黄疸、腹泻.ppt

Jaundice;;Jaundice;Catalog;Bilirubin Metabolism Bilirubin formation Transport of bilirubin in plasma Hepatic bilirubin transport Hepatic uptake Conjugation Biliary excretion Enterohepatic circulation;;Transport of Bilirubin in Plasma; CB;UDPGT: Uridine Diphosphate Glucuronyl Transferase UCB: because of its tight albumin binding and lipid solubility, it is not excreted in urine. CB: is less tightly bound to albumin and is water soluble, so it is filtered at the glomerulus and appears in the urine.;Entero-hepatic circulation;Pathophysiologic classification of Jaundice;Jaundice classification ;Hemolytic Jaundice;Hemolytic Jaundice Symptoms weakness, Dark urine, anemia, Icterus, splenomegaly Lab UB? without bilirubinuria fecal and urine urobilinogen? hemolytic anemia hemoglobinuria (in acute intravascular hemolysis) Reticulocyte counts? ;Obstructive Jaundice;Etiology of Obstructive Jaundice;Etiology of Obstructive Jaundice;;cholestasisclinical features;General signs of cholestasis; Obstructive Jaundice Lab Findings Serum Bilirubin? Feceal urobilinogen? (incomplete obstruction) Feceal urobilinogen absence (complete obstruction) urobilinogenuria is absent in complete obstructive jaundice bilirubinuria ? ALP ? cholesterol ?;Obstructive Jaundiceextrahepatic;Hepatic Jaundice;Hepatic Jaundice Pathogenesis Impaired or absent hepatic conjugation of bilirubin decreased UDPGT activity (Gilbert‘s syndrome) hereditary absence or deficiency of UDPGT (Grigler-Najjar Syndrome) Hereditary disorders of UCB transporter, excretion and uptake Dubin-Johnson Syndrome(transporter and excretion ) Rotor syndrome(uptake) Acquired disorders hepatocellular necrosis intrahepatic cholestasis (Hepatitis, Cirrhosis, Drug-related) ;Gilbert‘s syndrome;;Hepatic Jaundice Symptoms weakness, loss appetite, hepatomegaly, palmar erythema, spider Lab Findings liver function tests are abnormal both CB and U