Jaundice

Question 1

What is the bilirubin liver function test?

Answer 1

Bilirubin is elevated as a result of haemolysis, parenchymal damage and obstruction of bile ducts

Question 2

What is the aminotransferases liver function test?

Answer 2

Enzymes present in hepatocytes therefore elevation suggests parenchymal involvement

Question 3

What is the alkaline phosphatase liver function test?

Answer 3

Enzyme in bile duct which is elevated in obstruction of bile ducts

Question 4

What is the Gamma GT liver function test?

Answer 4

A non-specific liver enzyme that is elevated with alcohol use

Question 5

What is the albumin liver function test?

Answer 5

Albumin synthesis is a key liver function therefore low levels suggest chronic liver disease

Question 6

What is the prothrombin time liver function test?

Answer 6

Shows degree of liver dysfunction

Question 7

What is the creatine liver function test?

Answer 7

Shows kidney function and is therefore important for assessing for liver transplant

Question 8

What is the platelet count liver function test?

Answer 8

Liver cirrhosis results in splenomegaly causing low platelet count

Question 9

What is jaundice?

Answer 9

Yellowing of the skin, sclerae and mucosae from increased plasma bilirubin levels

Question 10

What is the pathway of Bilirubin metabolism?

Answer 10

Bilirubin is formed by the breakdown of Haemoglobin
In the liver, Bilirubin is conjugated with glucuronic acid by hepatocytes, making it water soluble.
Conjugated bilirubin is secreted in bile and passes into the gut.
Some is taken up again by the liver and the rest is converted to urobilinogen.
Urobilinogen is either reabsorbed and excreted by kidneys or converted to stercobilin which colours faeces brown.

Question 11

How is jaundice classified?

Answer 11

By the site of the problem: Pre hepatic, Hepatic, Post hepatic
By the type of circulating bilirubin: Conjugated or Unconjugated

Question 12

What is unconjugated hyperbilirubinemia?

Answer 12

Unconjugated bilirubin is water-insoluble so it does not enter the urine.
Pre hepatic

Question 13

What is conjugated bilirubinaemia?

Answer 13

Conjugated bilirubin is water-soluble so it is excreted in urine, making it dark. Less conjugated bilirubin enters the gut and the faeces become pale. When severe it can be associated with pruritis.
Hepatic and Post hepatic

Question 14

What is Pre- hepatic jaundice?

Answer 14

• Increased quantity of bilirubin (haemolysis)
• Impaired transport

Question 15

What is Hepatic jaundice?

Answer 15

• Defective uptake of bilirubin
• Defective conjugation
• Defective excretion

Question 16

What is Post hepatic jaundice?

Answer 16

Defective transport of bilirubin by biliary ducts

Question 17

What is Pre-hepatic Jaundice associated with?

Answer 17

History of anaemia
Pallor
Splenomegaly

Question 18

What is Hepatic Jaundice associated with?

Answer 18

IVDU
Drug intake
Ascites
Variceal bleed
Encephalopathy
Spider neavi
Gynaecomastia
Aterixis

Question 19

What is Post-hepatic jaundice associated with?

Answer 19

Primary biliary cholangitis
Primary sclerosing cholangitis
Cholestasis: dark urine, pale stools, pruritis
Palpable gall bladder (Courvoisier’s sign)

Question 20

What is cholestasis and what causes it?

Answer 20

Accumulation of bile within hepatocytes or bile canaliculi
- Viral hepatitis
- Alcoholic hepatitis
- Liver failure
- Drugs

Question 21

What tests are carried out for Jaundice?

Answer 21

Urine- presence of bilirubin
Haematology- FBC, clotting
Chemistry- U%E, LFT, total protein, albumin
Microbiology- hepatitis serology

Question 22

What imaging modalities are used for Jaundice

Answer 22

• Ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTC)
• Endoscopic ultrasound (EUS)