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3: MED2 Y3 - Gastrointestinal [7] > [38] Jaundice > Flashcards

[38] Jaundice Flashcards

1
Q

What is the normal range of bilirubin?

A

3-17uM

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2
Q

At what bilirubin level is jaundice visible?

A

50uM

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3
Q

How is bilirubin produced?

A

Unconjugated bilirubin (uBR) is produced from the breakdown of haemoglobin by splenic macrophages

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4
Q

What happens to uBR produced by splenic macrophages?

A

It is converted to conjugated bilirubin (cBR) by BR-UDP-glucuronyl transferase in the liver

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5
Q

What happens to cBR after it has been produced in the liver?

A

It is secreted in the bile, then converted into urobilinogen

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6
Q

What colour is urobilinogen?

A

Colourless

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7
Q

What happens to urobilinogen in the GIT?

A

Some is reabsorbed

The urobilinogen that remains in the GIT is converted to stercobilin and excreted

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8
Q

What colour is stercobilin?

A

Brown

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9
Q

What happens to the urobilinogen that is reabsorbed into the liver?

A

It is returned to the liver and re-excreted into bile or urine

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10
Q

What causes pre-hepatic jaundice?

A

Excess bilirubin production

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11
Q

What can cause excess bilirubin production?

A

Haemolytic anaemia

Ineffective erythropoiesis

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12
Q

Give an example of something that can cause ineffective erythropoiesis

A

Thalassaemia

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13
Q

What are the categories of hepatic jaundice?

A

Unconjugated

Conjugated

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14
Q

What causes unconjugated hepatic jaundice?

A

Decreased bilirubin uptake

Decreased bilirubin conjugation

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15
Q

What can cause decreased bilirubin uptake?

A

Drugs

CCF

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16
Q

Give 2 examples of drugs that can cause decreased bilirubin uptake

A

Contrast

Rifampicin

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17
Q

What can cause decreased bilirubin conjugation?

A

Hypothyroidism
Gilbert’s
Crigler-Najjar

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18
Q

What causes neonatal jaundice?

A

Increased production and decreased conjugation of bilirubin

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19
Q

What causes conjugated hepatic jaundice?

A

Hepatocellular dysfunction

Decreased hepatic bilirubin excretion

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20
Q

What are the categories of causes of hepatocellular dysfunction leading to conjugated hepatic jaundice?

A 
Congenital 
Infection
Toxin
Autoimmune
Neoplasia
Vascular
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21
Q

What are the congenital causes of hepatocellular dysfunction?

A

Heriditary haemochromotosis
Wilson’s
Alpha 1 anti-trypsin deficiency

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22
Q

What are the infectious causes of hepatocellular dysfunction?

A

Hepatitis A/B/C
CMV
EBV

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23
Q

What are the toxic causes of hepatocellular dysfunction?

A

Alcohol

Drugs

24
Q

What are the autoimmune causes of hepatocellular dysfunction?

A

Autoimmune hepatitis

25
Q

What are the neoplastic causes of hepatocellular dysfunction?

A

Hepatocellular carcinoma

Mets

26
Q

What are the vascular causes of hepatocellular dysfunction?

A

Budd-Chiari

27
Q

What are the causes of decreased hepatic bilirubin excretion?

A

Dubin-Johnson

Rotor’s

28
Q

What causes post-hepatic jaundice?

A

Obstruction

29
Q

What can cause obstruction leading to post-hepatic jaundice?

A 
Stones
Pancreatic cancer
Drugs
PBC
PSC
Biliary atresia
Choledochal cyst (wtf is this????) 
Cholangiocarcinoma
30
Q

What are the mechanisms of drug-induced jaundice?

A

Haemolysis
Hepatitis
Cholestasis

31
Q

What drug causes jaundice through haemolysis?

A

Antimalarials, e.g. dapasone

32
Q

What drugs cause jaundice through causing hepatitis?

A 
Paracetamol (in overdose)
Rifampicin, isoniazis, pyramizide (idk how you spell it, its the TB one) 
Valproate
Statins
Halothene
MOAIs
33
Q

What drugs cause jaundice through causing cholestasis?

A 
Fluclox
Co-amox
OCP
Sulphonylureas
Chlopromazine
Prochloperazine
34
Q

What is Gilbert’s syndrome?

A

Partial UDP-GT deficiency

35
Q

What is the inheritance pattern of Gilbert’s syndrome?

A

Autosomal dominant

36
Q

What % of the population have Gilbert’s syndrome?

37
Q

When does jaundice occur in Gilbert’s syndrome?

A

During intercurrent illness

38
Q

How is a diagnosis of Gilbert’s syndrome confirmed?

A

Increased unconjugated bilirubin on fasting

Normal LFTs

39
Q

What is Crigler-Najjar syndrome?

A

Rare condition with total UDP-GT deficiency

40
Q

What is the inheritance pattern of Crigler-Najjar syndrome?

A

Autosomal recessive

41
Q

What does Crigler-Najjar syndrome result in?

A

Severe neonatal jaundice

Kernicterus

42
Q

How is Crigler-Najjar syndrome managed?

A

Liver transplant

43
Q

What is found on urine testing in pre-hepatic jaundice?

A

No bilirubin

Increased urobilinogen

44
Q

When is increased Hb seen in urine testing in pre-hepatic jaundice?

A

If intravascular haemolysis

45
Q

What will be found on LFTs in pre-hepatic jaundice?

A

Increased uBR
Increased AST
Increased LDH

46
Q

What other tests should be done in pre-hepatic jaundice?

A

FBC and film
Coombs test
Hb electrophoresis

47
Q

What is found on urine testing in hepatic jaundice?

A

Increased BR

Increased urobilinogen

48
Q

What is found on LFTs in hepatic jaundice?

A 
Increased cBR
Increased AST and increased ALT
Increased ALP
Decreased albumin
Increased prothrombin time
49
Q

What does a AST:ALT ratio of >2 indicate is the cause of hepatic jaundice?

50
Q

What does a AST:ALT ratio of <1 indicate is the cause of hepatic jaundice?

51
Q

What does increased GGT indicate is the cause of hepatic jaundice?

A

Alcohol or obstruction

52
Q

What other tests should be done in hepatic jaundice?

A

FBC
Anti-SMA, LKM, SLA, and ANA
Alpha1-AT, ferritin, and caeruloplasmin
Liver biopsy

53
Q

What may be found on FBC in hepatic jaundice?

54
Q

What is found on urine testing in post-hepatic jaundice?

A

Greatly increased bilirubin

No urobilinogen

55
Q

What is found on LFTs in post-hepatic jaundice?

A

Greatly increased cBR
Increased AST and increased ALT
Greatly increased ALP
Increased GGT

56
Q

What other investigations should be done in post-hepatic jaundice?

A

Abdominal US
ERCP and MRCP
Anti-AMA, ANCA, and ANA

57
Q

What may be found on abdominal US in post-hepatic jaundice?

A

Ducts >6mm

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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