Icterus Flashcards
What is bilirubin?
Breakdown products of hemoglobin
How long does it take each cell line to break down?
RBC: 7 weeks
Platelet: 7 days
WBC: 7 hours
What is the pathophysiology of bilirubin?
Old RBC stripped for parts (hemoglobin valuable)
Hemoglobin released from RBC, Hem,(macrophages and monocyte) biliverdin (macrophages), unconjugated bilirubin (got to liver for conjugation), conjugated bilirubin then exits in bile
What are the 3 possible types of hyperbilirubinemia?
Pre-hepatic: before going to the liver, break down too many RBC
Hepatic: break down normal amount but liver struggling to conjugate
Post-hepatic: Right amount and liver working but there is a obstruction that prevents its exit into the gut
What are some causes of pre-hepatic hyperbilirubinemia? (hemolysis)
Immune Mediated (IMHA)
Toxic (Onion, Garilic, Zinc)
Post-transfusion (Poor match, older unit)
What are some causes of hepatic failure?
Toxicity- xylitol, algee, antifreeze, NSAID
Hepatic (infectious) - most vaccinated for
Chirrhosis (normal to scar tissue)
Portosystemic Shunt (End stage)
Microvascular Dysplasia (mini shunts)
Secondary Injury (hepatic lipidosis)
Congenital Defiecncies
What are some post hepatic causes of hyperbilirubinemia?
Obstruction
Gall Bladder Mucocele
Cholelithiasis
Pancreatitis
Tumors
What color MM is associated with hyperbilirubenimia?
Yellow or Jaundice
What color MM are associated with anemia?
Orange or pink
What is evidence for pre-hepatic hyperbilirubinemia?
Yellow
No anemia
What is evidence for hepatic damage?
Liver enzyme elevation
Leakage enzyme
pseudofunction analytes
History liver disease or injury
What do oragane MM mean?
Heaptic or post hepatic
What does the chemistry look like for:
Pre:
Hepatic:
Post:
Pre: Hyperbilirubinemia, liver normal
Hepatic: Hyperbilirubinemia, ALT rough, ALT and ALP lower than normal in end stage, ALT when hepatocyte die (confirm with bile acids and ammonia quantification)
Post: Hyperbilirubinemia
What is evidence of a post hepatic injury?
Belly pain
Liver enzyme elevation (ALT ALP)
Cholestatic enzyme
Imaging helps - kiwi on ultrasound
-See galbladder backed up and distended bile ducts
What are some diagnostics for a icteric patient?
PCV/TS or CBC (pre and post)
Blood Smear (Heinz, sphereocyte)
Chemistry (bilirubin)
Ammonia
Abdominal Rads (penny)
Abdominal Ultrasound (mineralization or gall bladder)
Other
What are signs that hyperbilirubinemia is an issue?
Nausea, aches, flu like, feel crumby
