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Jaundice Introduction Jaundice results from the accumulation of bilirubin(a reddish pigmentproduct of heme metabolism)in the body tissues; Hyperbilirubinemia may be due to abnormalities in the formation, uptake, conjugation, and excretion of bilirubin. Outline The normal metabolism of bilirubin Pathophysiologic classification of jaundice Manifestations of diseases associated with jaundice Normal total serum bilirubin level: 0.1-1.0 mg/dl Conjugated bilirubin level: 0-0.2 mg/dl Unconjugated bilirubin level: 0.1-0.8 mg/dl The normal metabolism of bilirubin Outline The normal metabolism of bilirubin Pathophysiologic classification of jaundice Manifestations of diseases associated with jaundice Pathophysiologic classification of jaundice Unconjugated Hyperbilirubinemia Conjugated Hyperbilirubinemia Unconjugated Hyperbilirubinemia Increased bilirubin production Impaired bilirubin uptake Impaired bilirubin conjugation Pathophysiologic classification of jaundice Increased bilirubin production a. Hemolysis b. Ineffective erythropoiesis c. Neonatal jaundice Pathophysiologic classification of jaundice Unconjugated Hyperbilirubinemia a. Gilbert syndrome: b. Congestive heart failure Pathophysiologic classification of jaundice Unconjugated Hyperbilirubinemia Impaired bilirubin uptake Pathophysiologic classification of jaundice Unconjugated Hyperbilirubinemia a. Gilbert syndrome b. Crigler-Najjar syndrome Impaired bilirubin conjugation Conjugated Hyperbilirubinemia Impaired canalicular excretion Obstruction of the intrahepatic bile ducts Obstruction of the extrahepatic bile ducts Pathophysiologic classification of jaundice Conjugated Hyperbilirubinemia Impaired canalicular excretion Hepatocellular injury (viral hepatitis, alcoholic hepatitis ,cirrhosis) b. Intrahepatic cholestasis (eg. Intrahepatic cholestasis of pregnancy, total parenteral nutrition-induced jaundice,primary biliary cirrhosis) c. Familial disorders of conjugated bilirubin tran