jaundice Flashcards
what is bilirubin
Bilirubin is a breakdown product of normal haem catabolism.
how is bilirubin excreted
Is excreted in the bile or urine.
haem is broken down into what by heme oxygenate
what colour is this- bruise
happens in macrophage
biliverdin
green - which is why you bruise goes green
biliverdin reductase converts it into bilirubin
Bilirubin is conjugated within the hepatocyte to …… …… by a family of enzymes, termed uridine-diphosphoglucuronic glucuronosyltransferase (UDPGT).
glucuronic acid
males it water soluble
In the large intestine, bacteria break down bilirubin from the bile and convert it to urobilinogen and then into ……., which is responsible for the brown color of feces.
stercobilin
Conjugated bilirubin reacts rapidly with the diazosulfanic acid to create azobilirubin 0 this is how you measure it using spectrophotometry too. Unconjugated bilirubin requires the addition of an accelerator compound ( indirect bilirubin)
causes of raiased unconguagted bilirubin
liver tap dad analogy
Overproduction
- Intra and extravascular haemolysis – haemorrhage
- Extravasation of blood into tissues
- dysErythropoiesis
Impaired hepatic uptake
- heart failure – when the bilirubin does not get to the liver
- portosystemic shunts
- drugs such as rifampicin( what does it do) – TB – blocks uptake into the liver
impaired bilirubin conjugation
what Gilbert’s syndrome
resulting in
variation where the enzyme that conjugated bilirubin – resulting in higher conc of unconjugated bilirubin - Changes in the UGT1A1 gene cause Gilbert syndrome. This gene provides instructions for making the bilirubin uridine diphosphate glucuronosyltransferase (bilirubin-UGT)enzyme, which is found primarily in liver cells and is necessary for the removal of bilirubin from the body.
higher conc of uncognugated bilirubin normally
causes of raised conjugated bilirubin
- biliary obstruction – extrahepatic cholestasis- can’t get out liver
- liver disease (intrahepatic cholestasis) – bilirubin transport ability affected
total bilirubin is normally in all of pre-hepatic, hepatic and post hepatic jaundice
conjugated bilirubin is only increased in hepatic and post hepatic when I suncognugated bilirubin raised
pre hepatic and hepatic jaundice
is splenomegaly present in post hepatic jaundice
no
ALP and ALT and AST are normal in pre hepatic jaundice what are they in hepatic and post hepatic jaundice
raised
stool colour is normal in pre hepatic jaundice what about in hepatic and post
pale
urine colour gets more dark
commonest cause of post hepatic jaundice
how do you distinguish from the causes
gallstones - painful
then pancreatic cancer - often painless
abrnoaml biliary tree
hepatic jaundice will show normal biliary tree what are the acute causes
viral hepatiis
drugs
autoimmune
decompensated cirrhosis’s due to liver failure
causes of cirrhosis
alcohol , HCV, HBV , NAFLD( metabolic syndrome due to diabetes and obesity) – patient will have confusion due to hepatic encephalopathy
other causes of this PBC, PSC , autoimmune, haemochromatosis, a
what does a high INR mean
When the INR is higher than the recommended range, it means that your blood clots more slowly than desired
causes of jaundice
18yr old asymptomatic
78yr old man painless jaundice
48 women fever, rigors, epigastric pain , vomiting
21yr old medical students returns from elective
48yr old publican – alcohol and liver cirrhosis decompensated cirrhosis
gilberts
pancreatic cancer?
– gallstoens in common bile duct
– hepatitis for sure maybe e and acute
decompensated cirrhosis
what is the child-pugs score
The Child-Pugh score is a system for assessing the prognosis — including the required strength of treatment and necessity of liver transplant — of chronic liver disease, primarily cirrhosis.
what two infection are most common at brith pathogen
what to you give to treat
E.coli and strep B
gentamicin cover the streps
aminoglycosdies - gram negative
these two work together in tandem
what are the two major side effects of gentamicin
ototoxicity and nephrotoxicity
why is high levels of uncojuagted bilirubin dangerous in the newborn
High levels of bilirubin can travel to your baby’s brain. This can cause seizures and brain damage. This is called kernicterus.
what is kernicterus and what can it cause
high levels of bilirubin
leading to cerebral palsy and hearing loss
also cause problems with vision and teeth and sometimes can cause intellectual disabilities
initial symptoms of kernicterus
poor feeding. irritability. a high-pitched cry. no startle reflex. lethargy (sleepiness) brief pauses in breathing (apnoea) their muscles becoming unusually floppy, like a rag doll.
yellow staining of the basal ganglia found at autopsy of severely jaundiced infants who died with severe erythroblastosis fetalis.
kernicterus
treatment for kernicterus
Treatment depends on how old the baby is (in hours) and whether the baby has any risk factors (such as prematurity). It may include: Light therapy (phototherapy) Exchange transfusions (removing the child’s blood and replacing it with fresh donor blood or plasma)
thats why babies under blue light same as sunlight coverts the bilirubin into safer from
photoisomerase
what causes jaundice of newborn
haemolytic disease - rhesus and ABO incompatibility
ventouse or forceps delivery - bruising on the head
delayed umbilical cord clamping is associated with significant neonatal benefits such as
Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
what does a positive Coombes test mean
antibodies against what
An abnormal (positive) direct Coombs test means you have antibodies that act against your red blood cells. This may be due to: Autoimmune hemolytic anemia. Chronic lymphocytic leukemia or similar disorder. Blood disease in newborns called erythroblastosis fetalis (also called hemolytic disease of the newborn)
ß-glucuronidase is an enzyme naturally present in the body that deconjugates bilirubin in the intestinal brush border, leading to increased serum reabsorption instead of excretion
what can this cause
breast milk jaundice after 2 weeks of birth
pale stools due to reduced what
sterobilin
ALP is a good marker of what
biliary obstruction
AST and ALT are good markers of
hepatocellualr injury
