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1、JaundiceGastroenterologyDepartment,FirstAffiliatedHospitalofChongqingMedicalUniversityBingqiangZhangAimsandDemands1.Grasptheconceptofjaundice,clinicalmanifestationandpointsofinquisition2.Familiartheetiologyandmechanismofjaundice3.Realizenormalbilirubinm
2、etabolismDefinition：jaundice,oricterusreferstotheyellowappearanceoftheskin,scleralandmucousmembranesresultingfromanincreasedbilirubinconcentrationinthebodyfluids.Totalbilirubin:1.7-17.1μmol/LConjugatedbilirubin:0-3.42μmol/l，Unconjugatedbilirubin:1.7-13.
3、68μmol/l.LiverAlbuninHemeFerrohemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteFerrohemeEnzyme15%~20%Bilirubin
4、Albumin
5、Erythrocyte80%~85%UDPUDPGABilirubinglucuronolactoneurobilinogenEnterohepaticcirculationY/ZproteincathepsinErythrocyteNormalbilirubinmetabolismNormalbilirubinmetabolismClassification1.DependingonEtiologyHemolyticJaundiceHepatocellularJaundiceCholestaticJ
6、aundiceCongenitaljaundice2.DependingonbilirubinUnconjungatedbilirubingincreasedjaundiceConjungatedbilirubingincreasedjaundiceEtiology1.Congenitalhemolyticanemia(thalassemia,hereditaryspherocytosis).2.Posteriorityacquiredhemolyticanemia(autoimmunityhemol
7、yticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism).MechanismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts1.HemolyticJaundiceHaemolyticJaundicemechanismClinicalManifestationMildjaundice,
8、lightlemon,noskinitch.Acutehemolytis:fever,chill,headache,vomit,backache,anemia,hemoglobinuria(darksauceortea),acuterenalfailure.Chronichemolysis:anemiaandsplenomegaly.LaboratoryExamination1.SerumTB↑,UCB↑,CBnormal.2.UCB↑→intestinalCB↑→faecalcolordeepen.
9、3.IntestinalUrobilinogen↑→urinaryUrobilinogen↑.4.Acutehemolytis,occultbloodtest(+).5.Bloodtest:anemia,reticulocyte↑,erythacyteproliferation↑.2.HepatocellularJaundiceEtiologyHepatocytedamage.MechanismImpairhepatocyteuptakeing,conj
