3.1. Liver + Biliary Tree Disease - Jaundice Flashcards
What are the 3 types of Jaundice?
- Pre-Hepatic (Haemolytic)
- Hepatic (Conjugative)
- Post-Hepatic (Cholestatic)
What is Pre-Hepatic (Haemolytic) Jaundice?
Pre-Hepatic = Jaundice caused by a problem in the blood, before it reaches the Liver
What is the cause of Pre-Hepatic (Haemolytic) Jaundice?
Haemolysis - The causes of Haemolytic Jaundice are that of Haemolytic Anaemia
What is Hepatic (Conjugative) Jaundice?
Hepatic = Jaundice caused by a problem within the Liver
What are the causes of Hepatic (Conjugative) Jaundice?
- An Uptake Problem
- A Conjugation Problem
- An Excretion Problem
What happens in an Uptake problem, causing Hepatic Jaundice?
The Hepatocytes cannot absorb the Bilirubin
What can cause a Conjugation problem, causing Hepatic Jaundice?
- Hepatitis
- Cirrhosis
- Drugs (Toxification)
- Pregnancy
- Recurrent Idiopathic Cholestasis
- Congenital Disorders:
a) Gilbert’s Syndrome
b) Crigler-Hajjar Syndrome
What can cause a Excretion problem, causing Hepatic Jaundice?
- Benign Recurrent Intrahepatic Cholestasis Syndromes
2. Progressive Familial Intrahepatic Cholestasis Syndromes
What is Post-Hepatic (Cholestatic) Jaundice?
Post-Hepatic = Jaundice caused by a problem in the Biliary Tree, after the Bile has left the Liver
What are the causes of Post-Hepatic (Cholestatic) Jaundice?
- Extrahepatic Cholestasis
2. Intrahepatic Cholestasis
What causes Extrahepatic Cholestasis, causing Post-Hepatic Jaundice?
A large obstruction of Bile Flow, at any point in the Biliary Tract distal to the Bile Canaliculi
What can cause Extrahepatic Cholestasis, causing Post-Hepatic Jaundice?
- Common Duct Stones
- Biliary Tract Carcinoma
- Biliary Stricture
- Sclerosing Cholangitis
- Pancreatic Carcinoma
- Pancreatic Pseudocysts
What causes Intrahepatic Cholestasis, causing Post-Hepatic Jaundice?
Failure of Bile Secretion into the Biliary Tree
The same as what causes Excretion Problems in Hepatic (Conjugative) Jaundice
What is the Pathology of Jaundice?
Due to the Aetiology there is an increase in the Concentration of Unconjugated Bilirubin in the Blood
What is Bilirubin?
A Break-Down Product of Old / Damaged Erythrocytes
What are the Clinical Features of all Jaundice?
- Hepatomegaly
- Splenomegaly
- Dark Urine
- Yellow Pallor
What is Hepatomegaly?
Enlargement of the Liver
Why might Hepatomegaly occur in Jaundice?
Due to the potential altered functional ability of the Liver - Due to the Aetiology
What is Splenomegaly?
Enlargement of the Spleen
Why might Splenomegaly occur in Jaundice?
This indicates Portal Hypertension - common in patients with Chronic Liver Disease who also present with Jaundice
Why does the Urine appear Darker in colour?
Due to the Increase in Unconjugated Bilirubin in the Blood, more is excreted at the Kidneys, changing the Urine colour
Why does the Skin/Sclera appear Yellow in colour?
Due to the excess presence of Bilirubin in these areas
What are some Clinical Features of Pre-Hepatic Jaundice?
- Anaemia
2. Acholuric Jaundice
Why might Anaemia be present in a patient with Pre-Hepatic Jaundice?
As the Aetiology of Pre-Hepatic Jaundice is the same as the of Haemolytic Anaemia
What is Acholuric Jaundice?
Jaundice without Bilirubinaemia
Why might Acholuric Jaundice be present in a patient with Pre-Hepatic Jaundice?
As the Erythrocytes are being broken down, and there is not a back up of Bilirubin anywhere
What are some Clinical Features of Hepatic Jaundice?
- Stigmata of Chronic Liver Disease
- Ascites
- Asterixis (Liver Tremor)
What is Stigmata of Chronic Liver Disease?
Signs of Chronic Liver Disease, including:
- Spider Naevi
- Gynaecomastia
Why might Ascites occur?
Due to the decomposition of the Liver
Why might Asterixis (Liver Tremor) occur?
Due to the inability of the Liver to process Ammonia / Urea, and its effect on the Brain
What is a major risk factor for Liver Disease?
Intra-Venous Drug Abusers (IVDA’s)
What are some Clinical Features of Post-Hepatic Jaundice?
- A Palpable Gallbladder
- Abdominal Pain
- Cholestasis Signs
What is a Palpable Gallbladder also known as?
Courvoisier’s Sign - This could also be due to Hepatomegaly / Pancreatic Carcinoma
Why might there be Abdominal Pain in Post-Hepatic Jaundice?
Due to the increased pressure within the Liver
What are Cholestasis Signs?
- Pruritus (Itching)
- Pale Stools
- Dark Coloured Urine
What investigations are required for Jaundice?
- An Abdominal Ultrasound
- A Liver Screen
- A CT / MRI Scan
- An ERCP / MRCP
What is the purpose of the Abdominal Ultrasound?
To look for the Site and Cause of a Blockage
What is looked for in a “LIver Screen”?
- Hepatitis B and Hepatitis C Serology
- An Autoantibody profile, in the form of Immunoglobulins
- Alpha-1-Antitrypsin
- Fasting Glucose and Lipid Profile
- Ferritin and Transferritin Saturations
- Caeruloplasmin and Copper
What is the purpose of a CT / MRI scan?
To identify the cause of the Jaundice
What is the purpose of the MRCP / ERCP?
To view what could be causing the blockage - if Post-Hepatic
What does MRCP and ERCP stand for?
MRCP - Magnetic Resonance Cholangio-Pancreatography
ERCP - Endoscopic Retrograde Cholangio-Pancreatography
What is the treatment of Jaundice?
Treat the Underlying Cause
