[30] Jaundice

Question 1

What is jaundice also known as?

Answer 1

Icterus

Question 2

What is jaundice?

Answer 2

A yellow discolouration of the skin and whites of the eyes due to high bilirubin levels

Question 3

When does jaundice occur?

Answer 3

When serum bilirubin is >25-30mmol/L

Question 4

What can jaundice be classified into?

Answer 4

• Unconjugated
• Intrahepatic
• Cholestatic (obstructive)

Question 5

What are the causes of unconjugated jaundice?

Answer 5

• Excess bilirubin production
• Impaired liver uptake
• Thalassaemia

Question 6

Give three examples of things causing excess bilirubin production leading to jaundice

Answer 6

• Haemolysis
• Sickle cell anaemia
• Impaired conjugation

Question 7

Give two examples of causes of haemolysis

Answer 7

• Spherocytosis

- G6PD deficiency

Question 8

Give two examples of impaired conjugation

Answer 8

• Gilbert synrome

- Crigler-Najjar syndrome

Question 9

What is intrahepatic jaundice due to?

Answer 9

Hepatocyte damage, with or without cholestasis

Question 10

What is found on bloods in intrahepatic jaundice?

Answer 10

Unconjugated or mixed hyperbilirubinaemia

Question 11

What are the categories of causes of intrahepatic jaundice?

Answer 11

• Infections
• Toxins
• Metabolic
• Biliary hypoplasia
• Cardiovascular
• Autoimmune

Question 12

What infections can cause intrahepatic jaundice?

Answer 12

• Viral hepatitis, including chronic hepatitis
• Bacterial hepatitis
• Toxoplasma gondii

Question 13

What toxins can cause intrahepatic jaundice?

Answer 13

• Drugs or poisons

- Fungi

Question 14

Give 4 examples of drugs that can cause intrahepatic jaundice?

Answer 14

• Paracetamol (in overdose)
• Sodium valproate
• Anti-TB drugs
• Cytotoxic drugs

Question 15

What metabolic disorders can cause intrahepatic jaundice?

Answer 15

• Galactosaemia or hereditary fructose intolerance
• Wilson’s disease
• Alpha-1 anti-trypsin deficiency
• Hypothyroidism

Question 16

What can biliary hypoplasia be subdivided into?

Answer 16

• Syndromic

- Non-syndromic

Question 17

Give an example of a syndromic cause of biliary hypoplasia

Answer 17

Alagille syndrome

Question 18

What autoimmune disorders can cause intrahepatic jaundice?

Answer 18

Autoimmune hepatitis

Question 19

What are the causes of cholestatic (obstructive) jaundice?

Answer 19

• Biliary atresia
• Choledochal cyst
• Primary sclerosing cholangitis
• Cholelithiasis
• Cholecystitis
• Cystic fibrosis
• Obstructive tumours or cysts

Question 20

What is the main presenting feature of jaundice?

Answer 20

Yellowing of whites of eyes or skin

Question 21

What are the other features of jaundice?

Answer 21

• Itchy skin
• Darker urine
• Pale stools

Question 22

What needs to be included in the history for jaundice?

Answer 22

• Medications
• Family history
• Overseas travel
• Past blood transfusions

Question 23

What needs to be checked for on examination in jaundice?

Answer 23

• Vital signs
• Hepatic stigmata of chronic liver disease
• Hepatomegaly or splenomegaly
• Peripheral oedema

Question 24

What will further investigations in jaundice depend on?

Answer 24

Findings on history and examination

Question 25

What might further investigation include in jaundice?

Answer 25

• FBC, blood film, and reticulocyte count
• Coagulation studies
• U&Es, SBR (total and unconjugated), LFTs, albumin, total protein
• TFTs
• Viral serology
• Abdominal ultrasound, or CT/MRI
• Liver biopsy

Question 26

What is the management for jaundice?

Answer 26

• Remove or treat underlying cause
• Treat any associated abnormalities
• Phototherapy may be helpful

Question 27

What associated abnormalities may need to be treated in jaundice?

Answer 27

• Blood glucose
• Clotting
• Liver failure

Question 28

When is phototherapy useful in jaundice?

Answer 28

Only when there is a significant unconjugated component, e.g. Criger-Najjar syndrome

Question 29

Add kernicterus

Oo

Answer 29

Gg