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What Causes Jaundice - Overview | Causes | Symptoms | Treatments | Prevention - Wit Biology

                                        What  Causes Jaundice


Jaundice is essentially a yellowing either at the skin level or at the sclera, which is the white of the eye. Jaundice is usually a complication of an increase in bilirubin. This is a type of by-product from the breakdown of ham, which is a breakdown product of part of hemoglobin of red blood cell. Now to develop jaundice you need to have approximately two point five milligrams per 100 mils of blood of bilirubin in your blood. To develop that yellowing aspect now because of your wider the eye. It has a greater propensity to take up this bilirubin, so that's probably the most sensitive part. But you can also see it on the skin when the bilirubin levels increase enough. 



So the first part of this article will look at how bilirubin is normally metabolized in the body and then we'll have a look at how when it breaks down you get these jaundice looking features. So what needs to happen first so in your systemic blood we have red blood cells. The red blood cells will be traveling through your blood, now red blood cells as you are aware they live for approximately 120 days and they when they get old and worn out. They lose their shape and then they can start to get stuck in very narrow blood vessels. So the most common place where you'll get the destruction of red blood cells is going to be in the spleen and in the liver and this is going to be incorporated with macrophages in those particular areas. 

So those are macrophages which would predominantly happen in the spleen. But it can also be macrophages could cook the cells in the liver can also do that role. So a person who wants to have their spleen removed the liver can still do this particular process, so red blood cells would come and essentially the macrophage within the spleen. 

Let's do the splendid example would destroy the red blood cell, now the red blood cell sort of it would get. So the globulin part would be used for further protein. So that would be used for proteins somewhere else broken into amino acids and so forth and the other part or the hand part.

The hand part is broken into iron and then iron would be taken to the liver to be reused and then the part that we're looking at today is the bilirubin. So bilirubin into the first main derivative that we want to look at as starts to break down. 

Now the bilirubin if it's in the blood of bling it would get added to by what we call an albumin molecule. So the bilirubin would sit on the albumin molecule or the albumin protein within the blood vessel and that then would be transported this together would get transported to the liver. Now because the bilirubin is fat soluble. So it can't dissolve in water it needs to be taken by that albumin molecule, which is in the blood all the time. 



Albumin is produced by the liver but it's always in your blood and so it binds to this albumin molecule a little bit transported. Now to the liver but please bear in mind the bilirubin at this point is what we call unconjugated. So I'll just labeled an acronym you see. So this unconjugated bilirubin is now taken to the liver by the blood to be further processed. Now as we said this unconjugated bilirubin is fat soluble, so it's going to get processed through the liver and essentially what it's going to happen as it moves through is it gets conjugated. 

Which are water soluble molecule or glutamic acid, glucuronic acid is added to it and so that then makes it conjugated. So this conjugated bilirubin can now safely pass into the area of the lemma that allowed it to excrete or get rid of its waste product. The conjugated bilirubin is now processed through into the gallbladder or into the cystic duct. So we got the left and you've got the right hepatic duct meeting the cystic duct and then it goes on the common bile duct. So this system is going to take bile down into the duodenum. So we've basically got the unconjugated bilirubin which is fat soluble it's coming to the liver is being conjugated with the addition of good running acid it's now become conjugated bilirubin and it's been excreted out of the liver through those hepatic ducts meeting the cystic duct with the gallbladder. 

Being in the gallbladder and then taking it down the common bile duct, where it's going to move down here like so where it enters the duodenum. Now within the duodenum it's now going to be further processed by the bacteria in your gut. So what happens there is a conjugated as it enters it's conjugated bilirubin. But it's going to be essentially oxidized and made back into unconjugated bilirubin. So it's going to be made back into a form of unconjugated bilirubin and this is what we call euro diligence. 

This is euro Billiton it's been oxidized by the bacteria it's now unconjugated bilirubin, but not so much the segment that up here slightly an oxidized version of the conjugated version. So what will happen now is probably 85% will be continued down the intestine whereas about 10% will be put back into the blood. So it'll be absorbed back in the intestine, so this 5% will go back to the liver, five percent of that unconjugated bilirubin or the euro billiton will be put back into the liver, which then will go back through again and that does another cycle back into this and so forth. 

So that's that 5% of the 10% the rest of it will go back into the blood. Remember it is the unconjugated euro billiton and it will get essentially processed in the kidney. So the kidney will then modify it slowly slowly and will make it into euro billiton. So that euro billiton will then be processed in the kidney and excreted out through urine and that euro billiton will be essentially the yellowing of the urine. So that's going to be the reason why the unconjugated aspect is going to be the reason why you get that yellow in aspect of your urine and then finally the last segment or the 85% of that unconjugated bilirubin, which has been modified by bacteria will be further oxidized and made into their cousins interstate I billiton inside of this essentially will be excreted out of the feces and this sticker billiton is what gives you that darkening color in your faces that's the brown in color the stare code billiton is the Browning color of your faces and that essentially is the process of bilirubin. 

So just to recap we start up in the red blood cells, so we have normal aging red blood cells or you could have an increase in destruction of red blood cells. But in any case the macrophages have to process the map look at the process of red blood cells to get rid of the of the hemoglobin and the hemoglobin is broken too into globulin, which is then protestors proteins behind portion that I've sent off for further processing. But the bilirubin is quite dangerous so you don't want to just put in bilirubin into your blood. So it gets further processed so seriously because it is fat soluble it will bind to albumin within your blood, because it can't dissolve in the plasma so that is that unconjugated bilirubin is fat soluble it will be taken to the liver where it's now processed or conjugated through glucuronic acid. 

