Jaundice or icterus is
pigmentation of yellow as a effect of hyperbilirubinemia and precipitation of
bile pigment in blood stream so that can causing change of colour at skin,
sclera, mucosa membrane, and excretion.
Rate of bilirubin serum is normal 0,3 - 1 mg / dl, and
icterus usually appear if rate of bilirubin serum reach 2 - 3 mg / dl. Cause of
icterus relate to dysfunction at metabolism of bilirubin ( process of forming,
transportation, absorption, conjugation, and excretion ) as a effect of abnormality
of congenital, infection, trauma, tumor, stone, and disease of degenerative.
Dysfunction at metabolism of bilirubin can happened through one of fourth of mechanism as follow :
1. Over production.
The increase level of haemoglobin that be released erythrocyte which have old or experienced of hemolysis will increase production bilirubin. This matter most often as a effect hemolysis of intravascular ( abnormality of autoimmune, hemoglobinopati or microangiopati ) or as effect resorbtion of hematom so that icterus which appear often be referred icterus of hemolytic. Some cause icterus of hemolytic include abnormal haemoglobin ( sickle cell anemia ), abnormality of erythrocyte ( sferositosis hereditary ), antibody serum ( Rh. Incompatibilities transfusion), and certain drug.
2. The decrease of intake hepatic.
Intake bilirubin unconjugation through dissociation of albumin and bind with protein of receiver. Some drug such as flavaspidat acid, novobiosin can influence this uptake.
3. Decrease of conjugation hepatic.
Dysfunction of conjugation bilirubin so that happened increase of bilirubin unconjugation. This matter caused by deficiencies at enzyme of glucoronil transferase.
4. Decrease of excretion bilirubin into bile.
Dysfunction at excretion bilirubin can be caused abnormality of intrahepatic or mechanic obstruction of extrahepatic, this matter depended excretion of bilirubin conjugation by hepatosit will generate entry of return bilirubin into systematical circulation so that appear hiperbilirubinemia. Abnormality of hepatoceluler can relate to reaction of drug, alcoholic hepatitis, icterus at last trimester of pregnancy, and icterus post surgical. Obstruction of bilier extrahepatic will generate hiperbilirubinemia conjugation be accompanied bilirubinuria. Obstruction of bilier extrahepatic occur total and partial. Total obstruction can be accompanied feces that alcoholic. Cause most often obstruction of bilier extrahepatic are gallstone under choledocus ductus, carcinoma caput pancreas, carcinoma ampula vateri, and stricture post inflammation or surgical.
Symptoms of jaundice include xantelasma, coloring of yellow at skin, pruritus, excoriation, symptoms of cirrhosis hepatic ( spider nevi, ascites, hepatosplenomegali, ratio of albumin and globulin inverse, venectation, hematemesis, erythema palmaris, and gynecomasty ), symptoms of right heart failure ( edema at foot, hypertrophies ventricle right, pulsation epigastrium, and hepatojugular reflux gallop )
Type of jaundice :
1. Acholuric jaundice.
Icterus without bilirubinuria that relate to increase of bilirubin unconjugation that fail be excreted renal.
2. Cholestatic jaundice.
Icterus as a effect of bile stream in liver abnormal.
3. Hemolytic jaundice.
Icterus as a effect of increase form bilirubin from hemoglobin so that causes acceleration at degradation of erythrocyte.
4. Retention jaundice.
Icterus which be caused disability of liver for excreting bilirubin.
5. Hepatocelular jaundice.
Icterus which be caused trauma or disease of liver.
6. Obstructive jaundice.
Icterus which be caused obstruction of bile stream.
7. Physiologic jaundice.
Icterus neonatorum mild will lost in some day after born.
8. Breast milk jaundice.
Increase of bilirubin unconjugation at baby be caused existence of 5-beta-pregnant-3-beta-20-beta-diol from milk of mother that can inhibit activity of conjugation glucoronil tranferase and as a causes of dehydration.
Dysfunction at metabolism of bilirubin can happened through one of fourth of mechanism as follow :
1. Over production.
The increase level of haemoglobin that be released erythrocyte which have old or experienced of hemolysis will increase production bilirubin. This matter most often as a effect hemolysis of intravascular ( abnormality of autoimmune, hemoglobinopati or microangiopati ) or as effect resorbtion of hematom so that icterus which appear often be referred icterus of hemolytic. Some cause icterus of hemolytic include abnormal haemoglobin ( sickle cell anemia ), abnormality of erythrocyte ( sferositosis hereditary ), antibody serum ( Rh. Incompatibilities transfusion), and certain drug.
2. The decrease of intake hepatic.
Intake bilirubin unconjugation through dissociation of albumin and bind with protein of receiver. Some drug such as flavaspidat acid, novobiosin can influence this uptake.
3. Decrease of conjugation hepatic.
Dysfunction of conjugation bilirubin so that happened increase of bilirubin unconjugation. This matter caused by deficiencies at enzyme of glucoronil transferase.
4. Decrease of excretion bilirubin into bile.
Dysfunction at excretion bilirubin can be caused abnormality of intrahepatic or mechanic obstruction of extrahepatic, this matter depended excretion of bilirubin conjugation by hepatosit will generate entry of return bilirubin into systematical circulation so that appear hiperbilirubinemia. Abnormality of hepatoceluler can relate to reaction of drug, alcoholic hepatitis, icterus at last trimester of pregnancy, and icterus post surgical. Obstruction of bilier extrahepatic will generate hiperbilirubinemia conjugation be accompanied bilirubinuria. Obstruction of bilier extrahepatic occur total and partial. Total obstruction can be accompanied feces that alcoholic. Cause most often obstruction of bilier extrahepatic are gallstone under choledocus ductus, carcinoma caput pancreas, carcinoma ampula vateri, and stricture post inflammation or surgical.
Symptoms of jaundice include xantelasma, coloring of yellow at skin, pruritus, excoriation, symptoms of cirrhosis hepatic ( spider nevi, ascites, hepatosplenomegali, ratio of albumin and globulin inverse, venectation, hematemesis, erythema palmaris, and gynecomasty ), symptoms of right heart failure ( edema at foot, hypertrophies ventricle right, pulsation epigastrium, and hepatojugular reflux gallop )
Type of jaundice :
1. Acholuric jaundice.
Icterus without bilirubinuria that relate to increase of bilirubin unconjugation that fail be excreted renal.
2. Cholestatic jaundice.
Icterus as a effect of bile stream in liver abnormal.
3. Hemolytic jaundice.
Icterus as a effect of increase form bilirubin from hemoglobin so that causes acceleration at degradation of erythrocyte.
4. Retention jaundice.
Icterus which be caused disability of liver for excreting bilirubin.
5. Hepatocelular jaundice.
Icterus which be caused trauma or disease of liver.
6. Obstructive jaundice.
Icterus which be caused obstruction of bile stream.
7. Physiologic jaundice.
Icterus neonatorum mild will lost in some day after born.
8. Breast milk jaundice.
Increase of bilirubin unconjugation at baby be caused existence of 5-beta-pregnant-3-beta-20-beta-diol from milk of mother that can inhibit activity of conjugation glucoronil tranferase and as a causes of dehydration.
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