Yellow Eyes

Yellow Eyes

1. hepatobiliary system

   • The (hepato) part
   • The (Biliary) part
     • Gallstone impacted in the neck or Hartmann's Pouch
       • Mirizzi syndrome
   • Having to do with the liver plus the gallbladder, bile ducts, or bile.

2. Hemoglobin metabolism

3. 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♠.

4. 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
         • immunization schedule
           • Recombinant HepB vaccines containing yeast-derived
             • HBsAg Recombivax-HER or Engerix-BR
               • Day zero, day 30, 6 months (0-1-6)
     • liver inflammation
   • Posthepatic
     • Causes
       • Primary biliary cirrhosis
       • Dubin-Johnson
       • Rotor’s syndrome
       • Gall stones in CBD
       • pancreas head cancer
       • Primary sclerosing cholangitis
       • Extrahepatic biliary atresia
       • Liver flukes
       • strictures
       • high conjugated bilirubin (more than 50%)
         • dark urine due to high conjugated bilirubin
           • clay colored stoold due to absence of urobilinogen
             • Normal liver enzymes but high alkaline phosphate due to the bile duct obstruction
   • a yellow discoloration of the skin, mucous membranes, and the whites of the eyes caused by increased amounts of bilirubin in the blood.

Images and files in the map