71. Jaundice

Question 1

Unconjugated bilirubin builds up due to problems with over production of bilirubin or due to problems with conjugation. This is termed pre#-hepatic jaundice. Give some examples of this

Answer 1

Increased hemaolysis (DIC, malaria)
Impaired hepatic uptake (paracetamol, ischaemic hepatitis)
Impaired conjugation (Gilbert’s)

Question 2

Jaundice may also occur due to hepatocellular dysfunction. This is termed, hepatic jaundice. Give some causes of hepatic jaundice.

Answer 2

Viruses: hepatitis, CMV, EBV

Drugs: paracetamol TB drugs, MOA, statin, sodium valproate.

Cirrhosis

Liver metastasis/abscess

Question 3

What are some rare causes of hepatic jaundice?

Answer 3

Heamochromatosis
Sepsis
Syphillis
A1 anti-trypsin
Budd-chari syndrome (hepatic obstruction due to thrombosis)
Right heart failure

Question 4

Post hepatic jaundice occurs when there is reduced outflow and a build up is caused. This is also termed cholestasis. What can cause post hepatic jaundice?

Answer 4

PBC
PSC
gall stones
Pancreatic cancer
Compression
Cholangiocarcinoma

Question 5

What drugs may cause cholestasis?

Answer 5

Flucloxacillin
Co amox
Steroids
Sulfonylureas
Prochlorperazine
Chlorpromazine

Question 6

What would you look for in the examination of a patient with jaundice?

Answer 6

Chronic liver disease
Hepatic encephalopathy
Splenomegaly
Palpable gall bladder

Question 7

What test is completed to identify jaundice?

Answer 7

FBC, clotting film, reticulocyte count
U&E,LFT,GGT, albumin
Paracetamol levels
Hepatitis screen
USS
liver biopsy
CT/MRI

Question 8

What can cause jaundice in previously stable patients with cirrhosis?

Answer 8

Sepsis
Alcohol:drugs
Malignancy
GI bleeding