- Hemolytic Jaundice
Results from increased destruction of the red blood cells, too much bilirubin
reaches the liver, although functioning normally, cannot excrete the bilirubin as
quickly as it is formed.
Occurs with patients with hemolytic transfusion reactions and other hemolytic
disorders.
Prolonged jaundice, however, even if mild, predisposes to the formation of
pigment stones in the gallbladder, and extremely severe jaundice (levels of free
bilirubin exceeding 20 to 25 mg/dL) poses a risk for brain stem damage.
- Hepatocellular Jaundice
• caused by the inability of damaged liver cells to clear normal amounts of
bilirubin from the blood. The cellular damage may be from infection, such as in
viral hepatitis or other viruses that affect the liver (eg, yellow fever virus,
Epstein-Barr virus), from medication or chemical toxicity (eg, carbon
tetrachloride, chloroform, phosphorus, certain medications), or from alcohol.
• Cirrhosis of the liver is a form of hepatocellular disease that may produce
jaundice. It is usually associated with excessive alcohol
- Obstructive Jaundice
Caused by occlusion of the bile duct by a gallstone, an inflammatory process, a
tumor, or pressure from an enlarged organ.
The obstruction may also involve the small bile ducts within the liver (ie,
intrahepatic obstruction), caused, for example, by pressure on these channels
from inflammatory swelling of the liver or by an inflammatory exudate within
the ducts themselves. Intrahepatic obstruction resulting from stasis and
inspissation (thickening) of bile within the canaliculi may occur after the
ingestion of certain medications ,
These include phenothiazines, antithyroid medications, sulfonylureas, tricyclic
antidepressant agents, nitrofurantoin, androgens, and estrogens.
Whether the obstruction is intrahepatic or extrahepatic, and whatever its cause
may be, bile cannot flow normally into the intestine but is backed up into the
liver substance. It is then reabsorbed into the blood and carried throughout the
entire body, staining the skin, mucous membranes, and sclerae. It is excreted in
the urine, which becomes deep orange and foamy.
Because of the decreased amount of bile in the intestinal tract, the stools
become light or clay-colored. The skin may itch intensely, requiring repeated
soothing baths. Dyspepsia and intolerance to fatty foods may develop because
