Download MBBS Pathology PPT 9 Jaundice Lecture Notes

INTEGRATED TEACHING

Jaundice: Causes and Etiopathogenesis

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Jaundice

? " Jaune" : Yellow

Deposition of bilirubin

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? Icterus

? Latin

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? Sighting the bird was thought to cure jaundice


IMBALANCE between

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production and clearance

Overproduction

Prehepatic

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: hemolysis

Impaired

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uptake/conjuga

Hepatic

tion/excretion:

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hepatocytes

Regurgitation

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:

Hepatocyte/

Posthepatic

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bileduct

What are the different etiopathogenic patterns?

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1) Haemolysis
2) Disorder of uptake and

conjugation

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3) Hepatocel ular injury
4) Cholestasis

Role of pathology in establishing diagnosis?

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1) Peripheral Smear examination
2) Liver biopsy


Haemolysis

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? Inherited

Vs

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Acquired

1. Spherocytosis

1. Microangiopathic haemolytic anemia (HUS)

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2. Sickle cel

2. Paroxysmal Nocturnal Haemoglobinuria

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3. Thalassemia

3. Immune hemolysis

4. Pyruvate kinase

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4. Parasitic infections (Malaria)

deficiency

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5. Ineffective erythropoiesis (B12, folate

5. G6PD deficiency

deficiency)

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Serum

Bilirubin

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Intravascular

Vs

Extravascular

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rarely >5

mg/dL

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Pigmented gal stones

Schistocytes

Nucleated

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RBCs


Spherocytes: No central pal or

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Coombs positive

Autoimmune

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haemolytic

anemia

Hereditary

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Microspherocytes in

Spherocytosis

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C.perfringens sepsis


Osmotic Fragility testing

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Bite cel s

Blister cel s

G6PD deficiency, Unstable Hb

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Irregularly

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Heinz bodies:

contracted cel s

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Crystal Violet stain

Unstable Hb

Microangiopathic

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Pyruvate Kinase def.

Hemolytic anemia

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Spiculated spheroid cel s

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INTRAVASCULAR HEMOLYSIS

Hemolysis,

serum

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Jaundice

Hemoglobinuria

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Paroxysmal Nocturnal Hemoglobinuria

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Sickle cel anemia

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Disorders of uptake and conjugation

INHERITED JAUNDICE

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Dubin Johson syndrome

Lipofuscin like pigment in Zone 3

Positive on Fontana Mason stain

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Hepatocellular Injury

Alcohol

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Viruses

Autoimmune

Drugs

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B
CE

Combination of

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EBV

reduced conjugation

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CMV

and cholestasis

CIRRHOSIS

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Hepatitis C

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Hepatitis B

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Autoimmune

hepatitis

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Fibrosis

Cirrhosis

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Normal liver

Cirrhotic liver

Cholestasis

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BENIGN

MALIGNANT

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Cholestasis

Feathery

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pattern

degeneration

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Cholestasis

SUMMARY

IMBALANCE between

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production and clearance

Overproduction

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Prehepatic

: hemolysis

Impaired

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uptake/conjuga

Hepatic

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tion/excretion:

hepatocytes

Regurgitation

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:

Hepatocyte/

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Posthepatic

bileduct