Jaundice

Jaundice is a yellowing of the skin and mucous membranes, caused by hyperbilirubinemia. Jaundice is visible at a bilirubin of 2-3 mg / dl (34-51 .mu.mol / l).

Jaundice is a yellowing of the skin and mucous membranes, caused by hyperbilirubinemia. Jaundice is visible at a bilirubin of 2-3 mg / dl (34-51 .mu.mol / l).

See also liver structure and function and evaluation of the patient with liver disease.) Jaundice is a yellowing of the skin and mucous membranes, caused by hyperbilirubinemia. Jaundice is visible at a bilirubin of 2-3 mg / dl (34-51 .mu.mol / l). Pathophysiology Most Bilirubin is produced when Hb in unconjugated bilirubin (and other substances) disintegrates. Unconjugated bilirubin binds to transport to the liver bound to albumin in the blood where it is taken up by hepatocytes and conjugated with glucuronic acid to make it water-soluble. Conjugated bilirubin is excreted via the bile into the duodenum. In the gut bacteria convert bilirubin to urobilinogen. Part of the urobilinogen is excreted through the intestine, a portion is reabsorbed, taken up by hepatocytes, processed and again excreted via the bile (enterohepatic circulation, overview of the Bilirubinmetabolismus). Mechanisms of hyperbilirubinemia hyperbilirubinemia can my predominantly unconjugated or conjugated bilirubin. Unconjugated hyperbilirubinemia is often caused by ? 1 of the following: Increased production Reduced hepatic uptake Decreased conjugation conjugated hyperbilirubinemia is often caused by ? 1 of the following: dysfunction of the liver cells (hepatocellular dysfunction) slowing of bile leakage from the liver (intrahepatic cholestasis) interference with the extrahepatic bile flow (extrahepatic cholestasis) consequences the result is determined primarily by the cause of jaundice, and the presence and severity of liver dysfunction. Liver dysfunction can coagulopathy, encephalopathy, and portal hypertension (which is bleeding in the gastrointestinal tract may result) lead. Etiology Although hyperbilirubinemia can be classified as predominantly unconjugated or conjugated in many biliary disorders cause both forms. Many conditions (see table: Several mechanisms and causes of jaundice in adults), including the use of certain drugs (see table: Some drugs and toxins that can cause jaundice), can lead to jaundice, but the most common causes are inflammatory hepatitis ( viral hepatitis, autoimmune hepatitis, toxic liver damage) alcoholic liver disease biliary obstruction Some mechanisms and causes of jaundice in adults mechanism examples Suggestive Findings * unconjugated hyperbilirubinemia Increased Bilirubinproduktion Common: hemolysis Less common: Absorption of large hematomas, ineffective erythropoiesis few or no clinical manifestations of hepatobiliary disease, sometimes anemia, ecchymosis Serum bilirubin is usually <3.5 mg / dl (<59 mol / l) no bilirubin in urine, normal aminotransferases Decreased liver uptake of bilirubin common: heart failure Less common: drugs, fasting, portosystemic shunts - Decreased hepatic conjugation common: Gilbert's syndrome Less common : Ethinyl estradiol, Crigler-Najjar syndrome, hyperthyroidism - Conjugated hyperbilirubinemia † hepatocellular dysfunction Common: drugs, toxins, viral hepatitis Less common: Alcoholic liver disease, hemochromatosis, primary biliary cirrhosis, primary sclerosing cholangitis, steatohepatitis, Wilson's disease aminotransferase usually> 500 U / l intrahepatic cholestasis common: alcoholic liver disease, drugs, toxins, viral hepatitis Less common: infiltrative diseases (eg. B. amyloidosis, lymphoma, sarcoidosis, tuberculosis), pregnancy, primary biliary cirrhosis, steatohepatitis Gradual onset of jaundice, sometimes itching If heavy, clay-colored stools, steatorrhea If long-standing, weight loss alkaline phosphatase and GGT usually normal> 3 times aminotransferase levels <200 U / l Extrahepatic cholestasis common: stones in the common bile duct, pancreatic cancer Less common: Acute cholangitis, pancreatic pseudocyst, primary sclerosing cholangitis, inflammatory narrowed bile ducts by previous surgery, other tumors Depending on the cause, manifestations may be similar to those of intrahepatic cholestasis or acute illness (eg. as abdominal pain or vomiting due to stones i m bile duct or acute pancreatitis) Alkaline phosphatase and GGT usually> 3 times normal aminotransferase levels <200 U / l Other less common mechanisms Congenital disorders (especially Dubin-Johnson syndrome and Rotor syndrome) Normal liver enzymes * Symptoms and signs of the causative disorder may be present. † bilirubin in urine GGT = gamma-glutamyl transferase Some drugs