Gallstone impacted in the neck or Hartmann's Pouch
Mirizzi syndrome
Having to do with the liver plus the gallbladder, bile ducts, or bile.
Hemoglobin metabolism
Hemoglobin Degradation
Porphyrin ring is opened by oxidation reaction that is
catalysed by the microsomal haem oxygenase, which requires
NADPH and O2.
The result of this reaction is linear biliverdin, Carbon
monoxide (CO) and release of Fe 3+.
Biliverdin (green) is reduced forming a red-orange bilirubin
Bilirubin is relatively insoluble this is why it binds
non covalently to albumin* to be transported to
the liver.
At the hepatocytes
Bilirubin dissociates from albumin and binds to an intracellular protein ligandin.
Microsomal bilirubin UDP-glucuronosyltransferase (bilirubin UGT)* conjugate bilirubin
to two molecules of glucuronic acid♠.
Jaundice
Prehepatic
Causes
Physiologic
Jaundice
hemolytic anemia
Gilbert syndrome
is a relatively mild condition characterized by periods of elevated levels
of a toxic substance called bilirubin in the blood (hyperbilirubinemia)
Criggler Naggar
Crigler–Najjar syndrome or CNS is a rare inherited disorder affecting the
metabolism of bilirubin, a chemical formed from the breakdown of the
heme in red blood cells.
High unconjugted bilirubin
Normal urine as there is no bilirubin(+++UBG )
Normal stool(+++UBG )
Liver enzymes are normal
conjugated bilirubin (<20%)
caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells).
Hepatic
Causes
Hepatitis
Hepatitis B signs and symptoms
variable fever
profound malaise
painful hepatomegaly
serum sickness prodrome
vasculitis
high levels of unconjugated bilirubin
dark urine due to high levels of Conjugated bilirubin
Stool color is normal
Liver enzymes are increased due to damage to the liver
+Conjugated Bilirubin (20-50%)
Treatment of HBV
Lamivudine
inhibits HBV DNA polymerase
In renal impairment , dose is adjusted
Entecavir
Guanosine monophosphate
inhibits HBV DNA polymerase
Pegylated interferons
Endogenous proteins
Polyethene glycol is added to make the drug last longer ( once weekly instead of 3 times a week)
Resistance to viruses
Inhibit proliferation
Inhibit multiplication of intracellular parasites
adefovir
Phosphorylated by cellular kinases (prodrug )
inhibits HBV DNA polymerase, causing chain termination
Nephrotoxicity, lactic acidosis (mitochondrial dysfunction) and hepatic steatosis