approach to jaundice

Question 1

● Complete absence
of glucuronyl transferase
● Liver transplant
● Rare

Answer 1

type I crigler-najjar syndrome

Question 2

● Decreased activity
of glucuronyl transferase
● Phenobarbital
● More common

Answer 2

type II crigler najjar

Question 3

impaired conjugation/clearance of bilirubin

Answer 3

gilbert’s syndrome

Question 4

mutation in the promoter/coding region of UDPGT gene

Answer 4

gilberts syndrome

Question 5

Defect in the secretion of bilirubin glucuronides

into the bile canaliculus, chronic conjugated

Answer 5

dubin-johnson

Question 6

biopsy dubin johnson

Answer 6

dark brown, iron free, granules in liver and kupfer cells

Question 7

defect in intracellular binding of organic ions

Answer 7

rotor syndrome

Question 8

deficiency in major hepatic drug uptake transporters: OATP1B1 and OATP1B3

Answer 8

rotor

Question 9

Environmental toxin

Answer 9

(Vinyl Chloride, Jamaica

Bush Tea, Kava Kava, Wild Mushroom)

Question 10

(autoimmune,
predominantly middle-aged women – progressive
destruction of interlobar bile duct)

Answer 10

primary biliary cirrhosis

Question 11

(destruction

and fibrosis of larger bile duct)

Answer 11

primary sclerosing cholangitis

Question 12

may reflect rhabdomyolysis or
injury to organs (heart, skeletal muscle, kidneys,
pancreas)

Answer 12

Elevated AST

Question 13

Alcohol-related liver disease = AST to ALT

Answer 13

> 2

Question 14

> 500 IU/L; normal, < 40 IU/L

Answer 14

acute hepatocellular necrosis or injury, usually result from any of the following:
○ Acute viral hepatitis
○ Toxin – or drug- induced hepatitis
○ Ischemic hepatitis or hepatic infarction

Question 15

Modest elevations (300 to 500 IU/L)

Answer 15

cheinic liver disorders

Question 16

Stigmata of chronic liver disease

Answer 16

(spider nevi,
palmar erythema, gynecomastia, caput medusae,
Dupuytren’s contractures, parotid gland
enlargement, and testicular atrophy)

Question 17

which is the
golden standard for biliary stone especially when
there is an obstruction.

Answer 17

ercp

Question 18

common bile duct obstruction or stone. You need to refer them for ______

Answer 18

ct scan or mri

Question 19

destruction

and fibrosis of larger bile duct)

Answer 19

Primary sclerosing cholangitis

Question 20

wilson’s disease

Answer 20

ceruloplasmin- initial screening test