12 Jaundice and LFTs

Question 1

What is jaundice?

Answer 1

Clinical manifestationof raised bilirubin

Question 2

What is bilirubin and how is it excreted?

Answer 2

Breakdown product of haem

Excreted: urine and faeces

Question 3

What are the 2 forms that bilirubin can be found in the body?

Answer 3

Unconjugated- bound to albumin not water soluble

Conjugated- in liver water soluble

Question 4

The causes of jaundice can be divided into 3 broad categories. What are these categories?

Answer 4

Question 5

Why are the levels of unconjugated bilirubin high in prehepatic jaundice?

Answer 5

Increased degradation of haemoglobin

• Bilirubin excretion fine*
• Hepatocyte function fine*

Question 6

Give some causes of prehepatic jaundice.

Answer 6

Question 7

Why is it so important to pick up jaundice in neonates?

Answer 7

High levels of bilirubin can damage neonate brain

Question 8

Explain how hepatic jaundice is caused.

Answer 8

Reduced hepatocyte function

-reduced conjugating ability so mix of conjugated and unconjugated bilirubin

• Cirrhosis
• Acute liver damage

(see flashcards 11)

Question 9

Why will raised bilirubin in post-hepatic jaundice be conjugated?

Answer 9

Question 10

Why will stools be lighter and urine be darker in posthepatic jaundice?

Answer 10

Obstructive cause- bilirubin goes to kidney instead of GI tract

Question 11

Give some causes of post hepatic jaundice. (3)

Answer 11

1. Gallstones
2. Biliary stricture
3. Pathology of head of pancreas

Question 12

Identify intrahepatic pathology that can cause compression of the intrahepatic bile ducts.

Answer 12

Question 13

Which LFTs give information about the function of the liver and which give information about liver damage?

Answer 13

Question 14

What does testing for albumin tell you about the function of the liver?

Answer 14

Liver’s synthetic function

• Low albumin contributes to ascites*
• Low albumin may also be linked to pathology in urinary system*

Question 15

What happens to levels of ALT and AST if the hepatocytes are damaged?

Answer 15

Levels rise

Question 16

Why is ALT more specific to the liver than AST?

Answer 16

AST found in cardiac/skeletal muscle and RBCs

Question 17

If ALT levels are higher than AST levels, what does this indicate? What does it indicate is AST levels are higher than ALT levels?

Answer 17

Question 18

What would cause ALP levels to rise? Why?

Answer 18

Question 19

What is the Gamma GT test used for?

(Gamma-Glutamyl Transferase)

Answer 19

ALP increased in increased bone turnover (may be high in kids)

Gamma GT used to differentiate between source of high ALP

Gamma-Glutamyl Transferase- found in bile duct

Question 20

If a patient is not jaundiced can LFTs still be abnormal?

Answer 20

Yes

Question 21

What LFT results will we see with pre-hepatic, hepatic and post-hepatic jaundice?

Answer 21

Question 22

For info about peptic ulcers: 4 Ps

Answer 22

Question 23

From an embryological point of view, why is the pain of peptic ulceration felt in the epigastric area of the abdomen?

Answer 23

Stomach is foregut embryologically

All referred pain is sympathetic- can’t feel pain of viscera

Greater splanchnic sympathetic nerve innervates epigastric area of abdomen and foregut

Question 24

Briefly describe fat absorption (duodenum to thoracic duct).

Answer 24