Jaundice Flashcards
What is jaundice already known as?
Icterus
What is jaundice?
A yellow discolouration of the skin and whites of the eyes due to high bilirubin levels
When does jaundice occur?
When serum bilirubin is >25-30mmol/L
What can jaundice be classified into?
- Unconjugated
- Intrahepatic
- Cholestatic (obstructive)
What are the causes of unconjugated jaundice?
- Excess bilirubin production
- Impaired liver uptake
- Thalassaemia
Give three examples of things causing excess bilirubin production leading to jaundice
- Haemolysis
- Sickle cell anaemia
- Impaired conjugation
Give two examples of causes of haemolysis
- Spherocytosis
- G6PD deficiency
Give two examples of impaired conjugation
- Gilbert synrome
- Crigler-Najjar syndrome
What is intrahepatic jaundice due to?
Hepatocyte damage, with or without cholestasis
What is found on bloods in intrahepatic jaundice?
Unconjugated or mixed hyperbilirubinaemia
What are the categories of causes of intrahepatic jaundice?
- Infections
- Toxins
- Metabolic
- Biliary hypoplasia
- Cardiovascular
- Autoimmune
What infections can cause intrahepatic jaundice?
- Viral hepatitis, including chronic hepatitis
- Bacterial hepatitis
- Toxoplasma gondii
What toxins can cause intrahepatic jaundice?
- Drugs or poisons
- Fungi
Give 4 examples of drugs that can cause intrahepatic jaundice?
- Paracetamol (in overdose)
- Sodium valproate
- Anti-TB drugs
- Cytotoxic drugs
What metabolic disorders can cause intrahepatic jaundice?
- Galactosaemia or hereditary fructose intolerance
- Wilson’s disease
- Alpha-1 anti-trypsin deficiency
- Hypothyroidism
What can biliary hypoplasia be subdivided into?
- Syndromic
- Non-syndromic
Give an example of a syndromic cause of biliary hypoplasia
Alagille syndrome
What autoimmune disorders can cause intrahepatic jaundice?
Autoimmune hepatitis
What are the causes of cholestatic (obstructive) jaundice?
- Biliary atresia
- Choledochal cyst
- Primary sclerosing cholangitis
- Cholelithiasis
- Cholecystitis
- Cystic fibrosis
- Obstructive tumours or cysts
What is the main presenting feature of jaundice?
Yellowing of whites of eyes or skin
What are the other features of jaundice?
- Itchy skin
- Darker urine
- Pale stools
What needs to be included in the history for jaundice?
- Medications
- Family history
- Overseas travel
- Past blood transfusions
What needs to be checked for on examination in jaundice?
- Vital signs
- Hepatic stigmata of chronic liver disease
- Hepatomegaly or splenomegaly
- Peripheral oedema
What will further investigations in jaundice depend on?
Findings on history and examination
What might further investigation include in jaundice?
- FBC, blood film, and reticulocyte count
- Coagulation studies
- U&Es, SBR (total and unconjugated), LFTs, albumin, total protein
- TFTs
- Viral serology
- Abdominal ultrasound, or CT/MRI
- Liver biopsy
What is the management for jaundice?
- Remove or treat underlying cause
- Treat any associated abnormalities
- Phototherapy may be helpful
What associated abnormalities may need to be treated in jaundice?
- Blood glucose
- Clotting
- Liver failure
When is phototherapy useful in jaundice?
Only when there is a significant unconjugated component, e.g. Criger-Najjar syndrome
Add kernicterus
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