Jaundice Flashcards
Jaundice associated with RUQ pain & fever with a history of travel & food is most probably due to?
Hepatitis
What will be found in lab investigations of hepatitis patient presenting with jaundice?
- increase WBC -> lymphocytes
- AST in 1000s
- increase in total & direct bilirubin
What are the prehepatic causes of jaundice?
- HEMOLYSIS
- increased bilirubin production -> massive blood transfusions
- side effect of medication -> impaired hepatic uptake of bilirubin
What are the different etiologies of hemolysis leading to jaundice?
- G6PD deficiency
- structural defects: sickle cell anemia, hereditary spherocytosis
- autoimmune hemolytic anemia
- hemolytic transfusion reaction
How is autoimmune & non-autoimmune hemolysis differentiated?
COOMBS TEST
- if positive -> autoimmune
- if negative -> non-autoimmune
What findings will be seen in jaundice due to hemolysis?
- increased INDIRECT bilirubin
- reticulocytes > 45
- increase LDH
- decreased hepatoglobin
- anemia
What are the intrahepatic causes of jaundice?
- Gilbert syndrome -> impaired bilirubin conjugation (INDIRECT BILIRUBIN HIGH)
- hepatocellular injury -> MIXED indirect & direct bilirubin
(viral hepatitis, alcoholic hepatitis, NASH, cirrhosis, drug toxicity) - impaired hepatic excretion & intrahepatic cholestasis -> DIRECT BILIRUBIN
(intrahepatic biliary tract disorders -> primary biliary cholangitis & primary sclerosing cholangitis)
What are the post hepatic causes of jaundice?
- malignancy -> pancreatic head cancer, cholangiocarcinoma
- gallbladder & gallstone disease
- inflammation -> primary sclerosing cholangitis
- infection
How is Gilbert syndrome identified?
- fluctuating levels of bilirubin triggered by stress, strain, dehydration
- history of flu
What level does bilirubin have to reach so jaundice becomes apparent?
- serum bilirubin > 2 - 3 mg/dL -> scleral icterus
- serum bilirubin > 4 - 5 mg/dL -> skin discoloration
What clinical features are associated with cholestasis or post-hepatic?
- pale, clay colored stool
- dark urine
- pruritis
- fat malabsorption (steatorrhea)
- RUQ abdominal pain
- chronic biliary obstruction -> backflow of bile -> inflammation & hepatomegaly
What features are seen with jaundice due to hemolysis?
- pallor
- fatigue
- exertional dyspnea
What features are seen with jaundice due to liver failure?
- anorexia
- fatigue
- nausea
- abdominal pain
What is seen on labs of prehepatic jaundice?
- indirect bilirubin -> increased
- direct bilirubin, AST & ALT, ALP & GGT, & urinary bilirubin -> normal
- urinary urobilinogen -> increased
- stool color -> dark
What is seen on labs of intrahepatic jaundice?
- indirect bilirubin -> increased
- direct bilirubin -> increased
- AST & ALT -> increased
- ALP & GGT -> increased
- urine -> dark, increased bilirubin, normal or increased urobilinogen
- stool -> dark or pale
