CHOUD-BSC GI phys Flashcards
What are the 4 steps of bilirubin transfer
hepatocellular uptake, intracellular binding, conjugation, biliary excretion
Mutations in the multidrug resistance associated protein 2 result in what syndrome
dubin johnson
what can lead to unconjugated hyperbilirubinemia
excessive production of bilirubin, reduced hepatic uptake
impaired conjugation
what can lead to conjugated hyperbilirubinemia
decreased hepatocellular excretion
impaired bile flow (intra and extra hepatic)
What are some disorders that lead to pre-hepatic jaundice
malaria, sickle cell anemia, thalassemia, G6PD deficiency, autoimmune, drugs or toxins
What are some causes of hepatic jaundice
hepatitis ABC yellow fever
bacterial sepsis, TB, alcohol, birth control, carcinoma, lymphoma, pre-operative hypo perfusion/shock, chronic active hepatitis
What are cuases of intra hepatic obstruction that lead to post hepatic jaundice
biliary atresia, primary biliary cirrhosis, malignant infiltration of ducts
What are causes of extra hepatic obstuction that lead to post hepatic jaundice
gallstones in bile ducts cancer strictures of bile ducts pressure on common bile duct from enlarged lymph nodes cholangitis pancreatitis
What is physiologic neonatal jaundice
massive fetal hemoglobin lysis shortly after birth because low UDPGT levels and the intestinal flora of a newborn is underdeveloped
unconjugated bilirubin levels rise about 2-5 days
What is breast milk jaundice
jaudive in breast-feeding newborns at end of first week, there are chemicals in breast milk that inhibit UDPGT
Describe physical findings in pre-hepatic jaundice
no bilirubin in urine, stool and urine are a darker color
spenomegaly with hemolytic disorders
Describe physical findings in hepatocellular (hepatic jaundice)
dark urine, low grade fever, RUQ discomfort
hepatomegaly
Describe physical findings in post-hepatic jaundice
RUQ pain, dark urine, pale stool
intermittent signs and symptoms caused by stones or carcinoma
occult blood in stool–>cancer of ampulla
hepatomegaly and palpable gall bladder
What is the usualy total serum bilirbuin number
<1mg/dL
What type of bilirubin is increased with each type of jaundice
pre-hepatic- unconjugated
hepatic- both types
post-hepatic both types
If alkaline phosphatase is increased which type of jaundice can be eliminated
pre-hepatic
when urine bilirubin and urobilinogen are both increased what type of jaundice can be suspected
hepatic jaundice
when urine bilirubin is increased and there is no urobilinogen which jaundice can be suspected
post hepatic
can a single test differentiate between various classifications of jaundice
no need a combination
Which type of jaundice is there splenomegaly
pre and intra hepatic
ALT and ASP levels are increased in which types of jaundice
hepatic and post-hepatic
antimalarial drugs can show light on what disease
G6PD deficiency
what are the symptoms of hemolysis
malaise, weakness, abdominal or lumbar pain
To determine G6PD what labs do you order
actual enzyme activity of G6PD
CBC with reticulocyte count to determine levels of anemia and bone marrow function
urinary urobilinogen
bilirubin levels to see if there is high unconj bilirubin
What is the Tx for G6PD
discontinuation of precipitating agent
O2 therapy
bedrest
blood transfusion
What can trigger G6PD deficiency
fava beans, antimalarials, antibiotics
elevated levels of amylase and lipase suggest what in someone with alcoholism
pancreatitis
What will a abdominal radiograph look like in a person with gallstones and secondary pancreatitis
gallstones and a “sentinel loop” which is a segment of air in the LUQ of small intestine
What type of imaging is used for gallstones
ERCP
What does phototherapy do in an infant
converts trans bilirubin to cis which is more water soluble
what type of light is used in phototherapy
blue light
