GI SYMPTOMS
GI SYMPTOMS
Jaundice
Jaundice refers to yellowing of skin, sclerae and mucosa from Plasma Bilirubin.Jaundice is manifestation of liver infection, which show as yellowish staining of pee and eyes.
Finding is affirmed by performing liver capacity test (blood test).
It is classified by the site of the problem
- Prehepatic
- Hepato Cellular
- Cholestatic / Obstructive
By the type of Circulating Bilirubin
- Conjugated
- Unconjugated
UnConjugated Hyperbdirubinaemia
Causes
- If Unconjugated bilirubin is water- Unsoluble, it does not enter urine , resulting in unconjugated hyper bilirubinaemia
- Overproduction – Hemolysis , ineffective aythropoiesis
- Impaired Hepatic Uptake –
Drugs (PCM, Refampicin)
Lschemic Hepatitis.
Impaired Conjugation :- Gelbertis higher Najgar Syndrome
Physiological Jaundice
Conjugated Hyperbdirubinaemia
Causes
- As Conjugated bilirubin is water soluble.It is encreated in Urine , making it dark
- Less Conjugated bilirubin enters the gut and faces becomes pale.When severe it can be associated with an intract able druritis which is best treated relief by the obstruction.
Hepato Cellular Dysfunction
There is hepatocyte damage, usually with some cholestasis.
Causes
- Hepatitis, CMV, EBV
- Drugs
- Alcohol : Cirrohosis
- Septicaemia
- Ceptospurosis
- Syphillis
- A-1 Antitrypsin Def
- Budd Chiari
- Wilson disease
- Failure to encreate conjugated bilirubin : DJ, Rotor
Impaired Hepatic Excretion (Cholestasis)
- Primary Biliary Cholangitis
- Primary Sclerosing Cholangitis
- CBD Gall Stones, Pancreatic Cancer
- Compression of bile duct . Eg: LN at the porta hepatis
- Cholangiocarcinoma
- Choledochal Cyst
- Caroli Disease
- Minimize Syndrome
Obstructive jaundice from CBD compression by a gall stone impacted in the Cystic duct often associated with cholangitis.
Diagnosis
- Bilirubin is absent in Prehepatic Causes
- Urobilinogen is absent in Obstructive Jaundice
- CBC
- Dotting
- RC
- Urinanalysis
- Coomb’s and hepatoglobins, farhemolysis
- LFT
- R-GT
- Total Protein
- Albumin
- Hepatitis Serology
- Gall Stone
- Bile duct dilated
- Hepatic Metastases
- Pancreatic Mass
