1st

UNDER GUIDANCE OFPROF. DR.A.N. MATHURPROF. DR.DILIP DADHICHPROF.DR.S.M.SHARMA

PRESENTED BYDR.HEMANT BHARDWAJMD.PART

Jaundice originated from French word

‘JAUNE’ that means yellow

•JAUNDICE

•ICTARUS

•PILIYA

A yellowish discoloration of the skin, sclerae(white part of eye) mucous membranes and deeper tissues with increased bilirubinlevel in plasma.

Yellow conjunctiva

Normal skin Yellowish skin

Yellowish nails

The concentration of bilirubin in the plasma must exceed above 1.5 Mg/dl ( > 35 micromole/l), three times more then usual value that is approximately

0.5 Mg/dl for the coloration to be easily visible.

Bilirubin

Metabolism

BETWEEN 250 TO 300 MG(425-510 MMOL ) OF UNCONJUGATED BILIRUBIN IS PRODUCED FROM THE CATABOLISM OF HAEM EVERY DAY. BILIRUBIN IN THE BLOOD IS NORMALLY ALMOST ALL UNCONJUGATED AND, BECAUSE IT IS NOT WATER-SOLUBLE, IS BOUND TO ALBUMIN AND DOES NOT PASS INTO THE URINE

UNCONJUGATED BILIRUBIN IS CONJUGATED BY THE ENDOPLASMIC RETICULUM ENZYME, GLUCURONYL TRANSFERASE, INTO BILIRUBIN MONO- AND DIGLUCURONIDE. THESE BILIRUBIN CONJUGATES ARE WATER-SOLUBLE AND ARE EXPORTED INTO THE BILE VIA SPECIFIC CARRIERS ON THE HEPATOCYTE MEMBRANE.

CONJUGATED BILIRUBIN IS METABOLISED BY COLONIC BACTERIA TO FORM STERCOBILINOGEN, WHICH MAY BE FURTHER OXIDISED TO STERCOBILIN. BOTH STERCOBILINOGEN AND STERCOBILIN ARE THEN EXCRETED IN THE STOOL

A SMALL AMOUNT OF STERCOBILINOGEN (10%) IS ABSORBED FROM THE BOWEL, PASSES THROUGH THE LIVER AND IS EXCRETED IN THE URINE, WHERE IT IS KNOWN AS UROBILINOGEN OR, FOLLOWING FURTHER OXIDISATION, UROBILIN.

Prehepatic or Hemolytic Pathologies prior to liver

Hepatocellular or Toxic Pathology of within liver

Post hepatic or Cholestatic Pathology after conjucation of bilirubun

Pre-hepatic

Haemolysis

Congenital defects: Gilbert’s syndrome (uptake/conjugation defect)

Crigler-Najar (conjugation defect)

Acute

Viral hepatitis A, B, C..

Drugs

Dose-dependant e.g. paracetamol

Idiosyncratic

Toxins

Autoimmune hepatitis

Alcoholic hepatitis

Tumours

Viral hepatitis B, C

End-stage liver disease (of any cause)

Alcoholic

Autoimmune

Haemochromatosis

Wilson’s disease

Chronic

Hepatocellular

Gallstones

Carcinoma of head of pancreas

Benign stricture Congenital Traumatic iatrogenic

Carcinoma of ampulla of bile ducts

SclerosingCholangitis

pancreatitis

Cholestatic

Yellow discoloration of the skin, mucous membranes, and the whites of the eyes

Light or dark colored stools

Dark-colored urine, and

Nausea and vomiting

Abdominal pain

Loss of appetite

Fever

Weakness

Headache

Confusion

Swelling of the legs and abdomen

Itching of the skin

Pain

Colour of stools and urine

Drugs

Recent blood transfusion

Alcohol intake

Contact with hepatitis infection

Occupation

F/H – Anaemia, Splenectomy, Gallstones

Pre-hepatic Hepatic Post-hepatic

Urine-color-bilirubin-urobilinogen

normalNo Bilirubin Urobilinogen

Dark/normal? Bilirubin Urobilinogen

DarkBilirubin Urobilinogen

Faces color Dark Pale Pale

Blood

Alkaline phosphates

Bilirubinunconjugated

normal

ReticulocytecountCoombs’ test

Bilirubin –mixed conjugated & unconjugated

increased

Bilirubin– conjugated

increased

Ultrasound Gallstones Bile duct dilatation Intra-hepatic lesions

CT Liver lesions Pancreatic lesions CT-IVC

MRI Liver lesions MRCP

X-ray Gallstones – only 10% radio-

opaque PTC, ERCP – can also be means

of therapy Isotope scan – HIDA

DEAFNESSCEREBRAL PALSYACUTE BILIRUBIN

ENCEPHALOPATHYLIVER FAILORCOMADEATH

Foods Permitted for a patient of Jaundice:

Bread or chapattis of wheat, rice, maize, jowar, bajra or ragi.

