Jaundice

Question 1

What is bilirubin ?

Answer 1

Breakdown product of haem

Question 2

How is bilirubin excreted?

Answer 2

Bile or urine

Question 3

How is bilirubin formed?

Answer 3

Haem -> biliverdin -> bilirubin

Question 4

What is conjugation?

Answer 4

bilirubin conjugated with glucuronic acid which makes it soluble in water, this occurs in liver

Question 5

Pathway for bilirubin excretion

Answer 5

Bilirubin → liver → conjugation → bile duct → gut → glucuronic acid removed by bacteria → stercobilinogen → stercobilin

Question 6

Causes of rising unconjugated bilirubin

Answer 6

• Too much bilirubin due to excess haem breakdown (major haemorrhage or haemolysis - autoimmune haemolysis or malformed RBCs)
• Heart failure with portal fusion
• Drugs block uptake of bilirubin into liver - rifampicin
• Impaired bilirubin conjugation: Gilbert’s, Crigler-Najjar and liver disease

Question 7

Causes of rising conjugated bilirubin

Answer 7

Biliary obstruction (extra hepatic) and liver disease (intrahepatic)

Question 8

What are we looking for o/e

Answer 8

• Spider naevi
• Prominent veins
• Distended abdomen with ascites
• Palmar erythema
• Measure albumin and bilirubin

Question 9

Causes of post-hepatic jaundice

Answer 9

Pancreatic cancer
Gallstones
Primary sclerosis cholangitis
Cholangiocarcinoma

Question 10

Hepatic jaundice causes

Answer 10

Hepatitis, drugs, autoimmune
Cirrhosis, alcohol
Ascites

Question 11

Lab results for pre-hepatic jaundice

Answer 11

Increased total bilirubin, normal conjugated but increased unconjugated
Normal urine and stool colour
Normal ALP and ALT
Splenomegaly

Question 12

Lab results hepatic jaundice

Answer 12

Increased total bilirubin 0 increased conjugated and unconjugated
Dark urine but pale stools
Increased ALP and ALT

Question 13

Lab results post-hepatic jaundice

Answer 13

Increased conjugated bilirubin and normal unconjugated
Dark urine and pale stools
Increased ALP and ALT

Question 14

Increased ALP and ALT