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Scleral icterus1/16/2024 ![]() ![]() ![]() Heme Metabolism production or a decrease in the hepatic uptake, conjugation Conjugation A parasexual process in bacteria algae fungi and ciliate eukaryota for achieving exchange of chromosome material during fusion of two cells. Hyperbilirubinemia is caused by either an increase in bilirubin Bilirubin A bile pigment that is a degradation product of heme. Eye: Anatomy caused by the accumulation of bilirubin Bilirubin A bile pigment that is a degradation product of heme. It is essentially avascular but contains apertures for vessels, lymphatics, and nerves. Skin: Structure and Functions and/or sclera Sclera The white, opaque, fibrous, outer tunic of the eyeball, covering it entirely excepting the segment covered anteriorly by the cornea. The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). Jaundice is the abnormal yellowing of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. Students: Educators’ Pro Tips for Tough Topics.Maternity Nursing and Care of the Childbearing Family.Diversity, Equity, Inclusion, and Belonging.The authors declare that no patient data appear in this article. The authors declare that they have followed the protocols of their work center on the publication of patient data. ![]() The authors declare that no experiments were performed on humans or animals for this study. Ethical disclosures Protection of human and animal subjects 4 ERCP treatment can be effective as a temporizing measure before surgery and can be definitive treatment for unsuitable surgical candidates. Surgery is the mainstay of therapy for Mirizzi syndrome. The Mirizzi syndrome is part of the differential diagnosis of obstructive jaundice and therefore the diagnostic approach usually begins with ultrasonography complemented by ERCP or magnetic resonance cholangiography.Ī useful classification system takes into account the presence and extent of a cholecystobiliary fistula, due to erosion of the anterior or lateral wall of the common bile duct by impacted stones. 1 The majority of the patients present the clinical triad of jaundice, fever, and right upper quadrant pain, showing in the laboratory evaluation elevations in the serum concentrations of alkaline phosphatase and bilirubin. The Mirizzi syndrome refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder. 2) with subsequent patient referral to surgery (cholecystectomy plus closure of the fistula). Successful biliary decompression was performed by internal stenting ( Fig. 1), compatible with the diagnosis of Mirizzi syndrome. We performed an endoscopic retrograde cholangiopancreatography (ERCP) that clearly showed common hepatic duct compression by a large gallstone (20 mm) impacted in the cystic duct ( Fig. Abdominal ultrasound demonstrated a scleroatrophic gallbladder with cholelithiasis and an impacted large gallstone in the common bile duct with dilated common and intrahepatic bile ducts. Laboratory workup revealed leukocytosis (12.4 × 10 3 μL), elevated C-reactive protein (8.3 mg/dL) and cholestasis (bilirubin 5.4 mg/dL, alkaline phosphatase 893 U/L, gamma-glutamyl transferase 1143 U/L) with elevated liver enzymes (aspartate aminotransferase 231 U/L, alanine aminotransferase 178 U/L). Physical examination showed scleral icterus and right upper quadrant tenderness without inspiratory arrest at palpation (absent Murphy's sign). An 84-year-old woman presented with a 2-day history of jaundice, fever and abdominal pain.
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