黄疸英文版本培训课件

1、黄疸英文版本黄疸英文版本Aims and Demands1. Grasp the concept of jaundice, clinical manifestation and points of inquisition2. Familiar the etiology and mechanism of jaundice3. Realize normal bilirubin metabolism黄疸英文版本2Aims and Demands黄疸英文版本2Definition：jaundice,or icterus refers to the yellow appearance of the sk

2、in,scleral and mucous membranes resulting from an increased bilirubin concentration in the body fluids. Total bilirubin: 1.7-17.1mol/LConjugated bilirubin:0-3.42mol/l，Unconjugated bilirubin:1.7-13.68mol/l.黄疸英文版本3Definition：jaundice,or icterusLiverAlbuninHemeFerrohemetransferase BilirubinConjugated b

3、ilirubinKidneyUrobilinStercobilinogenUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidase BiliverdinMarrowInfantility ErythrocyteFerroheme Enzyme15%20%Bilirubin |AlbuminErythrocyte80%85%UDPUDPGABilirubin glucuronolactoneurobilinogenEnterohepatic circulation Y/Z protein cathepsi

4、n Erythrocyte Normal bilirubin metabolism黄疸英文版本4LiverAlbuninHemeFerrohemetransNormal bilirubin metabolism黄疸英文版本5Normal bilirubin metabolism黄疸英Classification1. Depending on EtiologyHemolytic JaundiceHepatocellular JaundiceCholestatic JaundiceCongenital jaundice 2. Depending on bilirubinUnconjungated

5、bilirubing increased jaundiceConjungated bilirubing increased jaundice黄疸英文版本6Classification1. Depending on Etiology1.Congenital hemolytic anemia (thalassemia,hereditary spherocytosis).2.Posteriority acquired hemolytic anemia (autoimmunity hemolytic anemia, hemolytic disease of newborn, posttransfusi

6、on hemolytic, Favism).MechanismA large number of erythrocyte destroyed rapidlyAnemia,hypoxia and toxity of erythocyte metabolism products1.Hemolytic Jaundice黄疸英文版本7Etiology1.Hemolytic Jaundice黄疸Haemolytic Jaundice mechanism黄疸英文版本8Haemolytic Jaundice mechanism黄Clinical Manifestation Mild jaundice,lig

7、ht lemon,no skin itch.Acute hemolytis: fever,chill,headache,vomit,backache,anemia, hemoglobinuria( dark sauce or tea), acute renal failure.Chronic hemolysis:anemia and splenomegaly.黄疸英文版本9Clinical Manifestation 黄疸英文版本9Laboratory Examination 1.Serum TB,UCB,CB normal.2.UCBintestinal CBfaecal color dee

8、pen.3.Intestinal Urobilinogenurinary Urobilinogen.4.Acute hemolytis, occult blood test (+).5.Blood test:anemia, reticulocyte,erythacyte proliferation. 黄疸英文版本10Laboratory Examination 黄疸英文版本12.Hepatocellular JaundiceEtiologyHepatocyte damage.MechanismImpair hepatocyte uptakeing,conjugating and excreti

9、ng bilirubin, UCBCB reflux into blood, serum CBjaundice.黄疸英文版本112.Hepatocellular JaundiceEtiolHepatocellular Jaundice mechanism黄疸英文版本12Hepatocellular Jaundice mechanClinical Manifestation Skin and mucosa:light to deep yellow, mild skin itchTired,loss of appetitehemorrhagic tendency,ascites,coma.Prim

10、ary disease manifestation黄疸英文版本13Clinical Manifestation 黄疸英文版本1黄疸英文版本培训课件 3.Cholestatic JaundiceEtiologyObstruction in liver:virus hepatitis,drug caused,drug hepatitis, primary biliary cirrhosis.Obstruction of Extrahepatic bile duct:narrow, obstruction,stone, inflammtory,tumor.MechanismObstruction c

11、auses small bile duct and bile capillary broken, conjugated bilirubin reflux to blood.Failure of hepatocyte excreting CB,bilirubin deposit and bile thrombus formation.黄疸英文版本15 3.Cholestatic JaundiceEtCholestatic Jaundice mechanism黄疸英文版本16Cholestatic Jaundice mechanismClinical featuresSkin dark yello

