Liver Pathology

A. Jaundice 1. General a. Clinical jaundice occurs with bilirubin levels >2-3 mg/dl b. Classic presentation: yellow skin (jaundice) and sclera (icterus)

c. Causes of jaundice i. Overproduction of bilirubin ii. Defective hepatic bilirubin uptake iii. Defective conjugation jv. Defective excretion

Table 18-1. Unconjugated Versus Conjugated Bilirubinemia

Unconjugated (Indirect) Bilirubinemia

Conjugated (Direct) Bilirubinemia

Increased RBC turnover (hemolytic anemias)

Biliary tract obstruction

Physiologic (newborn babies)

Biliary tract disease (PSC and PBC)

Hereditary (Gilbert and Crigler-syndromes)

Hereditary (Dubin-Johnson and Najjar Rotor syndromes)

Liver disease (cirrhosis and hepatitis)

2. Increased RBC turnover a. RBCs are the major source of bilirubin b. Etiology i. Hemolytic anemia ii. Ineffective erythropoiesis (thalassemia, megaloblastic anemia, etc.)

c. Lab: increased unconjugated bilirubin d. Chronic hemolytic anemia patients often develop pigmented bilirubinate gallstones

3. Physiologic jaundice of the newborn a. Definition: transient unconjugated hyperbilirubinemia due to the immaturity of the Ever b. Risk factors i. Prematurity ii. Hemolytic disease of the newborn (erythroblastosis fetalis)

c. Complication: kernicterus d. Treatment: phototherapy

Clinical Correlate

In infants, increased levels of unconjugated bilirubin (lipid-soluble) may cross the blood-brain barrier and deposit in the basal ganglia, causing irreversible brain damage (kernicterus).

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