Jaundice - causes, treatment & pathology

Fantastic video

Ol'Yeller (PokitoHighed Road)

I finally know why nigerians put their babies in the sun when they have jaundice. I'm amazed by the wisdom of our mothers.

Thank you very much. I understood the topic very well. 👍🧡

❤❤

gosh there are so many little things that could go wrong in our body... this made me realize how lucky i am ;(

Thanks Osmosis ✨️

Heyyyyy @osmosis why r u sooo cute whyyyyy 🥹❤️

This is a phenomenal video. Much love from Nigeria ❤👏👏

Heme is broken down to biliverdin by heme oxygenase.

Biliverdin is then broken down to bilirubin by biliverdin reductase.(NADP dependent enzyme).

Excellent video!! 😊

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Jaundice/Icterus = Yellowing of the skin and sclera due to bilirubin
Bilirubin metabolites are responsible for yellowness of urine and brown needs of faeces.

When RBCs have lived their full term, spleen and lymph nodes macrophages digest theme. Hemoglobin is broken up into heme and globin. Globin is digested into AAs and heme is split into Iron and Protoporphyrin.
Protoporphyrin is converted into Unconjugated Bilirubin (UCB). UCB is lipid soluble (not water soluble). Albumins bind UCB and carry it to liver for hepatocyte uptake where it's converted to water soluble Conjugated Bilirubin (CB) by Uridine Glucuronyl Transferase (UGT).

CB is secreted out into bile canaliculi and drains into bile ducts and is stored in gallbladder as bile.
When you eat fatty food, gallbladder secretes bile into duodenum via common bile duct. At small intestine, CB is converted by gut microbes into Urobilinogen (UBG).

UBG is converted to stercobilin (responsible for brown colour of faeces). Alternatives, some UBG is reabsorbed into blood and spontaneously oxidises into Urobilin. Most Urobilin is sent to liver, and a little to the kidneys (responsible for yellow colour of urine).
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A disruption in this process can result in increased blood bilirubin (more than 2.5mg/dL in serum) causing yellow skin and eyes. Scleral tissue is high in elastin, which binds bilirubin with high affinity.
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Increased Unconjugated Bilirubin (UCB):
Extravascular hemolytic anemias (rbcs broken down earlier than they should be)
Ineffective hematopoiesis (improper rbc formation in bone marrow causes macrophages to break them down).
When hepatocytes are overwhelmed, UCB accumulates.
Excess UCB stays in blood (bound to albumin) rather than being absorbed by hepatocytes.
The excess Conjugated Bilirubin being produced goes into bile increasing the risk for pigmented bilirubin gallstones.
In duodenum, UCB is not excreted because it's not water soluble.
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When hepatocytes struggle to keep up with normal load, UCB can accumulate as well.
E.g. physiological jaundice in newborns.
Newborns have less UGT so UCB levels can be high. This is normal. But if UCB rises high enough it may dissolve in basal ganglia of the brain and cause brain damage or death.

Phototherapy changes UCB shape making it more water soluble allowing for excretion.
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Genetic defects
e.g. Gilbert's syndrome whereby UGT activity is low. In times of increased hemolysis (starvation, infection, stress) will increase UCB resulting in Icterus as hepatocytes are easily overwhelmed.
E.g. crigler najjar syndrome whereby there's almost no UGT at all so UCB can't be converted to CB. UCB accumulates and is deposited in brain causing kernicterus (brain-affecting jaundice). It's fatal.
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Increased Conjugated Bilirubin (CB)
Dubin-Johnson syndrome autosomal recessive disorder causing deficiency in protein (MRP2 transporter) moving CB from liver to bile ducts, resulting in CB buildup in hepatocytes . When MRP2 is defective, MRP3 is upregulated. CB is moved into interstitial space and blood flow rather than bile canaliculi. Increased CB in blood is also excreted in urine (dark brown urine). Liver also gets dark.

