a.Gilbert's/Crigler Najjar syndromes
b.physiologic jaundice of newborn
c.hemolysis

CB 20-50%
a.viral hepititis

CB MORE THAN 50%
a.drugs e.g. OCP
b.Dubin-Johnson/Rotor syndromes
c.primary biliary cirrhosis
d.obstruction e.g. stone
Pathophysiology
1.hepatocytes convert unconjugated bilirubin into conjugated bilirubin
2.performed by glucuronyl transferase enzyme to make bilirubin water soluble
3.high increases can result in kernicterus and death deposition of bilirubin in the brain

Types
HEMOLYTIC
destruction of RBCs than conjugation/excretion system can handle can result from hereditary hemolytic anemias, Rh incompatibility, ect.

OBSTRUCTIVE
intrahepatic or bile duct block does not allow body to excrete bilirubin can result from

A.oral contraceptives
B.gallbladder stone
C.carcinoma of the head of the pancreas

HEPATOCELLULAR
damage to liver ↓ ability of conjugation/excretion system to handle normal bilirubin load

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