Jaundice

Jaundice A Supplementary Report on the Gastrointestinal System (Liver) Chiu,Ribaya, & Urtula IV-BSHSc October 1, 2011

Part I: Background The Liver Hepatic Lobule Enterohepatic Circulation (Bile & Blood) Bile Components Jaundice 2 External, Physical Characteristics 4 Types of Jaundice

The Liver (a summary) Some functions: Glycogen formation, storage, and break-down Synthesis & secretion of bile Cholesterol synthesis Detoxifies by acting like a “sieve” for the hepatic portal system Vitamin, iron, and copper storage

Hepatic Lobule (liver unit) Hepatic Portal System / Triad: Portal artery for oxygenated blood from aorta) Portal vein for blood from SI Bileduct

Enterohepatic Circulation Blood: Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries) Liver cells or hepatocytes get nutrients from sinusoids. Old/damaged erythrocytes are broken down Blood drained out via the central vein -> hepatic veins -> vena cava Bile: Hepatocytes, in turn, synthesize and secrete bile into bile canaliculi Bile ducts constantly secrete bile into the duodenum of the small intestine. The rest is concentrated in the gallbladder. The most important components of bile, bile salts, are taken back via the PV.

Bile (4 parts) Bile Salts & Lecithin: Portal vessels bring in blood from SI (PV) and aorta (PA) into sinusoids (capillaries) [e.g.: used in bile soaps] Cholesterol & Trace Metals: Synthesized/stored material excreted for maintaining blood homeostatis. Cholesterol is a raw material for bile salts. HCO3- and related salts: Neutralizes acids in the duodenum of the intestine

Bile (4 parts) Bile Pigments: “left-over” material of broken down hemoglobin from the damaged erythrocytes sieved-out as old or damaged Urine (yellow)-reduced into urobilin Feces (brown)-processed by enzymes into stercobilin BILIRUBIN (cooked in pinapaitan)

Jaundice CHARACTERISTIC 1: IcterusYellowing of the skin– extreme increase of bilirubin levels in extracellular fluid Hyperbilirubinemia: an excess of bilirubin in the blood

Jaundice CHARACTERISTIC 2: IctericscleraeThe yellowing of the conjuntival membranes of the sclera. Hyperbilirubinemia: an excess of bilirubin in the blood

Types of Jaundice Pre-Hepatic: Pathology occurs prior to the liver.[e.g.: malaria, caused by Plasmodium (protist parasites)][e.g.: Gilbert’s syndrome, genetic defect in bilirubin metabolism] Hepatic (or Hepatocellular): Pathology occurs within the liver (or hepatocytes).[e.g.: Cirrhosis, scarring of liver tissue][e.g.: Hepatitis, inflammation of the liver] Post-Hepatic: Pathology after formation of bilirubin in the liver.[e.g.: Obstructive jaundice by gallstones (cholesterol precipitation)][e.g.: Obstructive jaundice by liver fluke (trematode flatworm)]

Types of Jaundice Neo-Natal: Commonly known as “yellow baby”. -jaundice in neonates that is usually non-fatal -affects about50% of all babies during their first week of life outside the womb -usually caused by: ,[object Object]

relatively immature liver still trying to cope up with the excretion of bilirubin,[object Object],[object Object]

Parasitic Infections 2 Common Parasitic Diseases: Trichinosis ,[object Object]

Parasites also block the bile ducts

Causes right-sided abdominal pain, fever, enlarged liver and jaundice

Treatment: Anti-parasitic drug therapy,[object Object]

Viral Infections Viral Hepatitis Inflammation of the liver Body will not be able to manufacture bile Bilirubin accumulates in the blood and leaks to surrounding tissue

Causes: Hepatitis A – Ingestion of contaminated food and water Hepatitis B – Exposure to contaminated blood or needles, body fluids Hepatitis C – Exposure to contaminated blood Hepatitis D – Occurs only when Hepatitis B is present in person Hepatitis E – Ingestion of contaminated food and water

Liver Cancer Originates in the liver Malignant tumors inside or on the surface of the liver Tumors form in the liver Destruction of liver cells around the tumor Body will not be able to manufacture bile Bilirubin accumulates in the blood and leaks to surrounding tissue

Congenital Disorders These are disorders present since birth that makes it hard for the body to process bilirubin. Common Disorder: Gilbert’s Syndrome ,[object Object]

Abnormality in the enzyme glucoronyltransferase

Results in mild elevations of bilirubin in the bloodstream,[object Object]

2 Types: Type I ,[object Object]

Associated with other autoimmune disorders

Type 1 Diabetes2. Type II - Less common - Affects girls between ages 2 to 14

II. Excessive Breakdown of Red Blood Cells

Hemolytic Anemia Not enough red blood cells in the blood Types -> reason for destruction of RBC Could be w/in RBC itself (Intrinsic factors) or outside the RBC (Extrinsic factors) Intrinsic Factors Defects in hemoglobin production Sickle-cell disease Defects of red blood cell membrane production Hereditary spherocytosis

Intrinsic Factors (Continued) Defective red cell metabolism Pyruvatekinase deficiency Extrinsic Factors Abnormal immune system responses Blood clots in small blood vessels Certain infections and diseases Malaria Side effects from medications

III. Blockage/Narrowing of Biliary Ducts

Obstructive Jaundice ,[object Object]

Jaundice

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