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,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Jaundice(,黄疸,),Department of Gastroenterology,First Affiliated Hospital of Chongqing Medical University,XIAOHONG TAO(,陶小红,),Jaundice or icterus:,What is jaundice?,Clinically it is the yellow,discoloration,of the,Sclera,(,巩膜,),Skin,Mucous membrane,due to deposition of bile pigment,(,bilirubin,胆红素,),Serum total bilirubin(normal 1.7-17.1 umol/lit),Conjugated bilirubin:0-3.42mol/l,，,Unconjugated bilirubin:1.7-13.68mol/l.,1.DEFINITION,2.BILIRUBIN METABNISM,Heme Degradation,HEME,BILIVERDIN,O,2,Fe,+3,NADPH,NADP,+,(opens the porphyrin ring),BILIRUBIN,NADPH,NADP,+,BILIRUBIN diglucuronide,BILE,The Fate of Bilirubin,Alb=albuminB=bilirubinGST=glutathione-S-transferase,UDPGA=uridine diphosphoglucuronic acid;CB=conjugated bilirubin,UGT1A1=UDP-glucuronosyltransferase 1A1,MRP2=Multi-drug Resistance Protein 2,Adapted from Harrisons 15th Ed.“Principles of Internal Medicine,2001.,MRP2,B,+GST,CB,Plasma,Hepatic Cell,Bile,Alb,B,Alb,?,:GST,B,sER,B,+,UDPGA,UGT1A1,Bilirubin Excretion,Intestines,Liver,B,CB,CB,B,Urobilinogen,B-glucoronidase,bacteria,bacteria,Bile,Enterohepatic circulation,Kidney,Urobilin,ox,Urobilinogen,Urobilin,Stercobilin,Stercobilingogen,feces,Urine,ox,Liver,Albunin,Heme,Ferroheme,transferase,Bilirubin,Conjugated bilirubin,Kidney,Urobilin,Stercobilinogen,Urobilinogen,Intestines,Albumin,Bilirubin,reductase,Heme,Globin,Hemoglobin,oxidase,Biliverdin,Marrow,Infantility Erythrocyte,Ferroheme Enzyme,15%20%,Bilirubin,|,Albumin,Erythrocyte,80%85%,UDP,UDPGA,Bilirubin glucuronolactone,urobilinogen,Enterohepatic circulation,Y/Z protein,cathepsin,Erythrocyte,Biochemical change of Normal bilirubin metabolism,3.CLASSFICATION,1.Depending on Etiology,Hemolytic Jaundice,溶血性黄疸,Hepatocellular Jaundice肝细胞性黄疸,Cholestatic Jaundice胆汁淤积性黄疸,Congenital jaundice,先天性黄疸,2.Depending on bilirubin,Unconjungated bilirubin increased jaundice,Conjungated bilirubin increased jaundice,Etiology,1.Congenital hemolytic anemia(,thalassemia(,海洋性贫血,),hereditary spherocytosis(,遗传性球形红细胞增多症,).,2.P,osteriority acquired hemolytic anemia(autoimmunity hemolytic anemia,hemolytic disease of newborn,posttransfusion hemolytic,Favism(,蚕豆病,),.,Mechanism,A large number of erythrocyte destroyed rapidly,Anemia,hypoxia and toxity of erythocyte metabolism products,3.1.Hemolytic Jaundice,Hemolytic Jaundice mechanism,Clinical Manifestation,Mild jaundice,light lemon,no skin itch(,痒,).,Acute hemolysis:fever,chill,headache,vomit,backache,anemia,hemoglobinuria(,血红蛋白尿,),acute renal failure.,Chronic hemolysis:anemia and splenomegaly(,脾大,).,Laboratory Examination,1.Serum TB,UCB,CB normal.,2.UCBintestinal CBfaecal color deepen.,3.Intestinal Urobilinogen(,尿胆原,)urinary Urobilinogen.,4.Acute hemolytis,occult blood test(+).,5.Blood test:anemia,reticulocyte(,网织红细胞,),erythrocyte proliferation.,3.2.Hepatocellular Jaundice,Etiology,Hepatocyte damage.,Mechanism,Impair hepatocyte uptakeing,conjugating and excreting bilirubin,UCB,CB reflux into blood,serum CBjaundice.,Hepatocellular Jaundice mechanism,Clinical Manifestation,Skin and mucosa:light to deep yellow,mild skin itch,(,痒,),Tired,loss of appetite,hemorrhagic tendency,ascites,coma.,Primary disease manifestation,Laboratory Examination,CB,UCB,Icteric hepatitis:CB UCB,Urine:CB(+),urobilinogen,Blood test:liver damaged,3.3.Cholestatic Jaundice,Etiology,Obstruction in liver:virus hepatitis,drug caused,drug hepatitis,primary biliary cirrhosis.,Obstruction of Extrahepatic bile duct:narrow,obstruction,stone,inflammtory,tumor.,Mechanism,Obstruction causes small bile duct and bile capillary broken,conjugated bilirubin reflux to blood.,Failure of hepatocyte excreting CB,bilirubin deposit and bile thrombus(,胆栓,)formation.,Cholestatic Jaundice mechanism,Clinical Manifestation,Skin dark yellow,yellow green.,Skin itch,(,痒,),bradycardia(,心动过缓,),dark yellow of urine,faecal light yellow or clay color.,Courvoisiers sign.,Laboratory Examination,Serum CB,Urine bilirubin(+),Urobilinogen,stercobilin(,粪胆原,)or absence,Serum alkaline phosphatase and Cholesterol(,胆固醇,),A.Hemolytic anemia,excess,hemolysis,unconjugated bilirubin,(in blood),conjugated bilirubin,(released to bile duct),UB,Urobilinogen,B.Hepatitis,unconjugated bilirubin,(in blood),conjugated bilirubin,(in blood),UB,Urobilinogen,C.Biliary duct stone,unconjugated bilirubin,(in blood),conjugated bilirubin,(in blood),UB,Urobilinogen,5.Genetic Disorders of Bilirubin Metabolism,Condition,Defect,Bilirubin,Clinical,Findings,Crigler-Najjar syndrome,severely defective,UDP-glucuronyl transferase,Unconjugated bilirubin,Profound jaundice,Gilberts syndrome,reduced activity of,UDP-glucuronyl transferase,Unconjugated bilirubin,Very mild jaundice during illnesses,Dubin-Johnson syndrome,abnormal transport of conjugated bilirubin into the biliary system,Conjugated bilirubin,Moderate jaundice,Rotors syndrome,deficiency of uptaking UCB,and excreting CB,CB,jaundice.,Crigler-Najjar syndrome,Gilberts syndrome,Three kinds of jaundice laborot
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