and toxins that can cause jaundice mechanisms drugs or toxins Increased Bilirubinproduktion drugs that cause hemolysis (often in patients with G6PD deficiency) Decreased as sulfonamides and nitrofurantoin hepatic uptake chlorine amphenicol, probenecid, rifampicin Decreased conjugation ethinylestradiol hepatocellular dysfunction Acetaminophen (high dose or overdose), amiodarone, isoniazid, NSAIDs, statins, many others, many drug combinations Amanita phalloides mushrooms, carbon tetrachloride, phosphorus Intrahepatic cholestasis amoxicillin / clavulanic acid, anabolic steroids, chlorpromazine , pyrrolizidine alkaloids (eg. B. herbal preparations), oral contraceptives, phenothiazines clarification history to a history of acute illness should include start and duration of jaundice. Hyperbilirubinemia can darken the urine before jaundice is visible. Therefore, the occurrence of dark urine indicates the beginning of hyperbilirubinemia accurate than jaundice. Important Accompanying symptoms include fever, prodromal symptoms (eg. As fever, malaise, muscle pain) before jaundice, color change in bowel, pruritus, steatorrhea and abdominal pain (including location, severity, duration, and broadcasting) occur. Important symptoms suggesting a serious condition suspect are nausea and vomiting, weight loss and possible symptoms of a bleeding disorder (eg. As easy bruising or bleeding, which heal slowly or bloody stools). Review of Organysteme should include the search for possible causes including weight loss and abdominal pain (cancer); Joint pain and swelling (autoimmune or viral hepatitis, hemochromatosis, primary sclerosing cholangitis, sarcoidosis) and lack of menstruation (pregnancy). History should known disorders such as liver and biliary diseases (eg. As gallstones, hepatitis, cirrhosis), disorders that can cause hemolysis (z. B. hemoglobinopathies, G6PD deficiency) and disorders with liver or gall bladder disease include including inflammatory bowel disease, and infiltrative disorders (eg. B. amyloidosis, lymphoma, sarcoidosis, TB) and HIV infection or AIDS. The Medikementenanamnese should include questions about the use of drugs or toxin exposure, which are known to affect liver disease (see table: Some drugs and toxins that can cause jaundice) and hepatitis vaccination. The surgical history should include questions about previous biliary surgery (a possible cause of stenosis). The social history should questions about risk factors for hepatitis (see table: Some risk factors for hepatitis), amount and duration of alcohol consumption, drugs and drug use and sex life include. Familienanamnestisch should questions about recurring easier jaundice in family members and diagnosed hereditary liver diseases are provided. The history of consumption of recreational drugs and alcohol consumption should be from friends or family members, if possible, be confirmed. Some risk factors for hepatitis type of hepatitis risk factors A stay in a day care or employment home or work in a closed institution travel to endemic areas Oral, anal sex ingestion of raw shellfish B Intravenous drug use Hemodialysis sharing razors or toothbrushes Tattoo Piercing Improper treatment at health workers Sexual high risk activities birth in areas of high endemicity C blood transfusion before 1992 Intravenous drug use hemodialysis employment in the medical field with an increased risk of transmission of birth from 1945 to 1965 Physical Examination During the physical examination, the vital signs collected and body temperature measured (fever, hypotension, tachycardia) (Heiner Wedemeyer) The patient's general condition should particularly with respect to assess the nutritional status and level of alertness. In head and neck, the sclera and tongue to jaundice and eyes are examined for Kayser-Fleischer rings. A slight jaundice can best be seen by examining the sclera in daylight. It is usually visible when the serum bilirubin is 2-2.5 mg / dl (34-43 .mu.mol / l). Bad breath is to be considered (eg. Because as fetor hepaticus). Jaundice DR P. MARAZZI / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: '/-/media/manual/professional/images/c0024908-jaundice-science-photo-library-high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/c0024908-jaundice-science-photo-library-high_de.jpg?la=de&thn=0', title: 'jaundice', description: ' u003Ca id = " v38395213 "class = " anchor "" u003e u003c / a u003e u003cdiv class = "" para "" u003e u003cp u003eGelbfärbung of the whites of eyes and the facial skin. u003c / p u003e u003c / div u003e 'credits' DR P. MARAZZI / SCIENCE PHOTO LIBRARY'

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