Differencial Diagnosis of di andi ce Zhang ghunesli Department ofGstroenterology, Zhongshan Hospitall
Differencial Diagnosis of Jaundice Zhang shuncai Department of Gastroenterology, Zhongshan Hospital
Summarization Definition: serum total bilirubin(STB)> 34umoI/L, causing a yellow color of skin sclera and tissue fluid Latent icterus. an increase of stb but not more than 34umoI/L, without color changes of skin and scIera False jaundice: yellow skin and sclera but without hyperbilirubinemia, due to ingestion of some drugs and foods
Summarization • Definition: serum total bilirubin (STB) > 34µmol/L, causing a yellow color of skin, sclera and tissue fluid • Latent icterus: an increase of STB but not more than 34µmol/L, without color changes of skin and sclera • False jaundice: yellow skin and sclera but without hyperbilirubinemia, due to ingestion of some drugs and foods
Metabolism of bilirubin Source of bilirubin Transport of bilirubin absorbed by hepatocytes Conjugation of bilirubin Excretion of bilirubin
Metabolism of Bilirubin • Source of bilirubin • Transport of bilirubin • Absorbed by hepatocytes • Conjugation of bilirubin • Excretion of bilirubin
Source of bilirubin Senile red blood cell(rBC) 80-85 RBCS lifetime: about 120 days Immature rBc 10-15% Others 1-5%. like free heme in liver and some proteins containing heme
Source of Bilirubin • Senile red blood cell (RBC) 80~85 % RBC’s lifetime: about 120 days • Immature RBC 10~15% • Others 1~5%, like free heme in liver and some proteins containing heme
Transport of Bilirubin Characteristic of free bilirubin x Unconjugated with glucuronate transferase x Undissolvable x Poisonous to biotic membrane which contains phospholid Transport formation Conjugated with albumin forming albumin-bilirubin complex, and transport to hepatocyte
Transport of Bilirubin • Characteristic of free bilirubin: Unconjugated with glucuronate transferase Undissolvable Poisonous to biotic membrane which contains phospholid • Transport formation: Conjugated with albumin forming albumin-bilirubin complex, and transport to hepatocyte