Approach to jaundice

Question 1

2 main types of bili

Answer 1

1. unconjugated - indirect

2. conjugated - direct - from liver

Question 2

3 Classes of high indirect

Answer 2

1. high production
   - hemolysis
   - hemolysis from drugs
2. low uptake
   - drugs
   - CHF
3. poor conjugation
   - gilbert
   - crijler-najjar

Question 3

***4 classes of high direct and causes

Answer 3

1. poor excretion
2. hepatocellular damage**
   - viral hep.
   - alco
   - drugs
   - sepsis
3. intrahepatic cholestasis
   - infiltrations
   - drugs
4. biliary obst.
   - gall stones
   - bilde duct carcinoma
   - panc.

Question 4

5 lab signs of failure

Answer 4

1. INR up
2. bili up
3. creat up
4. low alb
5. low glucose

Question 5

4 clinical signs

Answer 5

1. confusion
2. jaundice
3. GI bleeds
4. ascites

Question 6

5 conditions that make very high AST/ALT

Answer 6

1. Hep A
2. Hep B
3. drugs
4. autoimmune
5. vascular liver disease

Question 7

2 causes of moderately high AST/ALt and bad synthetics

Answer 7

1. cirrhosis

2. liver failure

Question 8

***5 causes of very high ALT >1000

Answer 8

1. viral
2. drugs
3. autoimmune
4. vascular
5. stones

Question 9

5 causes of mod high ALT/AST (200-500)

Answer 9

1. alc
2. viral
3. wilsons
4. hemochrom
5. NASH

Question 10

what does AST/ALt indicate

Answer 10

hepatocellular damge

Question 11

what does total bili mean

Answer 11

obs or cholestasis

Question 12

what does ALP mean

Answer 12

obs or cholestasis

Question 13

what does INR/albumin mean

Answer 13

synthesis

Question 14

ways to assess liver

Answer 14

1. fibroscan

2. Bx - gold standard

Question 15

6 major complications of cirrhosis

Answer 15

1. encephalopathy
2. Ascites
3. SBP
4. portal HTN
5. hepatorenal syndrome
6. variceal bleeds