A 45-year-old woman comes to the out patient clinic with complaints of yellow all
over the body that have been experienced for the past 3 days, complaints of right
abdominal pain over loss arising from the last 1 month. History of frequent
consumption of fatty foods
A 45-year-old woman
yellow all over the body that have been experienced for the past 3 days
complaints of right abdominal pain over loss arising from the last 1
month
History of frequent consumption of fatty foods
1. How could the skin become yellow
2. explain the patomechanism of bilirubin and what is the difference between
direct bilirubin indirect?
3. What is the relationship between fatty foods and jaundice that patients
suffer from?
4. what causes right upper abdominal pain in the scenario?
5. explain the differential diagnosis of the scenario?
6. explain prevention according to the scenario?
7. Islamic perspective on the scenario?
1. HOW COULD THE SKIN BECOME YELLOW?
Jaundice occurs when there is too much
bilirubin (a yellow pigment) in the blood—a
Increased bilirubin production due to increased red
condition called hyperbilirubinemia. Bilirubin
blood cells being destroyed (this is known as this is
is formed when hemoglobin (the part of red
known as hemolysis)
blood cells that carries oxygen) is broken
down as part of the normal process of
recycling old or damaged red blood cells.
Bilirubin is carried in the bloodstream to the
liver, where it binds with bile. Bilirubin is then Failure of the liver to process the bilirubin to be
moved through the bile ducts into the excreted
digestive tract, so that it can be eliminated
from the body. Most bilirubin is eliminated in
stool, but a small amount is eliminated in
urine. If bilirubin cannot be moved through
the liver and bile ducts quickly enough, it
builds up in the blood and is deposited in Blockage of the passage of bile into the gut: this include
the skin.The result is jaundice gallstones and cancer of the bile duct or liver.
Harrine, S. 2018. Jaundice In Adults. Division of Gastroenterology and Hepatology. Thomas Jefferson University.
Abbas, M. 2016. Jaundice: A Basic Reviews. Nishtar Medical College. International Journal of Research in
Medical Sciences. Vol 4. Issue 5. pp 1313-1314.
2. explain the patomechanism of bilirubin and what is the difference
between direct bilirubin indirect?
Differences in indirect bilirubin & direct bilirubin :
Ref : https://www.ncbi.nlm.nih.gov/pmc
4.what causes right upper abdominal pain in the scenario?
1.cholangitis
Definition
Acute cholangitis is a morbid condition with acute inflammation and
infection in the bile duct.
Pathophysiology
The onset of acute cholangitis involves two factors: (1)increased bacteriain the
bile duct, and (2) elevated intra-ductal pressure in the bile duct allowing
translocation ofbacteria or endotoxin into the vascular and lymphatic system
(cholangio-venous/lymphatic reflux). Because of its anatomical characteristics, the
biliary system is likely to be affected by the elevated intraductal pressure. In
acute cholangitis, bile ductules tend to become more permeable to the translocation
of bacteria and toxins with the elevated intraductal biliary pressure.
Historical aspect of terminology
Signs of hepatic fever Hepatic fever was a term used forthe first time by Charcot in
his report published in 1887 [3].Intermittent fever accompanied by chills, right
upper quadrant abdominal pain, and jaundice have been estab-lished as
Charcot’s triad.Acut obstructive cholangitis Acute obstructive cholangitis was
defined by Reynolds and Dargan [4] in 1959 as a syndrome consisting of lethargy
or mental confusion and shock, as well as fever, jaundice, and abdominal pain
caused by biliary obstruction.
Causes and symptoms
As noted above, the two things that are needed for cholangitis to occur are: 1) obstruction to bile flow, and 2)
presence of bacteria within the bile ducts. The most common cause of cholangitis is infection of the bile ducts
due to blockage by a gallstone. Strictures (portions of ducts that have become narrow) also function in the
same way. Strictures may be due to congenital (birth) abnormalities of the bile ducts, form as a result of injury
to the bile duct (such as surgery, trauma), or result from inflammation that leads to scar tissue and
narrowing.The bacterium most commonly associated with infection of the bile ducts is Escherichia coli (E.
