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Hepatic And Post-hepatic Jaundice

Hepatic And Post-hepatic Jaundice. Sonal Pruthi Roll Number - 82. Hepatic Jaundice. Defective Hepatic Uptake Abnormal Conjugation Hepatocellular Damage. Gilbert’s Syndrome Drugs Rifampicin Novobiocin Probenecid. Criggler Najjar Syndrome Viral Hepatitis Drugs Primaquine Novobiocin

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Hepatic And Post-hepatic Jaundice

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  1. Hepatic And Post-hepatic Jaundice Sonal Pruthi Roll Number - 82

  2. Hepatic Jaundice • Defective Hepatic Uptake • Abnormal Conjugation • Hepatocellular Damage • Gilbert’s Syndrome • Drugs • Rifampicin • Novobiocin • Probenecid • CrigglerNajjar Syndrome • Viral Hepatitis • Drugs • Primaquine • Novobiocin • Pregnanediol • Chloramphenicol Viral HepatitisAlcoholic HepatitisDrug Induced HepatitisAutoimmune hepatitisToxic Hepatitis

  3. Viral Hepatitis

  4. Hepatitis A

  5. HBV DNA HBsAg Total Anti-HBc IgM Anti-HBc Anti-HBe Anti-HBs HBeAg Hepatitis B

  6. HBV DNA

  7. HBsAg

  8. HBeAg

  9. Total Anti - HBc

  10. IgM-Anti HBc

  11. Hepatitis C

  12. Clinical Features- Hepatic Jaundice • Icterus • Spider telangiectasia • Asterixis • Palmar erythema • Fetor hepaticus • Gynaecomastia • Testicular atrophy • Ascites

  13. Obstructive Jaundice • Bile duct strictures • Common duct stone. • Periampullary carcinoma • Intrahepatic Cholestasis • Extrahepatic Cholestasis • PrimiaryBiliary Cirrhosis • Primary SclerosingCholangitis • Dubin Johnson Syndrome • Rotor’s Syndrome • BRIC • PFIC • Drugs - phenothiazines

  14. 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

  15. Periampullary Carcinoma • CBD • Duodenum • Ampulla • Pancreas

  16. 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

  17. Investigations

  18. Enzymes that reflect damage to hepatocytes • ALT and AST – Raised ALT specific for liver injury ALT>1000 IU/L - suggestive of Hepatocellular injuryAST:ALT > 2:1 Suggestive of ALD AST:ALT < 1 Suggestive of viral hepatitis

  19. Enzymes that reflect Cholestasis • Alkaline Phosphatase – Raised • large bile duct obstruction • Intrahepaticcholestasis • Gamma Glutamyltransferase • more sensitive marker for cholestasis as compared to ALT

  20. 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

  21. 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

  22. A 40-year-old white female complains of pruritus. • She has an elevated alkaline phosphatase and positive antimitochondrial antibody test. CHOOSE 1 DISEASE PROCESS

  23. 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

  24. 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

  25. 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

  26. THANK YOU

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