11.3 - Liver - Jaundice

Question 1

Earliest sign of jaundice?

Answer 1

scleral icterus - eye

Question 2

Bilirubin levels to show jaundice?

Answer 2

> 2.5mg/dL

Question 3

What happens to conjugated bilirubin that is excreted from gallbladder??

Answer 3

• converted to urobilinogen by bacteria ==> brown poop
• helps with digestion
• partially reabsorbed into the blood and filtered by kidney = yellow pee

Question 4

Extravascular hemolysis or ineffective erythropoiesis:

• etiology
• lab finding
• clinical features

Answer 4

1) high levels of UCB –> liver cant conjugate it all (consumption of RBC by macrophages)
2) INC UCB
3) -dark urine bc inc urobilinogen in pee (UCB is not water soluble=not in urine)
- inc risk for pigmented bilirubin gallstones

Question 5

Physioogical jaundice of the newborn

• etiology
• lab finding
• clinical features

Answer 5

1) newborn liver has low UGT activity
2) INC UCB
3) -UCB is fat soluble = deposition in basal ganglia (kernicterus) = neurological deficits and death
- phototherapy Tx = more soluble UCB (light DOES NOT CONJUGATE IT)

Question 6

Gilbert Syndrome

• etiology
• lab finding
• clinical features

Answer 6

1) low UGT activity, autosomal recessive
2) INC UCB
3) jaundice during stress - not much else (GILBERT IS STRESSED)

Question 7

Crigler Najjar syndrome

• etiology
• lab finding
• clinical features

Answer 7

1) type 1=absence of UGT (auto rec)
type 2=dec UGT activity (auto dom with variable penetrance)
2) INC UCB
3) type 1=kernicterus / fatal
type 2= mild

Question 8

Dublin Johnson syndrome

• etiology
• lab finding
• clinical features
• Rotor syndrome?

Answer 8

1) deficiency of bilirubin canalicular transport protein (MRP2); autorecessive
2) INC CB
3) -liver is dark (black liver) due to bilirubinemia) - not clinically significant
- ROTOR SYNDROME IS SAME/SIMILAR JUST NO BLACK LIVER

Question 9

biliary tract obstruction (obstructive jaundice)

• etiology
• lab finding
• clinical features

Answer 9

1) associated with gallstones, pancreatic carcinoma, cholangiocarcinoma, parasites, and liver fluke (clonochis)
2) -INC CB
- DEC urine urobilinogen
- INC alkaline phospate
3) -Dark urine (due to CB)
- pale stool
- puritus due to inc plasma bile acids
- hypercholesterolemia with xanthomas
- steatorrhea with malabsorption of fat soluble vitamins

Question 10

viral hepatitis

• etiology
• lab finding
• clinical features

Answer 10

1) inflammation disrupts hepatocytes and small bile ducts
2) INC CB
INC UCB
3) Dark urine - due to inc Conjugated bilirubin
-urine urobilinogen is normal or decreased