DSA 4: Approach to the Hepatobiliary Patient (Jaundice) Flashcards
Clinical jaundice is seen when bilirubin is?
Greater than 3 mg/dL
The initial steps in evaluating a pt with jaundice is to determine if the hyperbilirubinemia is?
Conjugated (Direct) or unconjugated (Indirect)
What labs should be ordered when a patient presents with jaundice?
1) AST/ALT
2) Total bilirubin
3) Alkaline phosphatase
What does a fractionated bilirubin lab tells us?
If its indirect or direct
If GGT is elevated the elevated ALP is most commonly coming from?
If it is normal?
1) Liver
2) Bone or placenta
With unconjugated hyperbilirubinemia, why do we order a CBC?
What do we order for possible schistocytes and sickle cells?
1) Anemia and thrombocytopenia from hemolysis
2) Peripheral smear
What causes the jaundice seen in Gilbert syndrome?
Unconjugated (Indirect) hyperbilirubinemia
What causes the jaundice seen in Dubin-Johnson syndrome and Rotor syndrome?
Conjugated (direct) hyperbilirubinemia
What is due to reduced excretory function of hepatocytes?
What is due to reduced hepatic reputka of bilirubin conjugates?
1) Dubin-Johnson syndrome
2) Rotor syndrome
What is seen pathologically in Dubin-Johnson syndrome?
1) Gallbladder doesn’t visualize on oral cholecystography
2) Liver darkly pigmented
3) Centrilobular brown pigment
What is seen pathologically in Rotor syndrome?
Similar to Dubin-Johnson but liver is not pigmented and the gallbladder is visualized on oral cholecystography
What causes the jaundice seen in intrahepatic cholestasis of pregnancy?
Conjugated (direct) hyperbilirubinemia
When does jaundice occur in intrahepatic cholestasis of pregnancy?
They are likely to occur due to?
1) Third trimester
2) Subsequent pregnancies or use of oral contraceptives