Egg

Milk or milk products

Soups

Vegetable salad

Patato

Sugar, jiggery or honey

Jam or Murabba

Pastry as biscuits

Fruits, Dry Fruits

Water as desired

Nuts,pulses

Condiments and spices

Papad, chutney or pickles

HOMOEOPATHIC MANAGEMENT

Increased rate of hemolysis (reticulocyte count elevated)-Syphilis

glucuronyl transferase deficiency, autosomal-Psora

Toxic liver injury Psora

Drug toxicity Psora

Iron overload (hemochromatosis) Psora

Copper overload (Wilson disease) Psora

Autoimmune hepatitis Psora/ Syphilis

Choledocholithiasis- presence of a stone in the common bile duct. Psora/ Sycosis

References- Miasmatic Diagnosis, Dr. S. K. Banerjea

SKIN - DISCOLORATION - yellow

acal. acetan. ACON. aesc. agar-ph. agar. agn. Aloe alum-p. alum. alumn. Am-m. Ambr. anders. Ant-c. ant-i. Ant-t. Arn. ars-i. Ars. asaf. astac. aur-m-n. aur-s. Aur. Bell. Berb. blatta-a. bov. brass-n-o. Bry. bufo cadm-s. calc-ar. Calc-p. calc-s. calc-sil. Calc. calen. cann-s. Canth.

Carb-v. carbn-s. CARD-M. cas-s. Caust. cean. cedr. Cham. CHEL. chelo. chen-a.

chim. CHIN. Chinin-ar. CHION. chol. cina coca cocc. CON. convo-s. corn-f. Corn.

croc. CROT-H. cupr. Dig. Dol. dulc. elat. eup-per. euph. fab. fel ferr-ar. Ferr-i. ferr-pic. Ferr. fl-ac. gels. granit-m. graph. Guat. hed. hell. Hep. hier-p. hip-ac. Hydr. Ign. ilx-a. ins.

IOD. iris Jug-c. kali-ar. kali-bi. kali-c. kali-i. kali-m. kali-p. Kali-pic. kali-s. kali-sil. LACH. lact. laur. Lept. lina. lipp. loxo-recl. LYC. mag-m. mag-s. mang. med. Merc-c. merc-d. MERC.

morg-p. myric. nat-ar. nat-c. nat-ch. nat-f. Nat-m. nat-p. NAT-S. NIT-AC. NUX-V. olnd. Op. petr. ph-ac. PHOS. pic-ac. plb-xyz. PLB. Podo. psor. Ptel. Puls. quas. ran-b.

rheum rhus-t. ric. sabad. Sang. saroth. Sec. SEP. Sil. Spig. sul-ac. sul-i. sulfa. Sulph. tab. tarax. tarent. ter. thuj. tinas. trinit. verat. vip.

SKIN AND EXTERIOR BODY - Color - yellow, jaundice

ACON. Aloe AMBR. Ant-c. arn. Ars. asaf. AUR. BELL. Berb. brom. BRY. bufo calc-p. Calc. CANTH.

CARB-V. Card-m. Caust. CHAM. CHEL. CHIN.

cina cocc. CON. Croc. Crot-h. cupr. Dig. dulc. euph.

FERR. gels. graph. hell. Hep. IGN. Iod. kali-c. LACH.

Laur. Lept. LYC. MAG-M. MERC. nat-c. nat-m. Nat-

s. Nit-ac. NUX-V. OP. petr. ph-ac. Phos. PLB. PODO. psor. Puls. ran-b. rheum Rhus-t. sabad. sec.

SEP. sil. SPIG. sul-ac. SULPH. tarax. Verat.

J - Jaundice

aesc. astac. card-m. chion. iod. lept. mag-m. myric. nat-p. pic-ac. tarax.

ABDOMEN - Jaundice

Acon. aloe am-m. arg-n. ars. astac. Aur-m-n. aur.

barbit. Berb. Bry. Card-m. cas-s. Cean. Cham. Chel.chelo. Chin. Chion. chol. corn. crot-h. Dig. dol. eup-per. hep. Hydr. iod. jug-c. kali-bi. kali-c. kali-pic. lach. Lept. Lyc. merc-c. Merc-d. Merc. Myric. nat-m. Nat-p. nat-s. nit-ac. Nux-v. ost. Phos. pic-ac. plb. Podo. ptel. rumx. ruta sep. still. sulph. Tarax. Vip. Yuc.

Arsenic album-

Face pale and weak.

Gastric derangements; after cold fruits; ice cream; ice water; sour beer; bad sausage; alcoholic drinks; strong cheese.

Diarrhoea, after eating or drinking; stool scanty, dark-colored, offensive, and whether small or large, followed by great prostration.

Berberis vulgeris

Pale, earthy complexion, with sunken cheeks and hollow, blue-encircled eyes.

