jaundice

Question 1

what is jaundice ?

Answer 1

yellowish discoloration of the skin and sclera due to buildup of bilirubin in the blood

Question 2

at what level does does the yellow discoloration start to appear ?

Answer 2

when the bilirubin exceeds 40 Umol/l

2.5mg/dl

Question 3

what is unconjugated bilirubin ?

Answer 3

insoluble bilirubin

Question 4

what is conjugated bilirubin ?

Answer 4

soluble bilirubin

Question 5

where does bilirubin come from ?

Answer 5

catabolism of haem from the breakdown of haemoglobin

Question 6

what is insoluble bilirubinn bound to ?

Answer 6

albumin

Question 7

what is the enzyme that catalyzes the reaction between conjugated and unconjugated bilirubin ?

Answer 7

uridine diphophoglucuronosyl transferase

Question 8

how is stercobilinogen made ?

Answer 8

conjugated bilirubin is metabolized by colonic bacteria

Question 9

what is urobilinogen ?

Answer 9

a small amount of stercobilinogen is absorbed from the bowel, passes through the liver and is excreted in the urine

Question 10

what gives stool the brown colour ?

Answer 10

stercobillinogen

Question 11

in total obstruction what would the colour of stool be?

Answer 11

clay coloured , loon elte7ena aw el 7alawa because there is no stercobilinogen

Question 12

what are the causes of unconjugated hyperbilirubinaemia ?

Answer 12

excessive extrahepatic production

impaired conjugation/ impaired uptake

Question 13

what are the causes of conjugated hyperbilirubinemia ?

Answer 13

parenchymal liver disease

obstruction of the biliary system

Question 14

what are the possible causes of obstruction of the biliary system ?

Answer 14

such as cancer head of pancreas

Question 15

what are the presentations of bilirubin in liver cirrohsis ?

Answer 15

both direct and indirect bilirubin are high

Question 16

what is the most common cause of unconjugated hyperbilirubinemia ?

Answer 16

hemolytic jaundice

Question 17

what are the different types of jaundice ?

Answer 17

pre hepatic
hepatic
post hepatic

Question 18

what are the causes of pre haptic jaundice ?

Answer 18

haemolysis

congenital hyperbilirubinemia

Question 19

what is the presentation of congenital hyperbilirubinemia ?

Answer 19

isolated bilirubin rise without LFTs abnormality

Question 20

what is the most common form of non-haemolytic hyperbilirubinemia ?

Answer 20

Gilbert’s syndrome , diagnosis made by exclusion

Question 21

how does hepato-cellular jaundice happen ?

Answer 21

results from an inability of the liver to transport bilirubin into the bile as a consequence of parenchymal disease

Question 22

what can confirm that the cause of jaundice is hepato cellular?

Answer 22

if both direct and indirect bilirubin are high along with aminotransferase

Question 23

what are the causes of intrahepatic cholestasis ?

Answer 23

viral hepatitis 
drugs 
cirrohsis 
pregnancy 
autoimmune cholangitis

Question 24

what can be found in the urine inn cases of hepato-cellular jaundice ?

Answer 24

bilirubin in urine

Question 25

why would we ask for a CBC in a patient with bilirubin n?

Answer 25

to check for hemolysis

Question 26

what is an obstructive pattern ?

Answer 26

high GGT, alkaline phosphate and hyperbilirubinemia , mainly direct , mainly conjugated

Question 27

what is the next best step in management after confirming an obstructive pattern ?

Answer 27

perform an ultrasound and if still nothing appears perform an MRCP

Question 28

what is your first step in management after noticing a patient is jaundiced ?

Answer 28

ask for bilirubin

Question 29

after asking for bilirubin levels of the patient what other tests should be asked for ?

Answer 29

direct bilirubin - ask for ALP GGT then UC, MRCP
indirect bilirubin - look for heamolysis through a CBC
if biphasic - ask for ALT AST , bilirubin , INR, Albumin

Question 30

in obstructive jaundice which type of bilirubin is predominantly higher ?

Answer 30

indirect bilirubin

Question 31

where is urobilinogen absorbed from ?

Answer 31

enterohepatic circulation

Question 32

what is the typical presentation of a patient with gilbert’s syndrome ?

Answer 32

• bilirubin usually never exceeds 3
• defective uptake of indirect bilirubin
• with fasting bilirubin levels increase