Obstructive jaundice: bile flow is blocked by gallstones, pancreatic carcinomas, parasites like liver flukes, cholangeo-carcinomas.
Bile is made up of CB. Blockage causes pressure to rise in bile ducts, and bile leaks through tight junctions between hepatocytes of bile duct walls.
Bile salts and bile acids and cholesterol also leak out and may enter blood. If they reach skin they will cause itchiness (pruritis), hypercholesterolemia, xanthomas.
Excess CB is excreted into urine making dark urine.
Bile loss will result in poor fat absorption in intestines resulting in steatorrhoea (fat excretion).
Bile loss results in poor Fat-soluble vitamin absorption.
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Viral hepatitis causes increase in both UCB and CB in blood.
Infected and dying Hepatocytes lose ability to conjugate bilirubin (hence more UCB in blood) and they allow bile to leak into blood (hence more CB in blood)

<3

Your baby can get intermittent exposure to sunlight with sunglass or eye covering to help if they need some ozone filtered UV exposure. There are lights that expose you to radiation that never makes it through the ozone, but is 6 inches from your brain as electricity passes through a radioactive gas. Let nature do its work instead. Have a memory of being very hot, for what seemed like days, wondering why it was so hot under the red light, and was that what we were made for? To suffer? The heat can cause veins to rapidly multiply as the testes and eyes don't have enough blood flow to cool. You can get vernaculease. RF energy can result in permanent injury. X rays also fry the optical nerve peripheral vision loss, and constructs blood supply to a fetuses brain and shrinks umbilical cords, less oxygen to a baby's brain, snake umbilical cord: low birth weight. X rays will constrict the blood supply to each tooth, if the root dies so does the tooth.
Ultrasounds cause cavitation of tissue, heading it until it turns into gas, causes neurological damage. Leonardo DaVinci and Albert Einstein came out natural geniuses, but their parents didn't hit them with Ultrasounds every month, even when their body was the size of a pebble. Why do mush mental retardation and ligature handicaps from the wing these days? Just run a radar gun or get x rays, Asp.en ain't give you a lead jacket but a plastic bib so you dint still on yourself while they x ray each tooth and run a panoramic. They icky used to do 3 if they wanted the whole mouth not 26, and they made sure you had a lead jacket that Akari covered your lower areas. Now they're going to put ultra sound chips in earbuds, starting this year 2024.

Osmosis never disappoints, you guys are always my Savior 🙇🏻

Thank you so much this is a very valuable content and It made the whole thing easier❤️❤️❤️

Amazing amazing amazing explanation you made everything so clear

I'm trying get rid of my yellow eyes

Well this has been extremely enlightening

amazing explanations, thank you so much!

Thank uu it is too useful I watch your videos from kurdistan❤❤

Great !👏

Hah really funny what the undertale yellow pll think about that

Thank uuuu

You can probably guess, Yellow's pretty fun! (Jaundice!) You can find it on a bus or the rays from the sun! (Jaundice!) If you asked me, Yellow's Number One! (Liver Failure!) If you like Yellow, and Sour, then try a lemon! JAUNDICE!!!

Man, why didn't I watched this when I was struggling with my CC 2. Anyways, thank you so much! Very helpful for visual fellas like me~

The best video ever

What is the exact colour of stool and urine in jaundice

😊

Perfect

Very useful, thank you.🙏

I don't have seen such a wonderful Teacher before l thank you alot

I know biliverdin and protoporphyrin are different things but how do they fit into the same mechanism of forming bilirubin, because in some books it is given that heme is converted to biliverdin by heme oxygenase which is further converted to bilirubin and in others it is explained similar to the video..I'd be really thankful for an answer!

Pls provide hindi dub of all ur vdos accent is different so difficult to understand

Why yall treating me like a disease!?!?

Very well explained ❤

Best 💯

Love this 💖

Please help me for this important investigation of pregnant lady with obstructive jaundice

One of the best videos out there😊

Very useful ....that really helped me thanks

Thank you im good now

My words can't describe how am I amazed 🥹 thank you ❤️

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Very useful thx❤

Thx for making med school 10 times easier

heme is broken down into biliverdin and iron and carbon monoxide and not protoporphyrin and then biliverdin is the one whic is converted into unconjugated bilirubin via biliverdin reductase can you clear that doubt please