Yellow Eyes

Description

Mind Map on Yellow Eyes, created by Fatma Shwaylia on 04/03/2018.
Fatma Shwaylia
Mind Map by Fatma Shwaylia, updated more than 1 year ago
Fatma Shwaylia
Created by Fatma Shwaylia over 6 years ago
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Resource summary

Yellow Eyes
  1. hepatobiliary system
    1. The (hepato) part
      1. The (Biliary) part
        1. Gallstone impacted in the neck or Hartmann's Pouch
          1. Mirizzi syndrome
        2. Having to do with the liver plus the gallbladder, bile ducts, or bile.
        3. Hemoglobin metabolism
          1. Hemoglobin Degradation
            1. Porphyrin ring is opened by oxidation reaction that is catalysed by the microsomal haem oxygenase, which requires NADPH and O2.
              1. The result of this reaction is linear biliverdin, Carbon monoxide (CO) and release of Fe 3+.
                1. Biliverdin (green) is reduced forming a red-orange bilirubin
                  1. Bilirubin is relatively insoluble this is why it binds non covalently to albumin* to be transported to the liver.
                    1. At the hepatocytes
                      1. 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♠.
            2. Jaundice
              1. Prehepatic
                1. Causes
                  1. Physiologic Jaundice
                    1. hemolytic anemia
                      1. Gilbert syndrome
                        1. is a relatively mild condition characterized by periods of elevated levels of a toxic substance called bilirubin in the blood (hyperbilirubinemia)
                        2. Criggler Naggar
                          1. 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.
                          2. High unconjugted bilirubin
                            1. Normal urine as there is no bilirubin(+++UBG )
                              1. Normal stool(+++UBG )
                                1. Liver enzymes are normal
                              2. conjugated bilirubin (<20%)
                            2. caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells).
                            3. Hepatic
                              1. Causes
                                1. Hepatitis
                                  1. Hepatitis B signs and symptoms
                                    1. variable fever
                                      1. profound malaise
                                        1. painful hepatomegaly
                                          1. serum sickness prodrome
                                            1. vasculitis
                                              1. high levels of unconjugated bilirubin
                                                1. dark urine due to high levels of Conjugated bilirubin
                                                  1. Stool color is normal
                                                    1. Liver enzymes are increased due to damage to the liver
                                                  2. +Conjugated Bilirubin (20-50%)
                                                  3. Treatment of HBV
                                                    1. Lamivudine
                                                      1. inhibits HBV DNA polymerase
                                                        1. In renal impairment , dose is adjusted
                                                        2. Entecavir
                                                          1. Guanosine monophosphate
                                                            1. inhibits HBV DNA polymerase
                                                          2. Pegylated interferons
                                                            1. Endogenous proteins
                                                              1. Polyethene glycol is added to make the drug last longer ( once weekly instead of 3 times a week)
                                                                1. Resistance to viruses
                                                                  1. Inhibit proliferation
                                                                    1. Inhibit multiplication of intracellular parasites
                                                              2. adefovir
                                                                1. Phosphorylated by cellular kinases (prodrug )
                                                                  1. inhibits HBV DNA polymerase, causing chain termination
                                                                    1. Nephrotoxicity, lactic acidosis (mitochondrial dysfunction) and hepatic steatosis
                                                            2. immunization schedule
                                                              1. Recombinant HepB vaccines containing yeast-derived
                                                                1. HBsAg Recombivax-HER or Engerix-BR
                                                                  1. Day zero, day 30, 6 months (0-1-6)
                                                          3. liver inflammation
                                                          4. Posthepatic
                                                            1. Causes
                                                              1. Primary biliary cirrhosis
                                                                1. Dubin-Johnson
                                                                  1. Rotor’s syndrome
                                                                    1. Gall stones in CBD
                                                                      1. pancreas head cancer
                                                                        1. Primary sclerosing cholangitis
                                                                          1. Extrahepatic biliary atresia
                                                                            1. Liver flukes
                                                                              1. strictures
                                                                                1. high conjugated bilirubin (more than 50%)
                                                                                  1. dark urine due to high conjugated bilirubin
                                                                                    1. clay colored stoold due to absence of urobilinogen
                                                                                      1. Normal liver enzymes but high alkaline phosphate due to the bile duct obstruction
                                                                              2. a yellow discoloration of the skin, mucous membranes, and the whites of the eyes caused by increased amounts of bilirubin in the blood.
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