Jaundice Flashcards
what is the definition of jaundice?
Jaundice (icterus) is the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes.
what is the epidemiology of jaundice?
Approximately 40,000 per 100,000 individuals of intensive care unit patients. Neonatal jaundice is more common among Asian and mixed Asian/white infants than white infants. Hepatocellular jaundice mainly from viral hepatitis commonly affects young patients
what is the aetiology of jaundice?
Jaundice might result from increased bilirubin production (prehepatic), diseases that impair hepatocyte function (hepatocellular), or obstruction of the biliary system (cholestatic).
what are the risk factors for jaundice?
biliary disease/intervention malignancy heart failure Autoimmune disease Alcohol misuse Unsafe sex Drug misuse
what is the pathophysiology of jaundice?
Increased red blood cell destruction or impaired bilirubin conjugation causes elevated unconjugated (indirect) bilirubin levels, whereas hepatocellular damage or biliary tract obstruction causes elevated conjugated (direct) bilirubin levels
Prehepatic (unconjugated) - haemolysis, gilberts
Hepatic (conjugated) - hepatitis HIV, parasitic infections,leptospirosis, toxins, ischemia, neoplasm, congestion, autoimmune, wilson’s disease, haemochromatosis
Post-hepatic (conjugated) - gallstones in common bile duct (Choledocholithiasis), inflammatory, stricture (cancer or inflammatory or ischaemic, after surgery)
what are the key presentations of jaundice?
Yellow discoloration of sclera, skin and mucous membranes
what are the signs of jaundice?
Anorexia, yellow discolouration
what are the symptoms of jaundice?
biliary pain, rigors, abdomen swelling, weight loss, pale stools, dark urine, Pruritus
what are the first line and gold standard investigations for jaundice
Urine - Normal(pre), Dark (hep or post)
Stools - Normal (pre), May be pale (hep or post)
Itching - No (pre), Maybe (hep or post)
Liver tests - Normal (pre), Abnormal (hep or post)
Liver enzymes: Very high AST/ALT suggests liver disease, some exceptions
Biliary obstruction: 90% have dilated intrahepatic bile ducts on ultrasound
Need further imaging:
CT, Magnetic resonance cholangiography MRCP, Endoscopic retrograde cholangiogram ERCP
what are the differential diagnoses for jaundice?
Alcoholic liver disease Choledocholithiasis Hepatitis A Hepatitis B Gilbert's syndrome Hepatitis E Hepatitis D Leptospirosis
how is jaundice managed?
Treat underlying cause
how is jaundice monitored?
Regular liver enzyme tests
what are the complications of jaundice?
bleeding anemia infections abdominal bloating swelling of legs liver failure kidney failure constipation
what is the prognosis fo jaundice?
The prognosis for individuals with jaundice depends on the underlying cause of the condition
