Hepatic And Posthepatic Jaundice Sonal Pruthi Roll Number

Hepatic And Post-hepatic Jaundice Sonal Pruthi Roll Number - 82

Hepatic Jaundice • Defective Hepatic Uptake • Gilbert’s Syndrome • Abnormal Conjugation • Drugs • Criggler Najjar Syndrome • Rifampicin • Hepatocellular Damage • Viral Hepatitis • Novobiocin • Drugs • Probenecid • Primaquine • Novobiocin Viral Hepatitis • Pregnanediol. Alcoholic Hepatitis Drug Induced Hepatitis • Chloramphenicol Autoimmune hepatitis Toxic Hepatitis

• Hepatitis A • Hepatitis B Viral • Hepatitis D Hepatitis • Hepatitis C • Hepatitis E • EBV • CMV

Hepatitis A

HBV DNA HBs. Ag Total Anti-HBc Ig. M Anti-HBc Anti-HBe Anti-HBs HBe. Ag Hepatitis B

HBV DNA

HBs. Ag

HBe. Ag

Total Anti - HBc

Ig. M-Anti HBc

Hepatitis C

Clinical Features- Hepatic Jaundice • • Icterus Spider telangiectasia Asterixis Palmar erythema Fetor hepaticus Gynaecomastia Testicular atrophy Ascites

Obstructive Jaundice • Bile duct strictures Cholestasis • Intrahepatic • Common duct stone. • Primiary Biliary Cirrhosis • Periampullary carcinoma • Primary Sclerosing Cholangitis • Dubin Johnson Syndrome • Rotor’s Syndrome • BRIC • PFIC • • Drugs Extrahepatic Cholestasis - phenothiazines

Gall bladder Stone The majority of cases (approximately 80%)are asymptomatic (silent) gall stones , discovered accidentally by abdominal sonar. Obstruction of common bile duct leading to pain & jaundice

Periampullary Carcinoma • • CBD Duodenum Ampulla Pancreas

Clinical features - Obstructive • Pain due to gallbladder disease, malignancy or stretching of the liver capsule • Fever due to ascending cholangitis • Palpable and / or tender gallbladder • • Enlarged liver usually smooth

Investigations Total Bilirubin Conjugated Bilirubin Unconjugated Bilirubin Urobilinogen Stercobilin Hepatic Increased Post-hepatic Increased Normal Increased Decreased/ absent Reduced/absent Normal

Enzymes that reflect damage to hepatocytes v. ALT and AST – Raised ALT specific for liver injury ALT>1000 IU/L - suggestive of Hepatocellular injury AST: ALT > 2: 1 Suggestive of ALD AST: ALT < 1 Suggestive of viral hepatitis

Enzymes that reflect Cholestasis v. Alkaline Phosphatase – Raised § large bile duct obstruction § Intrahepatic cholestasis v. Gamma Glutamyl transferase § more sensitive marker for cholestasis as compared to ALT

Investigations v Prothrombin Time § might be increased in cases of hepatic jaundice. § Disorders that lead to Vitamin K deficiency v Serum ANA and Anti Smooth Muscle Antibody § positive in patients with PBC

Clinical Vignette Match the clinical description with the most likely disease process. • a. Primary biliary cirrhosis • b. Sclerosing cholangitis • c. Anaerobic liver abscess • d. Hepatoma • e. Hepatitis C • f. Hepatitis D • g. Hemochromatosis

• A 40 -year-old white female complains of pruritus. • She has an elevated alkaline phosphatase and positive antimitochondrial antibody test. CHOOSE 1 DISEASE PROCESS

• A 70 -year-old male with a long history of diverticulitis has low-grade • fever, elevated alkaline phosphatase, and right upper quadrant pain. CHOOSE 1 DISEASE PROCESS

A 30 -year-old male with ulcerative colitis develops jaundice, pruritus, and right upper quadrant pain. Liver biopsy shows an inflammatory obliterative process affecting intrahepatic and extrahepatic bile ducts. CHOOSE 1 DISEASE PROCESS

• A 40 -year-old white male complains of weakness, weight loss, and abdominal pain. • On examination, the patient has diffuse hyperpigmentation, icterus and a palpable liver edge. Polyarthritis of the wrists and hips is also noted. Fasting blood sugar is 185 mg/d. L. The most likely diagnosis is • a. Insulin-dependent diabetes mellitus • b. Pancreatic carcinoma • c. Addison’s disease • d. Hemochromatosis

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