Colic from gall-stones. Bilious colic, followed by jaundice; clay-colored stools, with bilious symptoms and itching of the parts.

BryoniaPressure as from stone at pit of the stomach, relieved by eructation. Constipation: inactive, no inclination; stool large, hard, dark, dry, as if burnt; on going to sea.

Diarrhoea: during a spell of hot weather; bilious, acrid with soreness of anus; like dirty water; of undigested food; from cold drinks when overheated, from fruit or sour krout;

< in morning,

<on moving, even a hand or foot.

Cardus Marinus

In complication with gall stone. Swelling of gall bladder with tenderness; stools hard, difficult, knotty, alternates with bright yellow diarrhoea.Jaundice with intolerable itching, when lying down at night.

Chelidonium mejusThe constant pain under inferior angle of right scapula, Desire for very hot drinks, unless almost boiling stomach will not retain them (Ars., Casc.) Constipation: stool, hard, round balls like sheep's dung (Op., Plumb.); alternate constipation and diarrhoea. Diarrhoea: at night; slimy, ligh-gray; bright-yellowish; brown or white, watery, pasty; involuntary.

Face, forehead, nose, cheeks, remarkably yellow. Yellow-gray color of the skin; wilted skin; of the palms of hands.

Tongue coated thickly yellow, with red edges, showing imprint of teeth

ChinaAilments: from loss of vital fluids, especially hemorrhages, fever of malarial origin, with marked periodicity; return every other day.Face pale, Hippocratic; eyes sunken and surrounded by blue margins; pale, sickly expression.

Excessive flatulence of stomach and bowels, belching gives no relief (belching relieves, Carbo v.); < after eating fruit (Puls.). Colic: at a certain hour each day; periodical, form gall-stones (Card.m.); worse at night and after eating; better bending double.

Crotalus HorridusHaemorrhagic diathesis, Yellow color of conjunctiva; Malignant jaundice; haematic rather than hepatic. Purpurahaemorrhagica; comes on suddenly from all orifices, skin, nails, gums.

Tongue fiery red, smooth and polished.

Instantly producing dark, green vomiting; black or coffee grounds, of yellow fever. Diarrhoea; stools black, thin; like coffee-grounds; offense; from noxious effluvia or septic matters in food or drinks; during yellow fever, cholera, typhoid, typhus.

LachesisThere is Fever annually returning; paroxysm every spring (Carbo v., Sulph.), after suppression by quinine the previous autumn. Fever: typhoid, typhus; stupor or muttering delirium, sunken countenance.

conjunctiva yellow or orange color; perspiration cold, stains yellow, bloody (Lyc.).

Tongue dry, black, trembles, is protruded

LEPTANDRA VIRGINICATongue coated yellow. Great distress in stomach and intestines, with desire for stool. Aching in region of liver extending to spine, which feels chilly.

Stool.--Profuse black, fetid stools, with pain at umbilicus. Stools turn black and look like tar. Clay colored stools with jaundice.

LycopodiumGastric affections; excessive accumulation of flatulence; constant sensation of satiety; good appetite, but a few mouthfuls fill up to the throat, and he feels bloated; fermentation in abdomen, with loud grumbling, croaking, especially lower abdomen (upper abdomen, Carbo v. - entire abdomen, Cinch.); fulnessnot relieved by belching (Cinch.).

Constipation: since puberty; since last confinement; when away from home; of infants; with ineffectual urging.

Mag MureaticumPressing pain in liver, when walking and touching it,

liver hard, enlarged, < lying on right side (Mer., Kali c.).

Constipation: stool hard, scanty, large, knotty, like sheep's dung; difficult to pass; crumbling at verge of anus (Am. m., Nat. m.); of infants during dentition.

Urine; pale, yellow, can only be passed by bearing down with abdominal muscles.

MYRICA CERIFERATaste bitter with offensive breath. Complete loss appetite, but with a feeling of fullness in the stomach after a meal. Strong desire for acids. Weak, sinking feeling in the epigastrium, approaching nausea; increased after eating; relieved by rapid walking.

Stool.--Constant discharge of flatus when walking. Urging to stool, with no other results than the expulsion of a great amount of flatus. Loose, light-colored stool; ash-colored and destitute of bile.

Urinary.--Dark, frothy, scanty, high-colored, biliary.

Skin.--Yellow and itching. Jaundice. Creeping sensation, as of insects.

Nux VomicaJaundice from anger (Cham.), high living. Nausea: constant; after eating; in morning; from smoking; and feels "If I could only vomit I would be so much better.".

Stomach: pressure an hour or two after eating as from a stone. Constipation; with frequent unsuccessful desire, passing small quantities of faeces sensation as if not finished.

Phosphorus

Constipation: faeces slender, long, dry, tough, and hard (Stap.); voided with great straining and difficulty (Caust.).

Diarrhoea: as soon as anything enters the rectum; profuse, pouring away as from a hydrant; watery, with sago-like particles.

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