High bilirubin and Jaundice Flashcards
What are some causes of high Bilirubin?
Gallstones, hepatitis (viral, alcoholic), alcohol, haemolytic anemia, autoimmune hepatitis
Overall-pre-hepatic, hepatic and post hepatic
How would you check what is causing the Jaundice (hepatic/pre/post)?
Pre-hepatic-unconjugated-blood film and test for conjugation. FBC
Hepatic-conjugated-do LFT’s
Post hepatic-alk Phos (goes up with obstructive jaundice and USS
What disease causes worse Jaundice on fasting but overall totally normal everything?
Gilberts syndrome-common-recessive (50% carry gene, 6% chance of having it)
Clue is worse with fasting and normal rest -usually not too much bilirubin
Heamolytic aneamia could-but expect other signs
What enzyme is most representative of liver function?
Liver function-Bilirubin, Albumin (change SLOW) and clotting factors (prothrombin time change fast-best marker-correlate with the function)-if PT goes up more than 1s/h-ring liver unit
Liver damage-ALT/AST/ALKphos
What are the potential alcohol causes of high Bilirubin?
Usually more hepatic-viral hepatitis, alcoholic hepatitis, Cirrhosis
=>expect high LFT’s
Always consider less likely-Gallstones, pans cancer, heamolysis,
MOST common-alcoholic fatty liver hepatitis-
How does biochemistry give you clues of the cause of high Bilirubin?
High liver enzymes-usually hepatic
Very High Alk phos-tend to be post hepatic
If normal LFT-usually pre-hepatic
what are viral causes of high Bilirubin?
Hep A-oral transmission. Ill 5 weeks after eating, and transmit after 4 weeks. Kill or cure-very immune after
Hep B- IV drug-multiply quietly over 6 weeks-makes 2 AG (E and Surface)-E AB is only in live-not vaccine (if u find anti E AB-always has really had it). Vaccine with AntiHBs-
If see only antiHBs-vaccinated. Both-HBs&e-has head real
And some people never clear the virus-subclinical tho but infectious
What are the most common causes of alcoholic hepatitis?
most-alcoholic fatty liver disease
can also be Non-alcoholic fatty liver disease (usually fat-insulin resistance, etc)
What are treatment for Alcoholic fatty liver disease? Why?
Supportive-stop alcohol
nutrition-B1, thiamine, B12,
(usually too much alcohol so don’t eat enough). B1 lack causes Beri-beri
What is a common symptom of POST hepatic jaundice?
scratch marks/scratching-most of the time post hepatic (pancreatic cancer-painless or gallbladder-painful)
Because bile salts get reabsorbed as obstructed-bilirubin back in blood+salts => salts is what make you itch
in other jaundices-no salts (they go to poo fine, not reasbsorbed)
What are biochemical signs of obstructive jaundice
SKY high Alk phos
high bili
normal ash LFT
What is courvoisiers Law?
If in jaundice can feel the gallbladder-its probably pancreatic cancer (because in gallstones, gallbladder becomes small, fybrolised, not stretched)
Common causes of liver disease?
Alcohol, Autoimmune, drugs, Viral, Biliary
Common causes of Splenomegaly?
portal hyper tense, Hematological, infection, inflammation
What are the 3 ways to think of jaundice causes?
Pre hepatic-Heamolyisis, conjugation issues (Gilbert’s)=> unconjugated
Hepatitic-alcohol, autoimmune, drugs, viruses => dark urine , conjugated Bilirubin
Post hepatic-Gall stones, Cancer of head of pancreas-pale stools and dark urine
