Jaundice

Question 1

accumulation of conjugated or unconjugated bilirubin in the blood, > 2 or 3 mg/dL

Answer 1

hyperbilirubinemia

Question 2

normal amount of bilirubin in the blood

Answer 2

< 1 mg/dL

Question 3

what causes jaundice or icterus

Answer 3

increased levels of bilirubin –> diffuses into tissues –> yellow discoloration of tissues

Question 4

Three major causes of jaundice

Answer 4

Pre-hepatic
Hepatic
Post-hepatic

Question 5

Jaundice caused by an excessive RBC breakdown

Answer 5

hemolytic jaundice

Question 6

Hemolytic Jaundice - findings in serum and why

Answer 6

Elevated serum levels of unconjugated (free) bilirubin (why: the body’s rate of conversion of Hb to UCB exceeds the rate of the liver to conjugate)
Slight increase in conjugated bilirubin (why: more CB than normal is formed by the liver and excreted into the gut)

Question 7

Is liver functioning normally during hemolytic jaundice?

Answer 7

yes

Question 8

Hemolytic jaundice - findings in urine

Answer 8

Free Hb in urine (clear red color)

Inc urobilinogen in urine

Question 9

Why does hemolytic jaundice cause hemoglobinuria?

Answer 9

Free Hb causes clear red urine because those Hb are still bound to O2

Question 10

Hemolytic jaundice - findings in feces

Answer 10

Increased sterocobilin - dark brown

Question 11

What is hepatic jaundice caused by?

Answer 11

liver disease such as cirrhosis or hepatitis (problem with the parenchyma)

Question 12

What is the rate of RBC breakdown with hepatic jaundice?

Answer 12

normal, thus normal amounts of free bilirubin presented to the liver

Question 13

hepatic jaundice - findings in serum

Answer 13

increased levels of unconjugated bilirubin (sick liver does not conjugate bilirubin as effective)
increased conjugated bilirubin (leaked back into blood)
increased urobilinogen (escape uptake and enter circulation)

Question 14

Hepatic jaundice - findings in urine

Answer 14

no Hb appears in urine (haptoglobin is not overloaded)
increases levels of conjugated (non-albumin bound) bilirubin (due to higher levels in blood)
increased urine levels of urobilinogen (reabsorbed serum urobilinogen is not readily re-excreted into the gut)