Jaundice Flashcards
How are red blood cells converted to Unconjugated bilirubin @ Spleen
RBC -> HAEM and Globin
HAEM -> BILIVERDIN and Fe
BILIVERDIN -> UNCONJ. BILIRUBIN
How is Biliverdin converted to Unconj. Bilirubin
Biliverdin reductase
What is a RBC broken down into
Haem and Globin
What is haem broken down into
Biliverdin and Iron
Biliverdin reductase converts what to what
Biliverdin to unconj.Bilirubin
How does Unconj. Bilirubin travel to the liver
UCB binds to Albumin
Where is UCB converted to Con Biliribuin
Liver
How is UCB converted to Con B at the liver
UGT and Glucorinic Acid
Which enzyme is used to convert UCB to Con Bilirubin w/ the addition of Glucorininc acid
UGT
-UDP Glucoronyl Transferase
What does Con Bilirubin become at the colon
Urobilinogen by Colonic Flora
How does Con Bilirubin travel to Colon to become Urobilinogen
Via CBD
What are the two products of Urobilinogen at the colon
Stercobilin (Brown shit)
Urobilin (Yellow Piss)
What is jaundice also known as
Icterus
Why does jaundice present as yellowed skin and eyes
Accumulation of UCB and Con bilirubin
What are the three types of causes for jaundice
Pre hepatic (Haemolytic anaemia) Hepatic (Parenchymal disease) Post Hepatic (Billiary obstruction)
Pre hepatic jaundice is due to raised…….
UCB due to RBC Breakdown (Haemolytic)
Intrahepatic jaundice is due to raised……
UCB and Con Bilirubin
Post hepatic Jaundice is due to raised…..
Con Bilirubin due to Biliary obstruction
What are some anaemias responsible for Prehepatic jaundice
Haemolytic
- SCD and Malaria
- G6PDH deficiency
- Autoimmune
- Thalassemia
What are some parenchymal diseases responsible for Intrahepatic Jaundice
HCC ALD/NAFLD Hepatitis Rifampicin Gilbert syndrome
What is Gilbert Syndrome
Aut Recessive mutation of the UGT1A1 gene
-Defective UGT = Less Con Bilirubin
In Gilbert syndrome less Con Bilirubin is produced why
Mutated UGT1A1 gene = Defective UGT
What is the most common sign of Post hepatic Jaundice
Pale stool
Dark Urine
What are some Biliary tree pathologies responsible for Post hepatic Jaundice
Choleodocolithiasis (Stone in CBD) Pancreatic cancer Cholangiocarcinoma Ampicillin PBC and PSC Mirizzi Syndrome
What is Mirizzi syndrome
Gallstones in Gallbladder neck compressing the CBD
Why is there dark urine and pale stools in post hepatic/obstructive jaundice
Increased Con Bilirubin in blood / less in Intestine
- Sterocobilin (Pale)
- Urobilin (Dark)
What is the typical presentation of a patient with Gilbert syndrome
Young male with painless, sudden jaundice
What is the Courvoisier sign in Jaundice
Painless jaundice w/ Palpable Gallbladder
-Most likely Pancreatic Cancer/Cholangiocarcinoma
What is the Charcot’s triad
Fever
RUQ pain
Jaundice
Bilary colic presents with what symptom found in the Charcot’s triad
RUQ pain
What triad is present in a patient with Ascending cholangitis
Charcot (Fever RUQ Jaundice)
How can you differentiate a patient with cholecystitis and Ascending Cholangitis
Cholecystitis has no jaundice
What is the Reynold Pentad
Ascending Cholangitis
- Fever
- RUQ Pain
- Jaundice
- Confusion
- Hypotension
What is the Murphy sign
Tender RUQ
“breathe while pressing RUQ” Pain = Cholecystitis
How can Jaundice be investogated
Blood and LFT
Urine Bilirubin/Urobilinogen
USS
Urine bilirubin is raised in what instance
Post hepatic Jaundice
Urobilinogen is raised and lowered in what instances
Raised = Haemolysis Low = Intra and Post Hepatic
