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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
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
obstruction:
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