GI - 4.5 Jaundice

Question 1

What is jaundice?

Answer 1

A state characterized by increased serum bilirubin

Yellow appearance due to deposition of bile pigment in the skin and mucous membranes

Question 2

What is Bilirubin? Where does it come from

Answer 2

Bilirubin is a waste product of hgb metabolism .

Therefore more RBC = more Bilirubin

Question 3

What causes clinical jaundice?

Answer 3

Marked increase in red cell destruction

Results in an increase in serum bilirubin and (if high enough) clinical jaundice

Question 4

What’s the metabolism from Hemoglobin - Urobilinogen? (7)

Answer 4

Hemoglobin -> bilirubin -> bound to albumin -> Transported to the plasma in liver cells -> Hepatocytes take up bilirubin and conjugate it to Glucoronide and excrete the Bilirubin Diglucoronide in bile into duodenum -> in bowel bacteria break down bilirubin into urobilonogen -> 80% in feces, 20% reabsorbed and excreted in bile and urine

Question 5

What causes jaundice?

Answer 5

There is a Functional or anatomic obstruction at any level in pathway results in increase in serum bili

Question 6

3 ways there may be an obstruction to cause jaundice

Answer 6

An obstruction in…
hemoglobin breakdown
uptake by the hepatocellular membrane
excretion into biliary system

Question 7

The causes of jaundice are usually identified as (4)

Answer 7

hemolysis
genetic defects in bilirubin handling
hepatocellular disease
obstruction

Question 8

Uncongugated bilirubinemia is also known as __. What is it?

Answer 8

Indirect. Breakdown products of hemoglobin (e.g., hemolytic anemia)
Impaired uptake and storage in the liver (not conjugated) (Gilberts, Crigler Najjar, drug reactions)

Question 9

decrease in glucoronyl transferase. high bili level, not high enough to be jaundice.

Answer 9

Gilberts. someone should know they have it, they should know so they know it’s not jaundice.

Question 10

Conjugated bilirubin is also known as ___. What is it?

Answer 10

Direct. Problem lies after the uptake and conjugation step

Question 11

Stool and urine color are normal
Mild jaundice
Indirect bili increased
Splenomegaly in hemolytic ds (except sickle cell)

Answer 11

Unconjugated (indirect) bilirubinemia

Question 12

Dark Urine and Light stools are main signs of

Answer 12

Conjugated (direct) bilirubinemia. Unconjugated’s stools and urine are normal

Question 13

retention of bile in liver

Answer 13

Cholestasis

Question 14

Conjugated hyperbilirubinemia due to impaired flow

Answer 14

Cholestatic jaundice

Question 15

Unconjugated bilirubin is a markedly increased in biliary tract obstruction.
True or False?

Answer 15

False