Icterus Flashcards
What are your differentials for prehepatic hyperbilirubinemia?
(Prehepatic = excessive RBC destruction → immune-mediated, toxin, and post-transfusion)
You have a patient that has hyperbilirubinemia and is icteric, what on your CBC might indicate it is prehepatic?
(Anemia)
What are some of the causes of hepatic hyperbilirubinemia?
(Toxicity, hepatitis, cirrhosis (rare), end-stage portosystemic shunts, microvascular dysplasia, secondary injury (such as hepatic lipidosis), and congenital deficiencies (such as copper storage dz))
What are some of the causes of post-hepatic hyperbilirubinemia?
(Biliary obstruction → gallbladder mucocele, cholelithiasis, pancreatitis, and tumors)
You have a patient that is icteric so obviously you run blood work and note hyperbilirubinemia and elevated ALT and AST values, is it prehepatic, hepatic, or post-hepatic?
(Hepatic, this would have just given it away but would probably also see decreased pseudofunction analytes (glucose, BUN, cholesterol, albumin))
You have a patient that is icteric so obviously you run blood work and note hyperbilirubinemia and elevated ALP values, is it prehepatic, hepatic, or post-hepatic and what further diagnostics might be especially helpful in confirming it?
(Post-hepatic, and ultrasound is good for post hepatic as you can look for a distended common bile duct)