General: Jaundice Flashcards
Outline the pathophysiology of jaundice
Yellow discolouration of the sclera and skin
Due to hyperbilirubinaemia (usually occurs at bilirubin levels >50 µmol/L)
Pre-hepatic = excessive RBC breakdown, overwhelms the liver’s ability to conjugate bilirubin
Intra-hepatic = dysfunction of the liver, loses ability to conjugate bilirubin
Post-hepatic = obstruction of biliary drainage
Discuss the aetiology of jaundice
Pre = autoimmune haemolytic anaemia
Intra = alcoholic liver disease, cirrhosis, viral hep, medication, autoimmune hep, primary biliary cirrhosis
Post = gallstones, cholangiocarcinoma, strictures, pancreatic cancer, abdo masses
How does jaundice present?
Yellowing of the skin
Yellowing of the sclera
Pruritus
Changes in stools/urine colour
Affects blood clotting = bilirubin effects liver function, vit K not produced appropriately
How should jaundice be investigated?
Bilirubin = quantify degree
Albumin = marker of liver synthesising function
AST and ALT = marks of hepatocellular injury
Alkaline phosphatase = raised in biliary obstruction
Gamma-GT = raised in biliary obstruction
Liver screen
US = identify obstructive pathology
MRCP = visual the biliary tree
Outline how jaundice should be managed?
Definitive treatment dependent on cause
Identify and manage any complications of liver failure where possible
Monitor for coagulopathy = treating promptly (Vitamin K or fresh frozen plasma)
Treat hypoglycaemia
What are the possible complications of jaundice?
Brain damage = bilirubin encephalopathy
Kernicterus = newborn brain damage
Cerebral palsy
What are the causes of painless jaundice?
Gallstones in the common bile duct
Pancreatic head carcinoma
What is a whipples procedure?
Pancreaticoduodenectomy
Removing the head of the pancreas