Hemoglobin
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5
Bilirubin metabolism in Kidney
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The Hepatobiliary & Portal System
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Pathophysiology
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Unconjugated vs. Conjugated
Unconjugated Conjugated
production exceeds ability Can produce but not excrete
of liver to conjugate
Metabolic defect
Ex. Hemolytic anemias,
hemoglobinopathies, in-born Intra- or extrahepatic
errors of metab., transfusion obstruction
reaction.
Clues from history taking(1)
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Tea like urine Differ. Dx
unconjugated
hepatocellular liver test or conjugated
or cholestatic abnormalities fraction
intra- or
extrahepatic
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Laboratory Tests
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Lab Diagnosis of Jaundice D.D
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