Jaundice

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  1. Bilirubin comes from the blood cells and is the chemical remain in the blood after the iron has been removed from hemoglobin. Once within a hepatocyte, unconjugated bilirubin undergoes conjugation ( glucuronic acid)in the endoplasmic reticulum
  2. All jaundiced patients have some degree of hyperbilirubinemia
  3. jaundice has three major causes
    1. overproduction of bilirubin (hemolytic anemia)
    2. hepatic defect that prevents bilirubin from being removed from the blood
    3. extrahepatic biliary obstruction
  4. elevation in serum bilirubin concentration is reflected in the conjugated fraction of bilirubin in patients with cholestasis; also increased in cholestasis are gamma-glutamyltransferase (GGT) and alkaline phosphatase with no increase in serum transaminases
    1. hepatocellular causes of jaundice typically have increases in unconjugated bilirubin and elevated serum transaminases
    2. the best way to see biliary obstruction is with an ultrasound
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