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1、JaundiceGastroenterologyDepartment,FirstAffiliatedHospitalofChongqingMedicalUniversityBingqiangZhangAimsandDemands1.Grasptheconceptofjaundice,clinicalmanifestationandpointsofinquisition2.Familiartheetiologyandmechanismofjaundice3.RealizenormalbilirubinmetabolismDefini
2、tion：jaundice,oricterusreferstotheyellowappearanceoftheskin,scleralandmucousmembranesresultingfromanincreasedbilirubinconcentrationinthebodyfluids.Totalbilirubin:1.7-17.1μmol/LConjugatedbilirubin:0-3.42μmol/l，Unconjugatedbilirubin:1.7-13.68μmol/l.LiverAlbuninHemeFerro
3、hemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteFerrohemeEnzyme15%~20%Bilirubin
4、AlbuminErythrocyte80%~85%UDPUDPGABilirubinglucuronol
5、actoneurobilinogenEnterohepaticcirculationY/ZproteincathepsinErythrocyteNormalbilirubinmetabolismNormalbilirubinmetabolismClassification1.DependingonEtiologyHemolyticJaundiceHepatocellularJaundiceCholestaticJaundiceCongenitaljaundice2.DependingonbilirubinUnconjungated
6、bilirubingincreasedjaundiceConjungatedbilirubingincreasedjaundiceEtiology1.Congenitalhemolyticanemia(thalassemia,hereditaryspherocytosis).2.Posteriorityacquiredhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism).Mecha
7、nismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts1.HemolyticJaundiceHaemolyticJaundicemechanismClinicalManifestationMildjaundice,lightlemon,noskinitch.Acutehemolytis:fever,chill,headache,vomit,backache,anemia,hemoglobin
8、uria(darksauceortea),acuterenalfailure.Chronichemolysis:anemiaandsplenomegaly.LaboratoryExamination1.SerumTB↑,UCB↑,CBnormal.2.UCB↑→intestinalCB↑→faecalcolordeepen.3.IntestinalUrobilinogen↑→urinaryUrobilinogen↑.4.Acutehemolytis,occultbloodtest(+).5.Bloodtest:anemia,ret
9、iculocyte↑,erythacyteproliferation↑.2.HepatocellularJaundiceEtiologyHepatocytedamage.MechanismImpairhepatocyteuptakeing,conj
