Jaundice

Question 1

What are reticuloendothelial cells?

Answer 1

macrophages which are responsible for the maintenance of the blood, through the destruction of old or abnormal cells

Question 2

What is the role of reticuloendothelial cells?

Answer 2

take up red blood cells and metabolise the haemoglobin present into its individual components; haem and globin

Question 3

What is globin broken down into?

Answer 3

amino acids which are subsequently recycled

Question 4

What is haem broken down into?

Answer 4

iron and biliverdin, a process which is catalysed by haem oxygenase

Question 5

What happens to the iron and bilverdin?

Answer 5

1. iron gets recycled

2. biliverdin is reduced to create unconjugated bilirubin

Question 6

What happens to the unconjugated bilirubin in the bloodstream?

Answer 6

binds to albumin to facilitate its transport to the liver

Question 7

What happens to unconjugated bilirubin in the liver?

Answer 7

glucuronic acid is added to unconjugated bilirubin by the enzyme glucuronyl transferase forming conjuagted bilirubin

Question 8

What happens to the conjugated bilirubin?

Answer 8

• it is soluble

- excreted into the duodenum in bile.

Question 9

What happens to the conjugated bilirubin in the colon?

Answer 9

colonic bacteria deconjugate bilirubin and convert it into urobilinogen

Question 10

What happens to 80% of urobilingoen?

Answer 10

1. oxidised by intestinal bacteria and converted to stercobilin and then excreted through faeces
2. stercobilin which gives faeces their colour

Question 11

What happens to 20% of urobilinogen?

Answer 11

reabsorbed into the bloodstream as part of the enterohepatic circulation and taken to liver and some to kidneys

Question 12

What happens to the urobilingoen in the kidneys?

Answer 12

oxidised further into urobilin and then excreted into the urine

Question 13

What are the pre-hepatic causes of jaundice?

Answer 13

1. Haemolysis

2. Gilberts syndrome

Question 14

What is gilberts syndrome?

Answer 14

UDPGT not effecting as usual at conjugating bilirubin (common)

Question 15

What are the signs of pre-hepatic jaundice?

Answer 15

normal urine or dark in haemolysis

Question 16

What type of bilirubin is there in pre-hepatic jaundice?

Answer 16

unconjugated

Question 17

What levels are raised in pre-hepatic jaundice?

Answer 17

only bilirubin

Question 18

What are the causes of hepatocellular jaundice?

Answer 18

1. Hepatitis: viral, alcoholic, AI, drug
2. Hepatocyte damage/hepatic picture
3. Cirrhosis

Question 19

What do blood tests show in hepatocellular jaundice?

Answer 19

Raised AST/ALT

Question 20

What are causes of obstructive jaundice?

Answer 20

1. Liver mass
2. Gallstone
3. PBC/PSC
4. Pancreatic cancer
5. Cholangiocarcinoma/GB cancer
6. Drug (ileus)

Question 21

What type of bilirubin is common in obstructive jaundcie?

Answer 21

conjugated bilirubin

Question 22

What are the signs in obstructive/cholestasis jaundice?

Answer 22

1. Dark urine (conj bilirubin going into urine)
2. pale stools (lack of stercobilin)
3. pruritus (bile salts into circulation)

Question 23

What are blood test results in obstructive jaundice?

Answer 23

1. Raised ALP/GGT

2. Bile duct damage/obstructive picture

Question 24

Why does urine turn dark>

Answer 24

when conjugated bilirubin (which is dark) gets into it, i.e., when there is some form of hepatocellular or post-hepatic jaundice

Question 25

Why is there itching in obstructive jaundice?

Answer 25

bile salts produced in the liver are also blocked from entering the duodenum so they leak into the circulation and causing itching (pruritus), which make be accompanied by scratch marks

Question 26

What are symptoms of Gilbert's?

Answer 26

healthy just turn jaundice in times of stress

Question 27

Where is bile produced?

Answer 27

hepatocytes in the liver

Question 28

Where is bile stored?

Answer 28

travels via hepatic ducts to gallbladder

Question 29

How does Bile enter the small intestine?

Answer 29

contractions of the gallbladder facilitate delivery of bile into the duodenum through the Ampulla of Vater

Question 30

What is the main function of bile?

Answer 30

emulsify fats to allow digestion and absorption – a lack of bile salts will therefore cause malabsorption of lipids which includes fat soluble vitamins such as ADEK

Question 31

What is the anatomical duct situation?

Answer 31

1. left and right hepatic ducts fuse to form common hepatic duct 2. common hepatic duct fuses with cystic duct (that comes from gallballder) to form the common bile dict

Question 32

What does the common bile duct fuse with?

Answer 32

fuses with the main pancreatic duct which carries other enzymes needed for digestion and this flows into duodenum

Question 33

What are causes of post-hepatic Jaundice?

Answer 33

1. Gallstones 2. Cholangitis 3. Pancreatic cancer 4. Bile duct cancer 5. PBC/PSC