65. Jaundice

Question 1

jaundice ?

Answer 1

abnormal yellowing of skin and / or sclera due to bilirubin deposition

Question 2

mechanism of jaundice

Answer 2

hyperbilirubinemia 2ry to increased production or decreased disposition ( impaired hepatic uptake, conjugation, excretion )

Question 3

bilirubin levels
total:
direct:
indirect:
jaundice:

Answer 3

total: 0.1-1 mg/dL
direct: 0-0.3 mg/dL
indirect: 0.2-0.7 mg/ dL
jaundice: more than 2.5 mg /dL

Question 4

jaundice types according to bilirubin

Answer 4

1. uncojugated ( indirect) hyperbilirubinemia
2. cojugated ( direct) hyperbilirubinermia
3. mixed ( direct and inderect) hyperbilirubinemia

Question 5

causes of uncojugated ( indirect) hyperbilirubinemia

Answer 5

1. hemolytic
2. physiology
3. Cringler Najjar
4. Gilbert syndrome

Question 6

causes of cojufated ( direct) hyperbilirubinemia

Answer 6

1. Biliary tract obstruction ( gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke)
2. Biliary tract disease ( 1ry sclerosing cholangitis, 1ry biliary cirrhosis)
3. excretion defect ( Dubin - Johnson syndrome, Rotor syndrome)

Question 7

causes of mixed ( direct and indirect ) hyperbilirubinemia

Answer 7

1. Hepatitis

2. Cirrhosis

Question 8

• Is the hyperbilirubinemia of an intrahepatic process (such as hepatitis or cirrhosis) conjugated, unconjugated, or mixed?

Answer 8

This is mixed (direct and indirect) hyperbilirubinemia

Question 9

• Lab results show high direct and indirect bilirubin levels. Is this process conjugated, unconjugated, or mixed?

Answer 9

This is mixed (direct and indirect) hyperbilirubinemia

Question 10

• Is the hyperbilirubinemia of biliary tract obstruction conjugated, unconjugated, or mixed?

Answer 10

This is conjugated (direct) hyperbilirubinemia

Question 11

• Labs show high direct bilirubin and normal indirect bilirubin levels. What types of biliary disease process might cause this?

Answer 11

Obstructive processes such as primary sclerosing cholangitis or biliary cirrhosis (this is a conjugated [direct] hyperbilirubinemia)

Question 12

• A 5-day-old infant has persistent hyperbilirubinemia despite phototherapy. Is it likely conjugated, unconjugated, or mixed?

Answer 12

This is unconjugated (indirect) hyperbilirubinemia, likely due to hemolysis

Question 13

• Labs show high indirect bilirubin levels. Does this represent a conjugated, unconjugated, or mixed hyperbilirubinemia?

Answer 13

Unconjugated (indirect) hyperbilirubinemia

Question 14

• A patient with Dubin-Johnson syndrome comes in to your office. What type of hyperbilirubinemia does she have?

Answer 14

Conjugated (direct) (Dubin-Johnson is a defect of bile excretion)

Question 15

• A patient presents with Crigler-Najjar syndrome. What sort of hyperbilirubinemia does she have?

Answer 15

Unconjugated (indirect) (Crigler-Najjar is a defect of conjugation)

Question 16

• Name some causes of an unconjugated (indirect) hyperbilirubinemia.

Answer 16

Hemolysis, physiologic (newborns), Crigler-Najjar syndrome, Gilbert syndrome

Question 17

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to biliary tract obstruction.

Answer 17

Gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver flukes

Question 18

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to biliary tract disease but are not obstructive.

Answer 18

Primary sclerosing cholangitis, primary biliary cirrhosis

Question 19

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to bile excretion defects.

Answer 19

Dubin-Johnson syndrome, Rotor syndrome

Question 20

• A newborn has persistent hyperbilirubinemia despite phototherapy. What type of bilirubinemia supports a diagnosis of Dubin-Johnson syndrome?

Answer 20

Conjugated hyperbilirubinemia (Dubin-Johnson is a defect of hepatic excretion of bile)

Question 21

• What physiologic process is defective in patients with Dubin-Johnson syndrome?

Answer 21

Excretion of bilirubin from hepatocytes

Question 22

• A patient has defective excretion of direct bilirubin. Gross pathology shows a black liver. Diagnosis?

Answer 22

Dubin-Johnson syndrome, which has the characteristic black liver on gross pathology