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JaundiceDefinitionDefinition：：jaundice,oricterusreferstotjaundice,oricterusreferstotheyellowappearanceoftheskin,scleralanheyellowappearanceoftheskin,scleralandmucousmembranesresultingfromanindmucousmembranesresultingfromanincreasedbilirubinconcentrationinthebodycreasedbilirubinconcentrationinthebodyfluids.fluids.ClassificationClassificationHemolyticJaundiceHemolyticJaundiceHepatocellularJaundiceHepatocellularJaundiceCholestaticJaundiceCholestaticJaundiceCongenitalJaundiceCongenitalJaundice1.DependingonEtiology1.DependingonEtiologyClassificationClassificationUnconjugatedbilirubinincreasedjaundiUnconjugatedbilirubinincreasedjaundiceceConjugatedbilirubinincreasedjaundiceConjugatedbilirubinincreasedjaundice2.Dependingon2.DependingonbilirubinEtiologyEtiology1.Congenitalhemolyticanemia1.Congenitalhemolyticanemia2.P2.Posteriorityacquiredhemolyticanemia(autoimmunityosteriorityacquiredhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,hemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism)posttransfusionhemolytic,Favism)..MechanismMechanismAlargenumberoferythrocytedestroyedrapidlyAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismAnemia,hypoxiaandtoxityoferythocytemetabolismproductsproducts1.HemolyticJaundiceClinicalManifestationClinicalManifestationMildjaundice,lightlemon,noskinitch.Mildjaundice,lightlemon,noskinitch.Acutehemolytis:fever,chill,headache,vomit,backachAcutehemolytis:fever,chill,headache,vomit,backache,anemia,acuterenalfailure.e,anemia,acuterenalfailure.Chronichemolysis:anemiaandsplenomegaly.Chronichemolysis:anemiaandsplenomegaly.2.HepatocellularJaundice2.HepatocellularJaundiceEtiologyEtiologyHepatocytedamage.Hepatocytedamage.MechanismMechanismImpairhepatocyteuptaking,conjugatingandexcrImpairhepatocyteuptaking,conjugatingandexcretingbilirubinetingbilirubinClinicalManifestationClinicalManifestationSkinandmucosa:lighttodeepyellow,mildskinSkinandmucosa:lighttodeepyellow,mildskinitchitchTired,lossofappetiteTired,lossofappetiteHemorrhagictendency,ascites,coma.Hemorrhagictendency,ascites,coma.PrimarydiseasemanifestationPrimarydiseasemanifestation3.CholestaticJaundice3.CholestaticJaundiceEtiologyEtiologyVirushepatitis,drugcaused,drughepatitis,primarybiliarycirrhosis.Virushepatitis,drugcaused,drughepatitis,primarybiliarycirrhosis.Obstructionofextrahepaticbileduct:narrow,obstruction,stone,inflammation,tumor.Obstructionofextrahepaticbileduct:narrow,obstruction,stone,inflammation,tumor.MechanismMechanismObstructioncausessmallbileductandbilecapillarybroken,conjugatedbilirubinrefluxtoObstructioncausessmallbileductandbilecapillarybroken,conjugatedbilirubinrefluxtoblood.blood.ClinicalfeaturesClinicalfeaturesSkindarkyellow,yellowgreen.Skindarkyellow,yellowgreen.Skinitch,bradycardia,darkyellowofSkinitch,bradycardia,darkyellowofurine,feceslightyelloworclaycolor.urine,feceslightyelloworclaycolor.4.CongenitalNonhemolyticJaundice4.CongenitalNonhemolyticJaundiceDuetothedeficiencyofthehepatocyteinDuetothedeficiencyofthehepatocyteinuptaking,conjugatingandexcretingbiliruuptaking,conjugatingandexcretingbilirubin.bin.AccessoryExaminationAccessoryExamination1.Ultrasound1.Ultrasound2.Xray2.Xray3.ERCP3.ERCP4.PTC4.PTC5.CT5.CT6.MRI6.MRI7.RadioNuclideExamination7.RadioNuclideExamination8.LiverBiopsyandLC8.LiverBiopsyandLCAccompanyingSymptomsAccompanyingSymptoms1.1.Fever:acutecholangitis,liverabscess,leptospirosisFever:acutecholangitis,liverabscess,leptospirosis((钩端螺旋体病钩端螺旋体病),),septicemiasepticemia（败血症）（败血症）,lobarpneumonia,virushe,lobarpneumonia,virushepatitis,acutehemolysis.patitis,acutehemolysis.AccompanyingSymptomsAccompanyingSymptoms2.Upperabdominalsharppain:biliarycalculi,liverabsc2.Upperabdominalsharppain:biliarycalculi,liverabscess.ess.Rightupperabdominalsharppain,chill,highfever,jaRightupperabdominalsharppain,chill,highfever,jaundice.undice.3.3.HepatomegalyHepatomegaly①①Mildormoderate,softormoderatehard,Mildormoderate,softormoderatehard,smoothsurface.smoothsurface.②②Obviousenlargement,hard,raggedsurface.Obviousenlargement,hard,raggedsurface.4.4.Gallbladderenlargement:commonbileductobGallbladderenlargement:commonbileductobstruction,pancreasheadcarcinoma,commonstruction,pancreasheadcarcinoma,commonbileductcarcinoma.bileductcarcinoma.5.5.SplenomegalySplenomegaly6.6.Ascite:serioushepatitisAscite:serioushepatitisJaundiceisacommonsymptomandsigninclinicalwork,gettoknowthemechanismcanhelpusidentifydifferentkindsofjaundices.Hemolyticjaundiceisduetotherapidlydestroyederythrocyte,sotheUCB(Unconjugatedbilirubin)increased.Hepatocellularjaundicereferstouptaking,conjugatingandexcretingbilirubin,sobothCBandUCBincreased.Cholestaticjaundiceduetotheobstructionofbiletrack,sotheCBincreasedandurinebilirubinpositive.SummaryThankYou!ThankYou!