Jaundice Flashcards
Definition
Yellow pigmentation of the skin, sclera + mucus membranes due to raised plasma bilirubin
Risk factors
Alcohol misuse
Factors which increase risk of Hep:
- IV drug use
- Travel
- History of blood transfusions
- High risk occupations such as healthcare workers or sex workers
Increased BMI
IBD
Previous malignancy
Abdo surgery
Pregnancy
Pre-hepatic
Unconjugated hyperbilirubinemia due to increased RBC breakdown
Haemolytic anaemia
- sickle cell
- G6PDH def
- autoimmune haemolytic anaemia
- thalassaemia
- malaria
Intra-hepatic
Conj/Unconj hyperbilirubinemia, may be mixed = parenchymal disease
- HCC
- ALD/NAFLD
- Hepatitis (viral, autoimmune)
- Hepatotoxic drugs e.g. rifampicin
- GILBERT SYNDROME (auto rec mutation of UGTA1 gene = underactive UGT enzyme therefore decrease conj bilirubin therefore sometimes classed as prehepatic = young male with painless jaundice + sudden onset
- Crigler-Najjar syndrome = auto-recessive = rare genetic condition that occurs when your liver can’t break down bilirubin
Post-hepatic (PALE STOOL + DARK URINE)
Conjugated hyperbilirubinemia due to biliary obstruction
- biliary tree pathology
= choledocholithiasis
= pancreatic cancer
= cholangiocarcinoma
= mirizzi syndrome - rarely gallstones stuck extremely compress CBD + cause obstruction in GB neck
= drug induced cholestasis (ampicillin, COCP)
= autoimmune - PBC + PSC
Why is there pale stools and dark urine in obstructive
Unconjugated bilirubin affects stool + urine
Conj hyperbilirubinemia = high in blood, low in intestine therefore less effect on poop =stercobilin, pee = urobilin
Diagnosis
FIRST LINE = USS
Bloods + LFTs = bilirubin, albumin, PT/INR, AST, ALT, GGP, ALP
Urinary bilirubin + urobilinogen
- high in haemolysis
- low in intra/post hepatic causes
Treatment
Treat underlying cause
Phototherapy = esp for neonates
- expose the skin
- a light box shines blue light onto skin
- UCB is converted into isomers that can be excreted in the bile and urine
