1、Jaundice(黄疸)Department of Gastroenterology,First Affiliated Hospital of Chongqing Medical UniversityXIAOHONG TAO(陶小红陶小红)Heme DegradationHEMEBILIVERDINO2Fe+3NADPHNADP+(opens the porphyrin ring)BILIRUBINNADPHNADP+BILIRUBIN diglucuronideBILEMild jaundice,light lemon,no skin itch(痒).Skin itch(痒),bradyca
2、rdia(心动过缓),dark yellow of urine,faecal light yellow or clay color.Cholestatic Jaundice mechanismurine bilirubin 十 十十Cecil mecidine 23rd edition.unconjugated bilirubinIcteric hepatitis:CB UCB Class Hemolytic Hepatocellular CholestaticUrobilinogenAccompany syndromePTC(Percutaneous transheptic cholangi
3、ography,UrobilinogenTime and fluctuation of jaundiceInquisition Points（问诊要点）Jaundice(黄疸)Old people fat accumulation at bulbar conjunctiva(球结膜),yellow,uneven distribution(in blood)Hepatocellular Jaundice（肝细胞性黄疸）Alb=albuminB=bilirubinGST=glutathione-S-transferaseUDPGA=uridine diphosphoglucuronic acid;
4、CB=conjugated bilirubinUGT1A1=UDP-glucuronosyltransferase 1A1MRP2=Multi-drug Resistance Protein 2 Adapted from Harrisons 15th Ed.“Principles of Internal Medicine”,2001.MRP2PlasmaHepatic CellBile?:GSTsER+UDPGAUGT1A1IntestinesLiverUrobilinogenB-glucoronidasebacteriabacteriaBileEnterohepatic circulatio
5、nKidneyUrobilinoxUrobilinogenUrobilinStercobilinStercobilingogenfecesUrineoxLiverAlbuninHemeFerrohemetransferase BilirubinConjugated bilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidase BiliverdinMarrowInfantility ErythrocyteFerroheme Enzym
6、e15%20%Bilirubin|AlbuminErythrocyte80%85%UDP UDPGABilirubin glucuronolactoneurobilinogenEnterohepatic circulation Y/Z protein cathepsin ErythrocyteBiochemical change of Normal bilirubin metabolism3.1.Hemolytic JaundiceHemolytic Jaundice mechanismHepatocellular Jaundice mechanismCholestatic Jaundice
7、mechanismA.Hemolytic anemiaexcess hemolysis unconjugated bilirubin (in blood)conjugated bilirubin (released to bile duct)UB UrobilinogenB.Hepatitis unconjugated bilirubin (in blood)conjugated bilirubin (in blood)UB UrobilinogenC.Biliary duct stone unconjugated bilirubin (in blood)conjugated bilirubi
8、n (in blood)UB Urobilinogen 5.Genetic Disorders of Bilirubin MetabolismHemolytic Jaundice mechanismCB normal increased markedly increasedB Ultrasound:normal.Davidson principles and practice of medicine.The Fate of BilirubinThree kinds of jaundice laborotory examination indentificationEnterohepatic c
9、irculationAnemia,hypoxia and toxity of erythocyte metabolism productsMild jaundice,light lemon,no skin itch(痒).Cecil mecidine 23rd edition.MRI(Magnetic resonance cholangiopancreatography)1.A 13 years old male,chief complaints“Finding skin and sclera yellow and feeling right upper abdomen swell pain for 1 week”Blood test:TBil:80mol/L,DBil:50mol/L,ALT:1200U/L.B Ultrasound:normal.What are the possible diagnoses and your suggested examinations.Hepatocellular and Cholestetic jaundice.Hepatitis virus test,Urine test,or MRCP.Question
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