CLINICAL BIOCHEMISTRY

Clinical Biochemistry



Clinical Biochemistry

Pathophysiology of Intrahepatic Post Hepatic Jaundice

Intrahepatic Post Hepatic Jaundice is a disease in which there is a condition that block bile flow coming from the liver. This causes overspill of bile on the blood cells present in the body and eliminate the excretion of bile products from the body. Jaundice is a symptom of many diseases of the blood and the liver associated with an excess of bile pigment in the blood of bilirubin. Bilirubin is formed from the breakdown of hemoglobin - a product of the exchange, which must be removed from the body (Konikoff & Shaklai, 1987: 903). It is not filtered by the kidneys, and therefore output from the liver, along with the feces. In various pathologies, especially hepatitis, liver is not working at full strength - and the body is looking for other ways to get rid of bilirubin. Liver Jaundice is a type of jaundice in which levels of ALT and AST are elevated but not alkaline phosphatase, the latter could only be elevated if caused by inflammation of hepatocytes occurs obstruction of bile duct , causing cholestasis (the alkaline phosphatase is not to indicate exclusive cholestasis also altered in other pathological processes unrelated to jaundice, for example, bone.)

Five Possible Causes of the Jaundice

Following are the causes of of Jaundice:

Urine: no bilirubin present.Usually the colour of the urine is dark.

Serum bilirubin conjugated increased.

Kernicterus is associated with increased bilirubin

Pale stools

Yellow colouration of skin and eyes

Itchy skin

Fever

Case results and clinical information Analysis

The case present is of a 28-year old women who felt pain in upper abdominal, vomiting and skin itching that are the symptoms of jaundiced. The following table present results obtained from patient's sample.

Total Protein: 71g/L (60-80)

Bilirubin: 136 µmol/L (0-20)

Urine Bilirubin: +++ (positive)

Urobilinogen: Normal

GGT: 300 U/L (5-55)

ALT: 110 U/L (7-55)

ALP: 231 IU/L (30-130)

AST: 98U/L (5-50)

Cholesterol: high

Triglycerides: high

Following are the normal values of the samples that must match to the pateints sample. The normal values ??are: TGP 0-45 IU / L, AST 0-35 IU / l, FAL 30-120 IU / l, GGT 0-30 IU / l, bilirubin 2-17 micromol / l, TP 10.9-12.5 sec and albumin 40-60 g / l (Rubinow & Koff, 1978: 937).

The case mentions that the patients was have dark urine. Urine bilirubin normally is absent. When it is present, only conjugated bilirubin is passed into the urine. This may be evidenced by dark-colored urine seen in patients with obstructive jaundice or jaundice due to hepatocellular injury. However, reagent strips are very sensitive to bilirubin, detecting as little as 0.05 mg/dL.

LT and AST levels are usually elevated to the same degree in patients with viral hepatitis and those with drug-induced liver damage. The patient had the history of intravenous drug and alcohol abuse. In association with alcoholic liver disease, cirrhosis, and metastatic lesions to the liver, the AST level is elevated more frequently than the ALT level (Levy & Eliakim, 1971: 234.

It can be seen that these values are not matching to the values that are present in the case of the patient's ...