Jaundice: Pathology review
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Jaundice: Pathology review
Pathology
Peritoneum and peritoneal cavity
Peritonitis
Pneumoperitoneum
Upper gastrointestinal tract disorders
Cleft lip and palate
Congenital diaphragmatic hernia
Esophageal web
Tracheoesophageal fistula
Pyloric stenosis
Sialadenitis
Parotitis
Oral candidiasis
Ludwig angina
Aphthous ulcers
Temporomandibular joint dysfunction
Dental abscess
Gingivitis and periodontitis
Dental caries disease
Oral cancer
Warthin tumor
Barrett esophagus
Achalasia
Plummer-Vinson syndrome
Mallory-Weiss syndrome
Boerhaave syndrome
Gastroesophageal reflux disease (GERD)
Zenker diverticulum
Diffuse esophageal spasm
Esophageal cancer
Eosinophilic esophagitis (NORD)
Gastritis
Gastric dumping syndrome
Peptic ulcer
Gastroparesis
Cyclic vomiting syndrome
Gastroenteritis
Gastric cancer
Lower gastrointestinal tract disorders
Gastroschisis
Imperforate anus
Omphalocele
Meckel diverticulum
Intestinal atresia
Hirschsprung disease
Intestinal malrotation
Necrotizing enterocolitis
Intussusception
Tropical sprue
Small bowel bacterial overgrowth syndrome
Celiac disease
Short bowel syndrome (NORD)
Lactose intolerance
Whipple's disease
Protein losing enteropathy
Microscopic colitis
Crohn disease
Ulcerative colitis
Bowel obstruction
Intestinal adhesions
Volvulus
Gallstone ileus
Abdominal hernias
Femoral hernia
Inguinal hernia
Small bowel ischemia and infarction
Ischemic colitis
Familial adenomatous polyposis
Peutz-Jeghers syndrome
Gardner syndrome
Juvenile polyposis syndrome
Colorectal polyps
Colorectal cancer
Carcinoid syndrome
Irritable bowel syndrome
Gastroenteritis
Diverticulosis and diverticulitis
Appendicitis
Anal fissure
Anal fistula
Hemorrhoid
Rectal prolapse
Liver, gallbladder and pancreas disorders
Crigler-Najjar syndrome
Biliary atresia
Gilbert's syndrome
Dubin-Johnson syndrome
Rotor syndrome
Jaundice
Cirrhosis
Portal hypertension
Hepatic encephalopathy
Hemochromatosis
Wilson disease
Budd-Chiari syndrome
Non-alcoholic fatty liver disease
Cholestatic liver disease
Hepatocellular adenoma
Autoimmune hepatitis
Alcohol-induced liver disease
Alpha 1-antitrypsin deficiency
Primary biliary cirrhosis
Primary sclerosing cholangitis
Hepatitis
Neonatal hepatitis
Reye syndrome
Benign liver tumors
Hepatocellular carcinoma
Gallstones
Biliary colic
Acute cholecystitis
Ascending cholangitis
Chronic cholecystitis
Gallstone ileus
Gallbladder cancer
Cholangiocarcinoma
Acute pancreatitis
Pancreatic pseudocyst
Chronic pancreatitis
Pancreatic cancer
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Gastrointestinal system pathology review
Congenital gastrointestinal disorders: Pathology review
Esophageal disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Malabsorption syndromes: Pathology review
Diverticular disease: Pathology review
Appendicitis: Pathology review
Gastrointestinal bleeding: Pathology review
Colorectal polyps and cancer: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Pancreatitis: Pathology review
Gallbladder disorders: Pathology review
Jaundice: Pathology review
Viral hepatitis: Pathology review
Cirrhosis: Pathology review
Assessments
Jaundice: Pathology review
USMLE® Step 1 questions
0 / 13 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
Reproduced from: Wikimedia Commons
Which of the following laboratory findings will most likely be present in this patient?
Memory Anchors and Partner Content
Transcript
Content Reviewers
Yifan Xiao, MDContributors
Filip Vasiljević, MD
Sam Gillespie, BSc
Christine, a 20-hour-old female infant presented with neonatal jaundice. She was born at term following an uncomplicated pregnancy. Physical examination shows she is alert, well-perfused, feeding normally, and afebrile. The skin is yellow in the face, trunk, and limbs, but there’s no organomegaly. Laboratory studies reveal high total bilirubin of 25mg/dL, normal liver function tests, and no evidence of hemolysis. On the other hand, a 17-year-old boy named Steven comes to his primary care physician because his sister has been telling him that periodically, he look a little yellow. Medical history is noncontributory, physical examination shows no abnormalities, but Steven mentions that he has recently started working out and dieting to prepare for prom. Laboratory studies show elevated total bilirubin concentration. A week later, his bilirubin concentration is normal.
Now, both Christine and Steven have jaundice, but the underlying cause of their problem is different. Jaundice, also called icterus, is the abnormal yellowish pigmentation of the skin, mucous membranes, and sclera due to the deposition of the bilirubin. The reference range for total bilirubin is 0.2 - 1.2 mg/dl; while jaundice typically occurs when total bilirubin levels exceed 2mg/dl. Now for your exam, it’s crucial to know the metabolism of bilirubin! When old red blood cells pass through the spleen, macrophages eat them up and break down the hemoglobin to heme and globin. Heme is then converted into biliverdin by an enzyme heme oxygenase. Biliverdin is further converted into unconjugated or indirect bilirubin by an enzyme biliverdin reductase.
Unconjugated bilirubin is the form of bilirubin that’s lipid-soluble.Since it’s not water soluble, this form of bilirubin binds tightly to albumin in the blood, therefore, it can’t be filtered by the kidneys and excreted in the urine. Instead, the unconjugated bilirubin undergoes hepatic metabolism of bilirubin, which consists of 3 main phases. The first phase is carrier-mediated uptake of bilirubin at the sinusoidal membrane of the hepatocyte. In the second phase two molecules of glucuronic acid are attached to bilirubin by an enzyme UDP glucuronyl transferase. The final product is bilirubin diglucuronide, which is also known as conjugated or direct bilirubin.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Oxford Textbook of Primary Medical Care" R.J. (Prof.) (2005)
- "Diagnostic Approach to the Patient with Jaundice" Primary Care: Clinics in Office Practice (2011)
- "Managing the jaundiced newborn: a persistent challenge" Canadian Medical Association Journal (2014)
- "Bilirubin in the Liver–Gut Signaling Axis" Trends in Endocrinology & Metabolism (2018)
- "Jaundice associated pruritis: A review of pathophysiology and treatment" World Journal of Gastroenterology (2015)
- "Inherited disorders of bilirubin clearance" Pediatric Research (2015)
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