Now that with a number of enzymes and then that will get pushed through into the bile system and that will be excreted down into the duodenum here the conjugated bilirubin will be oxidized and further modified by the bacteria now 10 to 15 percent of that will be absorbed back into the blood. Now five percent of or about half of that amount we'll get further looped around the liver and that will be cycled whereas the other five percent will be taken to the blood where it will be taken to the kidney and remember the durability pillagin origin will just be made into euro billiton and that you're a billiton will then be excreted as urine and that's what gives you the yellow color on your urine and then finally that eighty-five percent 85 anonymous end of the now unconjugated part in in the intestine will be modified or oxidized further to stare covalent which will then color the fetus brown and will be excreted, so we've done the metabolism of bilirubin. 

So let's move into now a pathology where there is excessive amount of bilirubin in one of its forms, so I've put a table up and these are the three main causes of why you have an increased amount of bilirubin in your blood it would be either and have pre hepatic cause, so before coming into the liver intrahepatic caused a problem with the liver itself and posted that it causes problems with getting the bilirubin or the bile out of the liver. 



So let's firstly just go over the process just so we have all the rows in the right order and then we'll move into the examples so the first thing that needs that happening is in a null process of bilirubin metabolism is the RBC's has hemolysis, so there's hemolysis of the red blood cells which would lead to the breakdown regime and that gets processed into unconjugated bilirubin which would get processed without early, but essentially this step is the on unconjugated. 

So unconjugated bilirubin and from what happens here is it gets processed through the hepatocyte into conjugated form and then that finally gets excreted into the bile to finally the fetus. So the process is you have red blood cell destruction which is a normal level we have the hemolysis the heme, so that the iron goes to one side the globulin goes to the other the heme creates the Billy Durden into bilirubin it is unconjugated, so it's fat soluble needs to jump on board with albumin and then it gets taken towards the liver. 

This unconjugated bilirubin gets processed through the hepatocyte which conjugates it and then that conjugated oil gets taken to the intestines to be taken and excreted through the feces. So that's the normal process that occurs now what happens with pre hepatic some examples of freedom pati causes is where you have excessive amount of hemolysis. So this area is excessive and some examples of what would cause excessive amounts of hemolysis would be fallacy Mia's sickle cell anemia or risk factor incompatibility, between a mother and the child and that would lead to an excessive amount of destruction of the hemoglobin. 

So this would be expected that all this process would be normal and we would come to the unconjugated amount, but because the parasites have parasites on they're essentially normal in their function, but they get overloaded so they kind of back into here, so too much Billy Reubens been produced too much unconjugated bilirubin has been produced. It goes to the liver which is normal the parasites are normal, but they just can't that would that amount and so it backs into this and so what we end up with is an increase in blood levels of unconjugated bilirubin and so that would cause the levels in your blood. So you become jaundice, but the type of would be unconjugated bilirubin form. 

Now I'm moving down here you would have probably a normal - maybe slightly darker colored feces because the processing all through here is the same and isn't changed, so you have still have the same color maybe a bit more, because you've still got extra on higher amounts of unconjugated going through, but most of the problem is a back and you have an increasing unconjugated bilirubin. Now when we move across to the interim hepatic causes this would be problems with the liver itself, so the parasites are damaged or dysfunctional itself. This could be also called hepatocellular dysfunction. 

The most common ones would be probably have hepatitis or cirrhosis and so this is going to be normal you have the normal hemolysis in the body, so that's not a problem and this is going through like, so this part of the process is, but hepatocyte and dysfunction. The hepatocyte are dysfunctional therefore what happens is both users not being processed, so you have an increased unconjugated bilirubin, so that part would be increased. But also the amount that you do the amount of conjugation one that you do carry out and they'll be still some conjugation it wouldn't process through into the CC. So well because not only other her parasites damaged but also the the bile connector lining so for the damage and it can leak out into the blood pretty quickly. 

The conjugated can be out as well so the conjugate it could be also up so in interest that causes both these levels are up which would both lead to jaundice. So the jaundice could be unconjugated and conjugated forms and so the color of the feces is probably going to be variable and could be light to be darker could be fairly normal looking, so that's the interest that it causes that's within the liver itself finally let's move to our change color to purple to the post herpetic causes, so this is where you have generally problems with the transport out of the liver and then good example of that stones gall stones, so again the hemolysis would be normal, so there's no change there and the processing through is going to be a pain there's no problems with this part the unconjugated amounts to being normal and the hepatocyte function in normal. 



So it will pass through it will conjugate it but the problem here is let's say that the problem here is the excretion part, so there's going to be a blockage here so the stone kind of puts a blockage at the between the bile secretion into these intestines so that would cause a build back into here so the unconjugated level is going to be built filter. So the conjugated should I say the conjugated level would be increased, because we processed that normal the conjugation has occurred in the liver as the cells and normal but the excretion out is built up so it will come back into the liver and then build up into the blood so the unsorted conjugated aspect would be increased and so what that would do to your feces is maintain light colored, because you're not getting any conjugated bilirubin into the feces to be made into your ability to make the coloring through the amount of speaker billiton and so the conjugated will be put into the blood and therefore the blood also causes the urine to become darker.

So that darker conjugated bilirubin because that remember is now water-soluble that's going to go and be excreted through the kidneys and that will make the urine darker color, so that's essentially all the types of all of these will cause jaundice,  so they'll all cause the person to go yellow because the Billy red have built up will just gone through how they do it differently some are caused by increased conjugated amount some are a mixture of both or some are caused by an increasing unconjugated. 

So I hope that has helped in you understanding what causes join us but also the normal processing of bilirubin metabolism... 

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