coli) which is a normal inhabitant of the intestine
Diagnosis
The above symptoms alone are very suggestive of cholangitis; however, it is important to determine the exact
cause and site of possible obstruction. This is because attacks are likely to recur, and different causes require
different treatments. For example, the treatment of cholangitis due to a stone in the CBD is different from that
due to bile duct strictures
Ref : Sudoyo, Aru W. et al. Internal medicine textbook. Volume II Edition VI. Jakarta: International
Publishing Center for Internal Medicine Publishing. Pages 2022-2025
3. CHOLECYSTITIS
Chronic cholecystitis
Chronic cholecystitis is more common in clinical
Acute cholecystitis settings, and is very closely related to litiasis and
inflammation of the gallbladder (acute cholecystitis) more often arises slowly.
is an acute inflammatory reaction of the gallbladder Clinical Symptoms
wall accompanied by complaints of right upper the diagnosis of chronic cholecystitis is often
abdominal pain, tenderness, and fever. until now the difficult to enforce because the symptoms are
pathogenesis of this disease that is quite often very minimal and not prominent such as
encountered is still unclear. although there are no dyspepsia, full feeling in the epigastrium and
epidemiological data on the population, the nausea especially after eating high-fat foods,
incidence of cholecystitis and gallstones which sometimes disappear after belching.
(cholelithiasis) in our country is relatively lower History of gallstones in the family, recurrent
compared to western countries. jaundice and colic, local pain in the gallbladder
area with positive Murphy signs, can support the
diagnosis.
1.Acute cholecystitis
Clinical Symptoms
the diagnosis of chronic cholecystitis is often difficult to enforce because the symptoms are very minimal and not
prominent such as dyspepsia, full feeling in the epigastrium and nausea especially after eating high-fat foods, which
sometimes disappear after belching.
Diagnosis
Oral cholecystography examination, ultrasonography and colloangiography can show cholelithiasis and gallbladder
function. endoscopie retrograde choledochopancreaticography (ERCP) is very useful for showing the presence of
gallstones in the gallbladder and koledokus duct.
Prognosis
In most patients with chronic cholecystitis with or without symptomatic gallbladder stones, it is recommended for
cholecystectomy. The decision for cholecystectomy is rather difficult for patients with minimal complaints or other
diseases that increase the risk of surgery.
Ref : Sudoyo, Aru W. et al. Internal medicine textbook. Volume II Edition VI. Jakarta: International
Publishing Center for Internal Medicine Publishing. Page 479-480
6. explain prevention according to the scenario?
Lightdiet
Providing adequate antibiotics
at the beginning of the attack to
prevent complications of
peritonitis, cholangitis, and Completerest
septicemia.
Parenteralnutritio
n
Reduceeating foods
containing betacarotine (such
as squash, melon, papaya, Painkillerssuch as
and carrots) pethidine and
antispasmodics
Ref : Sudoyo, Aru W, et al.2015. Book Teaching Internal Medicine Volume II edition V. Jakarta:
Interna Publishing
7. islamic perspective on the scenario?
Prophet Muhammad sallallaahu 'alaihi wa sallam said:
( أخرجه الحافظ السيوطي في الجامع الصغير: التخمة:صل كل داء البردة) البردة
" The source of all diseases is al-baradah." Al-baradah: at-Tukhmah (Poor digestion of food) (narrated by
Imam al-Hafizh as-Suyuthi rahimahullah in al-Jaami 'ash-Shaghiir)
Basically, self-originating diseases do not originate from viruses, bacteria, germs, mosquitoes, cell mutations
and other viruses or bacteria that are rampant in the body when sick are not as a result.
So the source of the disease is human actions themselves through our daily behavior that is less praiseworthy
before Allah SWT, unfavorable character makes the angel Ratib record and report it before Allah SWT. where
it has been going on for years or even decades so that finally Allah decreases disaster in the form of a disease
as a warning to his people to immediately return to its path
Word of Allah SWT in surah As-Surah verse 42-30
"And whatever changes happen to you are caused by the creation of your own hands and Allah forgives as
much of your mistakes. And you do not let go (of the punishment of Allah) on the face of the earth and you
do not get a protector or helper besides Allah ".