Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Pathology PPT 9 Jaundice Lecture Notes
INTEGRATED TEACHING
Jaundice: Causes and Etiopathogenesis
Jaundice
? " Jaune" : Yellow
Deposition of bilirubin
? Icterus
? Latin
? Sighting the bird was thought to cure jaundice
IMBALANCE between
production and clearance
Overproduction
Prehepatic
: hemolysis
Impaired
uptake/conjuga
Hepatic
tion/excretion:
hepatocytes
Regurgitation
:
Hepatocyte/
Posthepatic
bileduct
What are the different etiopathogenic patterns?
1) Haemolysis
2) Disorder of uptake and
conjugation
3) Hepatocel ular injury
4) Cholestasis
Role of pathology in establishing diagnosis?
1) Peripheral Smear examination
2) Liver biopsy
Haemolysis
? Inherited
Vs
Acquired
1. Spherocytosis
1. Microangiopathic haemolytic anemia (HUS)
2. Sickle cel
2. Paroxysmal Nocturnal Haemoglobinuria
3. Thalassemia
3. Immune hemolysis
4. Pyruvate kinase
4. Parasitic infections (Malaria)
deficiency
5. Ineffective erythropoiesis (B12, folate
5. G6PD deficiency
deficiency)
Serum
Bilirubin
Intravascular
Vs
Extravascular
rarely >5
mg/dL
Pigmented gal stones
Schistocytes
Nucleated
RBCs
Spherocytes: No central pal or
Coombs positive
Autoimmune
haemolytic
anemia
Hereditary
Microspherocytes in
Spherocytosis
C.perfringens sepsis
Osmotic Fragility testing
Bite cel s
Blister cel s
G6PD deficiency, Unstable Hb
Irregularly
Heinz bodies:
contracted cel s
Crystal Violet stain
Unstable Hb
Microangiopathic
Pyruvate Kinase def.
Hemolytic anemia
Spiculated spheroid cel s
INTRAVASCULAR HEMOLYSIS
Hemolysis,
serum
Jaundice
Hemoglobinuria
Paroxysmal Nocturnal Hemoglobinuria
Sickle cel anemia
Disorders of uptake and conjugation
INHERITED JAUNDICE
Dubin Johson syndrome
Lipofuscin like pigment in Zone 3
Positive on Fontana Mason stain
Hepatocellular Injury
Alcohol
Viruses
Autoimmune
Drugs
B
CE
Combination of
EBV
reduced conjugation
CMV
and cholestasis
CIRRHOSIS
Hepatitis C
Hepatitis B
Autoimmune
hepatitis
Fibrosis
Cirrhosis
Normal liver
Cirrhotic liver
Cholestasis
BENIGN
MALIGNANT
Cholestasis
Feathery
pattern
degeneration
Cholestasis
SUMMARY
IMBALANCE between
production and clearance
Overproduction
Prehepatic
: hemolysis
Impaired
uptake/conjuga
Hepatic
tion/excretion:
hepatocytes
Regurgitation
:
Hepatocyte/
Posthepatic
bileduct
This post was last modified on 07 April 2022