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 diglucuronideBILEAlb=albuminB=bilirubinGST=glutathione-S-transferaseUDPGA=uridi
2、ne diphosphoglucuronic acid;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-glucoronidasebacteriabacteria
3、BileEnterohepatic circulationKidneyUrobilinoxUrobilinogenUrobilinStercobilinStercobilingogenfecesUrineoxLiverAlbuninHemeFerrohemetransferase BilirubinConjugated bilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidase BiliverdinMarrowInfantilit
4、y ErythrocyteFerroheme Enzyme15%20%Bilirubin|AlbuminErythrocyte80%85%UDP UDPGABilirubin glucuronolactoneurobilinogenEnterohepatic circulation Y/Z protein cathepsin ErythrocyteBiochemical change of Normal bilirubin metabolism2.Depending on bilirubinnUnconjungated bilirubin increased jaundicenConjunga
5、ted bilirubin increased jaundice3.1.Hemolytic JaundiceHemolytic Jaundice mechanismHepatocellular Jaundice mechanismCholestatic Jaundice mechanismA.Hemolytic anemiaexcess hemolysis unconjugated bilirubin (in blood)conjugated bilirubin (released to bile duct)UB UrobilinogenB.Hepatitis unconjugated bil
6、irubin (in blood)conjugated bilirubin (in blood)UB UrobilinogenC.Biliary duct stone unconjugated bilirubin (in blood)conjugated bilirubin (in blood)UB Urobilinogen 5.Genetic Disorders of Bilirubin Metabolism(Endoscopic retrograde cholangiopancreatography,逆行胰胆管造影)(Percutaneous transheptic cholangiogr
7、aphy,经皮肝穿刺胆管造影)(Computed tomography(Magnetic resonance cholangiopancreatography)(Laparoscopy，腹腔镜)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