12、w,yellow green.Skin itch, bradycardia,dark yellow of urine,facal light yellow or clay color. Courvoisiers sign.黄疸英文版本17Clinical features黄疸英文版本17Laboratory Examination Serum CBUrine bilirubin (+)Urobilinogen , stercobilin or absenceSerum alkaline phosphatase and Cholesterol黄疸英文版本18Laboratory Examinat

13、ion 黄疸英文版本1Three kinds of jaundice laborotory examination indentification Class Haemolytic Hepatocellular Cholestatic TB increased(UCB) increased increased CB normal increased markedly increased CB/TB 15一20 30一40 50一60 urine bilirubin 十 十十 urobilinogen increased slight increased decreased or absence

14、 ALT、AST normal markedly increased may increased ALP normal increased markedly increased r-GT normal increased markedly increased PT normal delayed delayed Vit K respond no poor good Cholesterol normal slight increased or decreased markedly increased Serum protein normal Alb decreased,Glob increased

15、 normal黄疸英文版本19Three kinds of jaundice laboro4.Congenital Nonhemolytic Jaundice Due to the deficiency of the hepatocyte in uptakeing,conjugating and excreting bilirubinUncommon黄疸英文版本204.Congenital Nonhemolytic Jaun1.Gilber syndrome:hepatocyte uptaking UCB abnormal, deficiency of glucuronyl transfera

16、se, UCB jaundice (no symptom,liver function normal).2.Dubin-Johnsons syndrome:abnormal of Hepatocyte excreting CB and some anion to bile capillary CB jaundice.3.Crigler-Najjars syndrome:absence of glucuronyl transferase in hepatocyte, UCB cant be transfered to CB，serum UCBjaundice,UCBnuclear jaundic

17、, newborn,poor prediction.4.Rotors syndrome:deficiency of Hepatocyte uptaking UCB and excreting CB,bilirubinjaundice.黄疸英文版本211.Gilber syndrome:hepatocyte uAccessory Examination 1.Ultrosound2.X ray3.ERCP(Endoscopic retrograde cholangiopancreatography)4.PTC(Percutaneous transheptic cholangiography)5.C

18、T(Computed tomography)6.MRI(Magnetic resonance cholangiopancreatography)7.Radio Nuclide Examination8.Liver Biopsy and LC(Laparoscopy)黄疸英文版本22Accessory Examination 1.UltroAccompanying Symptoms Fever:acute cholangitis,liver abscess, leptospirosis, septicemia, lobar pneumonia.Fever then jaundice:virus

19、hepatitis,acute hemolysis.Upper abdominal sharp pain:biliary calculi,liver abscess, biliary ascariasis, Right upper abdom sharp pain,chill, high fever,jaundice, Charcot triad sign:acute pyogenic cholangitis, Sustained right upper abdominal blur or swell pain:virus hepatitis,liver abscess,primary car

20、cinoma of liver黄疸英文版本23Accompanying Symptoms Fever:acHepatomegaly Mild or moderate,soft or moderate hard,smooth surface:Virus hepatitis,acute infection of biliary tract.obstruction of biliary tract Obvious enlargement, hard, ragged surface:primary or secondary carcinoma of liver. Not obvious enlarge

21、ment,hard,edge not tidy,nodule on the surface:cirrosis.黄疸英文版本24Hepatomegaly黄疸英文版本24Gallbladder enlargement:common bile duct obstruction, pancrease head carcinoma,common bile duct carcinoma, carcinoma of ampulla.Splenomegaly:virus hepatitis,leptospirosis, septicemia, Malaria,biliary cirrhosis,hemolyt

22、ic anemia,lymphoma.Acite:serious hepatitis,decompensation of cirrosis, carcinoma of liver.黄疸英文版本25Gallbladder enlargement:commonInterrogatoire Points1.Assure jaundice2.Etiology and onset 3.Accompany syndrome4.Time and fluctuation of jaundice5.Influnce to the overall healthIn one word: make sure the

23、type of jaundice then find the pathogeny黄疸英文版本26Interrogatoire Points1.AssureRecognise jaundice Position：sclera,skin and tongue sleeves Pseudojaundice:eat Carotene food(Carotene,pumpkin, tomato,orange)also can cause skin stained yellow,but bilirubin is not increased. Old people fat accumulation at bulbar conjunctiva，yellow,uneven distribution黄疸英文版本27Recognise jaundice黄疸英文版本27Jaundice is a common symptom and sign in clinical work, get to know the mechanism can help us identi