Hepatic And Post-hepatic
Jaundice
Sonal Pruthi
Roll Number - 82
Hepatic Jaundice
• Defective Hepatic Uptake
•Gilbert’s
Syndrome
• Abnormal
Conjugation
•Drugs
•Criggler
Najjar Syndrome
•Rifampicin
• Hepatocellular
Damage
•Viral
Hepatitis
•Novobiocin
•Drugs
•Probenecid
•Primaquine
•Novobiocin Viral Hepatitis
•PregnanediolAlcoholic Hepatitis
Drug Induced Hepatitis
•Chloramphenicol
Autoimmune hepatitis
Toxic Hepatitis
•Hepatitis A
•Hepatitis B
Viral
•Hepatitis D
Hepatitis
•Hepatitis C
•Hepatitis E
•EBV
•CMV
Hepatitis A
HBV DNA
HBsAg
Total Anti-HBc
IgM Anti-HBc
Anti-HBe
Anti-HBs
HBeAg
Hepatitis B
HBV DNA
HBsAg
HBeAg
Total Anti - HBc
IgM-Anti HBc
Hepatitis C
Clinical Features- Hepatic Jaundice
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•
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•
•
•
•
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Icterus
Spider telangiectasia
Asterixis
Palmar erythema
Fetor hepaticus
Gynaecomastia
Testicular atrophy
Ascites
Obstructive Jaundice
•Bile
duct strictures Cholestasis
• Intrahepatic
•Common duct stone.
•Primiary Biliary Cirrhosis
•Periampullary carcinoma
•Primary Sclerosing Cholangitis
•Dubin Johnson Syndrome
•Rotor’s Syndrome
•BRIC
•PFIC
••Drugs
Extrahepatic
Cholestasis
- phenothiazines
Gall bladder Stone
The majority of cases
(approximately 80%)are
asymptomatic (silent) gall
stones , discovered accidentally
by abdominal sonar .
Obstruction of common
bile duct leading to pain &
jaundice
Periampullary Carcinoma
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•
•
•
CBD
Duodenum
Ampulla
Pancreas
Clinical features - Obstructive
• Pain due to gallbladder disease, malignancy or
stretching of the liver capsule
• Fever due to ascending cholangitis
• Palpable and / or tender gallbladder
•
• Enlarged liver usually smooth
Investigations
Total Bilirubin
Conjugated
Bilirubin
Unconjugated
Bilirubin
Urobilinogen
Stercobilin
Hepatic
Increased
Increased
Post-hepatic
Increased
Increased
Increased
Normal
Increased
Decreased/
absent
Reduced/absent
Normal
Enzymes that reflect damage to hepatocytes
ALT and AST – Raised
ALT specific for liver injury
ALT>1000 IU/L - suggestive of Hepatocellular
injury
AST:ALT > 2:1
Suggestive of ALD
AST:ALT < 1
Suggestive of viral hepatitis
Enzymes that reflect Cholestasis
Alkaline Phosphatase – Raised
 large bile duct obstruction
 Intrahepatic cholestasis
Gamma Glutamyl transferase
 more sensitive marker for cholestasis as compared
to ALT
Investigations
 Prothrombin Time
 might be increased in cases of hepatic jaundice.
 Disorders that lead to Vitamin K deficiency
 Serum ANA and Anti Smooth Muscle
Antibody
 positive in patients with PBC
Clinical Vignette
Match the clinical description with the most
likely disease process.
• a. Primary biliary cirrhosis
• b. Sclerosing cholangitis
• c. Anaerobic liver abscess
• d. Hepatoma
• e. Hepatitis C
• f. Hepatitis D
• g. Hemochromatosis
• A 40-year-old white female complains of
pruritus.
• She has an elevated alkaline phosphatase and
positive antimitochondrial antibody test.
CHOOSE 1 DISEASE PROCESS
• A 70-year-old male with a long history of
diverticulitis has low-grade
• fever, elevated alkaline phosphatase, and right
upper quadrant pain.
CHOOSE 1 DISEASE PROCESS
A 30-year-old male with ulcerative colitis
develops jaundice, pruritus,and right upper
quadrant pain.
Liver biopsy shows an inflammatory obliterative
process affecting intrahepatic and
extrahepatic bile ducts.
CHOOSE 1 DISEASE PROCESS
• A 40-year-old white male complains of
weakness, weight loss, and abdominal pain.
• On examination, the patient has diffuse
hyperpigmentation, icterus and a palpable
liver edge. Polyarthritis of the wrists and hips
is also noted. Fasting blood sugar is 185
mg/dL. The most likely diagnosis is
• a. Insulin-dependent diabetes mellitus
• b. Pancreatic carcinoma
• c. Addison’s disease
• d. Hemochromatosis
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