黄疸英文版本.pptx

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,Gastroenterology Department,First Affiliated Hospital of Chongqing Medical University,Bingqiang Zhang,Aims and Demands,1.Grasp the concept of jaundice,clinical manifestation,and points of inquisition,2.Familiar the etiology and mechanism of jaundice,3.Realize normal bilirubin metabolism,Definition：jaundice,or icterus refers to the yellow appearance of the skin,scleral and mucous membranes resulting from an increased bilirubin concentration in the body fluids.,Total bilirubin:1.7-17.1mol/L,Conjugated bilirubin:0-3.42mol/l，,Unconjugated bilirubin:1.7-13.68mol/l.,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,Normal bilirubin metabolism,Normal bilirubin metabolism,Classification,1.Depending on Etiology,Hemolytic Jaundice,Hepatocellular Jaundice,Cholestatic Jaundice,Congenital jaundice,2.Depending on bilirubin,Unconjungated bilirubing increased jaundice,Conjungated bilirubing increased jaundice,Etiology,1.Congenital hemolytic anemia(,thalassemia,hereditary spherocytosis).,2.P,osteriority acquired hemolytic anemia(autoimmunity hemolytic anemia,hemolytic disease of newborn,posttransfusion hemolytic,Favism),.,Mechanism,A large number of erythrocyte destroyed rapidly,Anemia,hypoxia and toxity of erythocyte metabolism products,1.Hemolytic Jaundice,Haemolytic Jaundice mechanism,Clinical Manifestation,Mild jaundice,light lemon,no skin itch.,Acute hemolytis:fever,chill,headache,vomit,backache,anemia,hemoglobinuria(dark sauce or tea),acute renal failure.,Chronic hemolysis:anemia and splenomegaly.,Laboratory Examination,1.Serum TB,UCB,CB normal.,2.UCBintestinal CBfaecal color deepen.,3.Intestinal Urobilinogenurinary Urobilinogen.,4.Acute hemolytis,occult blood test(+).,5.Blood test:anemia,reticulocyte,erythacyte proliferation.,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,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 demaged,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 formation.,Cholestatic Jaundice mechanism,Clinical features,Skin dark yellow,yellow green.,Skin itch,bradycardia,dark yellow of urine,facal light yellow or clay color.,Courvoisiers sign.,Laboratory Examination,Serum CB,Urine bilirubin(+),Urobilinogen,stercobilin or absence,Serum alkaline phosphatase and Cholesterol,Three kinds of jaundice laborotory examination indentification,Class Haemolytic Hepatocellular Cholestatic,TB increased,(UCB,)increased increased,CB normal increased markedly increased,CB/TB 15一20 30一40 50一60,urine bilirubin 十 十十,urobilinogen increased slight increased decreased or absence,ALT、AST normal markedly increased may increased,ALP normal increased markedly increased,r-GT normal increased markedly increased,PT normal delayed delayed,Vit K respond no poor good,Cholesterol normal slight increased or decreased markedly increased,Serum protein normal Alb decreased,Glob increased normal,4.Congenital Nonhemolytic Jaundice,Due to the deficiency of the hepatocyte in uptakeing,conjugating and excreting bilirubin,Uncommon,1.Gilber syndrome:hepatocyte uptaking UCB abnormal,deficiency of glucuronyl transferase,UCB jaundice(no symptom,liver function normal).,2.Dubin-Johnsons syndrome:abnormal of Hepatocyte excreting CB and some anion to bile capillary CB jaundice.,3.Crigler-Najjars syndrome:absence of glucuronyl transferase in hepatocyte,UCB cant be transfered to CB，serum UCBjaundice,UCBnuclear jaundic,newborn,poor prediction.,4.Rotors syndrome:deficiency of Hepatocyte uptaking UCB and excreting CB,bilirubinjaundice.,Accessory Examination,1.Ultrosound,2.X ray,3.ERCP,(Endoscopic retrograde cholangiopancreatography),4.PTC,(Percutaneous transheptic cholangiography),5.CT,(Computed tomography,),6.MRI,(Magnetic resonance cholangiopancreatography),7.Radio Nuclide Examination,8.Liver Biopsy and LC,(Laparoscopy),Accompanying Symptoms,Fever:acute cholangitis,liver abscess,leptospirosis,septicemia,lobar pneumonia.Fever then jaundice:virus hepatitis,acute hemolysis.,Upper abdominal sharp pain:biliary calculi,liver abscess,biliary ascariasis,Right upper abdom sharp pain,chill,high fever,jaundice,Charcot triad sign:acute pyogenic cholangitis,Sustained right upper abdominal blur or swell pain:virus hepatitis,liver abscess,primary carcinoma of liver,Hepatomegaly,Mild or moderate,soft or moderate hard,smooth surface:Virus hepatitis,acute infection of biliary tract.obstruction of biliary tract,Obvious enlargement,hard,ragged surface:primary or secondary carcinoma of liver.,Not obvious enlargement,hard,edge not tidy,nodule on the surface:cirrosis.,Gallbladder enlargement:common bile duct obstruction,pancrease head carcinoma,common bile duct carcinoma,carcinoma of ampulla.,Splenomegaly:virus hepatitis,leptospirosis,septicemia,Malaria,biliary cirrhosis,hemolytic anemia,lymphoma.,Acite:serious hepatitis,decompensation of cirrosis,carcinoma of liver.,Interrogatoire,Points,1.Assure jaundice,2.Etiology and onset,3.Accompany syndrome,4.Time and fluctuation of jaundice,5.Influnce to the overall health,In one word:make sure the type of jaundice then find the pathogeny,Recognise jaundice,Position：sclera,skin and,tongue sleeves,Pseudojaundice:,eat,Carotene food(Carotene,pumpkin,tomato,orange)also can cause skin stained yellow,but bilirubin is not increased.,Old people fat,accumulation at bulbar conjunctiva,，yellow,uneven distribution,Jaundice is a common symptom and sign in clinical work,get to know the mechanism can help us identify different kinds of jaundices.hemolytic jaundice is due to the rapidly destroyed erythocyte,so the UCB increased.hepatocellular jaundice refers to uptakeing,conjugating and excreting bilirubin,so both CB and UCB increased.Cholestatic jaundice due to the obstruction of bile track,so the CB increased and urine bilirubin positive.,Summary,1.A 13 years old male,chief complaints“Finding skin and sclera yellow and feeling right upper abdomen swell pain for 1 week”,What are the possible diagnoses and your suggested examinations.,Question,Reference books,Cecil mecidine 23,rd,edition.,Davidson principles and practice of medicine.,Harrisons principles of internal medicine.16,th,edition.,