General: Jaundice Flashcards

1
Q

Outline the pathophysiology of jaundice

A

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

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2
Q

Discuss the aetiology of jaundice

A

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

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3
Q

How does jaundice present?

A

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

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4
Q

How should jaundice be investigated?

A

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

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5
Q

Outline how jaundice should be managed?

A

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

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6
Q

What are the possible complications of jaundice?

A

Brain damage = bilirubin encephalopathy

Kernicterus = newborn brain damage

Cerebral palsy

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7
Q

What are the causes of painless jaundice?

A

Gallstones in the common bile duct

Pancreatic head carcinoma

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8
Q

What is a whipples procedure?

A

Pancreaticoduodenectomy

Removing the head of the pancreas

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