16. Jaundice

Question 1

Outline the pathophysiology of jaundice

Answer 1

Yellow discolouration of the sclera and skin

Due to hyperbilirubinaemia (usually occurs at bilirubin levels >50 µmol/L)

Pre-hepatic = excessive RBC breakdown, overwhelms the liver’s ability to conjugate bilirubin

Intra-hepatic = dysfunction of the liver, loses ability to conjugate bilirubin

Post-hepatic = obstruction of biliary drainage

Question 2

Discuss the aetiology of jaundice

Answer 2

Pre = autoimmune haemolytic anaemia

Intra = alcoholic liver disease, cirrhosis, viral hep, medication, autoimmune hep, primary biliary cirrhosis

Post = gallstones, cholangiocarcinoma, strictures, pancreatic cancer, abdo masses

Question 3

How does jaundice present?

Answer 3

Yellowing of the skin

Yellowing of the sclera

Pruritus

Changes in stools/urine colour

Affects blood clotting = bilirubin effects liver function, vit K not produced appropriately

Question 4

How should jaundice be Ix?

Answer 4

Bilirubin = quantify degree

Albumin = marker of liver synthesising function

AST and ALT = marks of hepatocellular injury

Alkaline phosphatase = raised in biliary obstruction

Gamma-GT = raised in biliary obstruction

Liver screen

US = identify obstructive pathology

MRCP = visual the biliary tree

Question 5

Outline how jaundice should be managed?

Answer 5

Definitive treatment dependent on cause

Identify and manage any complications of liver failure where possible

Monitor for coagulopathy = treating promptly (Vitamin K or fresh frozen plasma)

Treat hypoglycaemia

Question 6

What are the possible complications of jaundice?

Answer 6

Brain damage = bilirubin encephalopathy

Kernicterus = newborn brain damage

Cerebral palsy

Question 7

What are the causes of painless jaundice?

Answer 7

Gallstones in the common bile duct

Pancreatic head carcinoma

Question 8

What is a whipples procedure?

Answer 8

Pancreaticoduodenectomy

Removing the head of the pancreas