Sie sind auf Seite 1von 17

Clinical Approach to

Neonatal Jaundice

:CONTENTS
INTRODUCTION
PATHOPHYSIOLOGY
DIFFERENTIAL DIAGNOSIS
HISTORY
EXAMINATION
INVESTIGATION

INTRODUCTION
Bilirubin is the end product of heme
degradation
Most of the daily production comes
from the breakdown of RBCs in the RES
Heme
biliverdin
bilirubin
Bilirubin is released & bound to serum
albumin
Bilirubin is uptake & conjugated with
glucuronic acid
Finally conjugated bilirubin is excreted
in bile

PATHOPHYSIOLOGY
UNCONJUGATED B.
Tightly
compounded to s.
albumin
Normally very
small amount is
present as albumin
free
Insoluble in water
can not be
excreted in urine
Toxic

CONJUGATED B.

Non toxic
Water soluble
Loosely bound to
albumin. Delta
fraction

Both conjugated & unconjugated


bilirubin may accumulate
systemically & deposit in tissues
Normally s. bilirubin level vary
b/w 0.3 & 1.2mg/dl.
The rate of systemic bilirubin
production is = to the rate of
hepatic uptake, conjugation &
biliray excretion .
Jaundice becomes evident when
the s.bilirubin levels rise above
2.0 to 2.5mg/dl

Levels as high as 30 to 40mg/dl


can occur with sever disease
Jaundice occurs when the = b/w
bilirubin production &clearance
is disturbed by one or more of
the following mechanisms:
1.Excessive production of bilirubin
2.Reduced hepatic uptake
3.Impaired conjugation
4.Decreased hepatocellular
excretion
5.Impaired bile flow

CAUSES OF JAUNDICE

Excessive production of

bilirubin

hemolytic anemia's
resorption of blood from
internal hemor.
ineffective erythropoiesis

Reduced hepatic
uptake:
drugs
some cases of Gilbert
syndrome

Impaired bilirubin

conjugation:

physiologic jaundice
breast milk jaundice
genetic deficiency of glcuronosyl
transferase
decreased expression of
glcuronosyl transferase
diffuse hepatocellular diseases

Decrease excretion of

conjugated bilirubin:
deficiency in canalicular
membrane transport
drug induced canalicular
membrane dysfunction
hepatocelluler damage or
toxicity

Decreased intrahepatic

bile flow :
inflammatory
destruction of
intrahepatic bile ducts

Extra hepatic biliary

obstruction:

gall stone obstruction of biliary


tree
extra hepatic biliary atresia
biliary stricture & choledochal
cyst
primary sclerosing cholangitis
liver fluke infestation
carcinoma

HISTORY
onset / duration
pain
nausea & vomiting
loss of weight
itching
color of stool
color of urine
past history
ttt &family history

EXAMINATION
color of skin
severity of jaundice
anemia
liver
spleen
gall bladder
ascites

INVESIGATION
CBC
LFT
Prothrombin time
Alfa feto proteins
UG
SG
U/S
ERCP & PTC
Liver biopsy

The End

Das könnte Ihnen auch gefallen