jaundice

Question 1

what is bilirubin

Answer 1

Bilirubin is a breakdown product of normal haem catabolism.

Question 2

how is bilirubin excreted

Answer 2

Is excreted in the bile or urine.

Question 3

haem is broken down into what by heme oxygenate

what colour is this- bruise

happens in macrophage

Answer 3

biliverdin

green - which is why you bruise goes green

biliverdin reductase converts it into bilirubin

Question 4

Bilirubin is conjugated within the hepatocyte to …… …… by a family of enzymes, termed uridine-diphosphoglucuronic glucuronosyltransferase (UDPGT).

Answer 4

glucuronic acid

males it water soluble

Question 5

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.

Answer 5

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)

Question 6

causes of raiased unconguagted bilirubin

liver tap dad analogy

Answer 6

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

Question 7

what Gilbert’s syndrome

resulting in

Answer 7

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

Question 8

causes of raised conjugated bilirubin

Answer 8

• biliary obstruction – extrahepatic cholestasis- can’t get out liver
• liver disease (intrahepatic cholestasis) – bilirubin transport ability affected

Question 9

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

Answer 9

pre hepatic and hepatic jaundice

Question 10

is splenomegaly present in post hepatic jaundice

Answer 10

no

Question 11

ALP and ALT and AST are normal in pre hepatic jaundice what are they in hepatic and post hepatic jaundice

Answer 11

raised

Question 12

stool colour is normal in pre hepatic jaundice what about in hepatic and post

Answer 12

pale

urine colour gets more dark

Question 13

commonest cause of post hepatic jaundice

how do you distinguish from the causes

Answer 13

gallstones - painful
then pancreatic cancer - often painless

abrnoaml biliary tree

Question 14

hepatic jaundice will show normal biliary tree what are the acute causes

Answer 14

viral hepatiis
drugs
autoimmune
decompensated cirrhosis’s due to liver failure

Question 15

causes of cirrhosis

Answer 15

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

Question 16

what does a high INR mean

Answer 16

When the INR is higher than the recommended range, it means that your blood clots more slowly than desired

Question 17

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

Answer 17

gilberts

pancreatic cancer?

– gallstoens in common bile duct

– hepatitis for sure maybe e and acute

decompensated cirrhosis

Question 18

what is the child-pugs score

Answer 18

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.

Question 19

what two infection are most common at brith pathogen

what to you give to treat

Answer 19

E.coli and strep B

gentamicin cover the streps
aminoglycosdies - gram negative

these two work together in tandem

Question 20

what are the two major side effects of gentamicin

Answer 20

ototoxicity and nephrotoxicity

Question 21

why is high levels of uncojuagted bilirubin dangerous in the newborn

Answer 21

High levels of bilirubin can travel to your baby’s brain. This can cause seizures and brain damage. This is called kernicterus.

Question 22

what is kernicterus and what can it cause

Answer 22

high levels of bilirubin
leading to cerebral palsy and hearing loss
also cause problems with vision and teeth and sometimes can cause intellectual disabilities

Question 23

initial symptoms of kernicterus

Answer 23

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.

Question 24

yellow staining of the basal ganglia found at autopsy of severely jaundiced infants who died with severe erythroblastosis fetalis.

Answer 24

kernicterus

Question 25

treatment for kernicterus

Answer 25

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

Question 26

what causes jaundice of newborn

Answer 26

haemolytic disease - rhesus and ABO incompatibility

ventouse or forceps delivery - bruising on the head

Question 27

delayed umbilical cord clamping is associated with significant neonatal benefits such as

Answer 27

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.

Question 28

what does a positive Coombes test mean

antibodies against what

Answer 28

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)

Question 29

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

Answer 29

breast milk jaundice after 2 weeks of birth

Question 30

pale stools due to reduced what

Answer 30

sterobilin

Question 31

ALP is a good marker of what

Answer 31

biliary obstruction

Question 32

AST and ALT are good markers of

Answer 32

hepatocellualr injury