Hemoglobin
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Pathophysiology
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Unconjugated vs.
Conjugated
Unconjugated Conjugated
production exceeds Can produce but not
ability of liver to excrete
conjugate
Metabolic defect
Ex. Hemolytic
anemias, Intra- or extrahepatic
hemoglobinopathies, obstruction
in-born errors of
metab., transfusion
reaction.
Clues from history taking (1)
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Tea like urine Differ. Dx
Bilirubin in urine due to Jaundice (CB)
Concentrated urine in dehydration
Fluid deprivation syndromes
Sulfasalazine use for Ulcerative colitis
Rifampicin, Pyridium, Clofazamine and
Thiamine use
Red urine Porphyria,
Hemoglobin & Myoglobinuria, Hematuria
Dark black urine in Ochronosis
Melanin excretion from Melanoma
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An Approach to Jaundice
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Laboratory Tests
14
Lab Diagnosis of Jaundice
D.D
Prehepatic Intrahepatic Posthepatic
Features
(Heamolytic) (Hepatocellular) (Obstructive)
Conjugated Normal
AST or ALT Normal Normal
Alkaline phos.
and GGT
Normal Normal
Urine bilirubin Absent Present Increased
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Causes of Jaundice - Frequency
When to refer to Specialist
Unexplained jaundice
Suspected biliary obstruction
Acute hepatitis - severe or fulminant
Unexplained abnormal LFTs persisting (for 6
months or greater)
Unexplained cholestatic liver disease
Cirrhosis (in non-alcoholic) for consideration of
liver transplant
Suspected hereditary hemochromatosis
Suspected Wilson's disease
Suspected autoimmune hepatitis
Chronic hepatitis C for consideration of
antiviral therapy