西安交通大学医学院消化系统疾病课件 Jaundice.pptVIP

Jaundice Qiao Wen the yellow color of skin, sclera, mucous membranes, body fluid (humor), and the other tissue in associated with an elevation in serum bilirubin. Normal total serum bilirubin isn’t more than17.1 μmol/L. When serum bilirubin is greater than 34μmol/L, jaundice is clinically apparent. If only serum bilirubin elevated, skin isn’t yellow, this is defined as occult jaundice. 1. Sources of bilirubin Normal: The amount of total bilirubin is 340-510 μmol/day. The average lifetime of normal erythrocyte is 120 days. There are three sources of bilirubin: (1) Main source is derived from hemoglobin in senescent erythrocyte (about 80%~85%). (2) Derived from hemoglobin of immature erythrocyte in bone marrow(10~15%). (3) Intrahepatic protein including heme such as hydrogen peroxide enzyme, cytochrome P450, etc (1~5%). 2. Bilirubin transporting Free bilirubin (unconjugated bilirubin, UCB) is fat-soluable. It is combined with albumin in blood circulation to form bilirubin-albumin compound and transported to liver. 3. Intaking of bilirubin In hepatic sinusoid, the bilirubin is intaked by hepatocyte, and separated from albumin. When the bilirubin entered hepatocyte, it is transported to microsome of smooth surface endoplasmic reticulum. 4. Conjugation of bilirubin The conjugation of free bilirubin combined with glucuronic. This course is catalyzed by glucuronyl transferase in microsome to form conjugated bilirubin (CB). CB is water-soluble. 5. Excretion of bilirubin After the conjugated bilirubin is secreted into bile capillaries, then entered intestinal cavity, it is dehydrogenated by bacteria to form urobilinogen. (1) Hemolytic jaundice A. The disfigurement of red-cell the fragileness of red-cell increase Etiology: a. paramorphia: hereditary spherocytosis. b.