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Digestive System > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is jaundice and what causes it

A
  • Yellow discolouration of the skin, eyes and other tissue.
  • It is caused by a build-up of bilirubin in tissue fluids and the bloodstream.
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2
Q

When diagnosing liver disease, what does a doctor need to look for in the blood sample

A
  • Increased transaminase enzymes (AST/ALT)
  • Decreased levels of albumin
  • Increased total amount of bilirubin
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3
Q

When diagnosing biliary disease, what does a doctor need to look for in the blood sample

A
  • Increased gamma glycosyltransferase (gGT)
  • Increased alkaline phosphate (AP)
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4
Q

Give some examples of liver tests a doctor may do to test for liver disease

A
  • Test for bilirubin levels
  • Test for liver enzymes (AST/ALT) levels
  • Test for hepatobiliary enzymes (gGT, Alk Phos) levels
  • Test for albumin levels
  • Test for protein levels
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5
Q

What are some examples of tests that allow a doctor to narrow down what type of liver disease

A
  • Antibody titre
  • Haematology
  • Viral Markers
  • Metabolic indicators
  • Tumour markers
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6
Q

What volume of bile is produced everyday and how many times is this volume recycled by the hepatocytes

A
  • 0.5L per day
  • Recycled 6-8 times per day
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7
Q

Why are bilirubin and bile salts recycled throughout the day

A
  • Daily production of bilirubin + 250-300mg
  • Daily amount required - 3.5g
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8
Q

How much bile can be stored in the gall bladder and what is the effect of this bile when it is released.

A
  • A few 100ml
  • Emulsifies fat in the intestine when released on demand.
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9
Q

What fat soluble vitamins does bile help us absorb

A
  • Vitamin A
  • Vitamin D
  • Vitamin E
  • Vitamin K
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10
Q

How does bile help process substances such as cholesterol and bilirubin

A
  • Excretion as they cannot be cleared by the kidneys
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11
Q

What is bilirubin

A
  • Raw material for bile
  • Breakdown product of haemoglobin, myoglobin, cytochromes and peroxidases
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12
Q

How is unconjugated bilirubin produced

A
  • Macrophages degrade old erythrocytes releasing haemoglobin molecules.
    Haemoglobin is broken down into haem and globin.
  • Haem is oxidised by oxygenase into biliverdin (green)
  • Biliverdin is reduced by biliverdin reductase to produce unconjugated bilirubin
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12
Q

How is unconjugated bilirubin produced

A
  • Macrophages degrade old erythrocytes releasing haemoglobin molecules.
    Haemoglobin is broken down into haem and globin.
  • Haem is oxidised by oxygenase into biliverdin (green)
  • Biliverdin is reduced by biliverdin reductase to produce unconjugated bilirubin
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13
Q

How is unconjugated bilirubin produced

A
  • Macrophages degrade old erythrocytes releasing haemoglobin molecules.
    Haemoglobin is broken down into haem and globin.
  • Haem is oxidised by oxygenase into biliverdin (green)
  • Biliverdin is reduced by biliverdin reductase to produce unconjugated bilirubin
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14
Q

How is conjugated bilirubin produced from unconjugated bilirubin

A
  • Unconjugated bilirubin is carried by albumin through bloodstream to the liver (because lipid soluble)
  • Hepatocytes add glucuronic acids via UPD glucuronyltransferase.
  • This is now conjugated bilirubin and is water soluble
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15
Q

How is conjugated bilirubin excreted by the liver

A
  • Through releasing bile from the gall bladder into the small intestine.
  • When conjugated bilirubin reaches the ileum or large intestine it is converted to urobilinogen by the enzymes of epithelial or intestinal bacteria.
  • Some urobilinogen is reabsorbed and transported back to the liver via the portal vein, some excreted as faeces, some transported by blood to the kidneys and excreted as urine
16
Q

What are the 3 categories of causes of jaundice

A
  • Prehepatic - cause is upstream and not liver related
  • Intrahepatic - Jaundice is liver disease related
  • Extrahepatic - Cause is downstream, issue occurs after bilirubin is processed in the liver
17
Q

What are some key features that would suggest pre-hepatic jaundice

A
  • High serum levels of unconjugated bilirubin
  • Normal levels of liver enzymes (AST/ALT) and biliary enzymes (ALP/gGT)
18
Q

What are some conditions that can cause pre-hepatic jaundice

A
  • Haemolytic anaemia - red cell destruction
  • PNS (genetic) - fragile RBCs
  • Sickle Cell Disease (genetic) - Varian form of Hb present
19
Q

What are some symptoms that may be present in the liver due to pre-hepatic jaundice

A
  • Gallstones, increased bilirubin, dark urine
  • Hepatomegaly, splenomegaly
  • AST/ALT elevation
  • Thrombosis
  • Iron overload
  • Hepatic thrombosis
  • Coagulation deficit
  • Altered MRI signal
20
Q

What is the treatment plan for a patient with liver disease associate with sickle cell disease

A
  • Aggressive manual exchange RBC transfusion (to reduce Hbs by around 30%)
  • Give fresh plasma and vitamin K (help with clotting deficit due to secondary liver failure)
21
Q

What is Gilbert’s Syndrome

A
  • Mutation which decreases efficiency of UPD glucuronyltransferase when conjugating bilirubin.
  • This causes increase in unconjugated bilirubin and pre-hepatic jaundice
22
Q

When does jaundice appear as a symptom of gilbert’s syndrome

A
  • During the presence of other stressors in the body
23
Q

How common is neonatal jaundice (%) and why does it occur

A
  • > 90%
  • Occurs due to delay in clearance of bilirubin from RBC breakdown
24
Q

How is neonatal jaundice treated and when does it become concerning

A
  • Treated by phototherapy
  • Concerning if persists and is accompanied by pale stool/ dark urine
25
Q

How is neonatal jaundice treated and when does it become concerning

A
  • Treated by phototherapy
  • Concerning if persists and is accompanied by pale stool/ dark urine
26
Q

What are some key features which would suggest intra-hepatic jaundice

A
  • Normal unconjugated bilirubin levels
  • Increased total bilirubin levels
  • Increased liver function test (ALT/AST/ALP/gGT)
27
Q

Causes of acute liver disease that causes intra-hepatic jaundice

A
  • Virus
  • Alcohol
  • Autoimmune
  • Toxic
28
Q

What are the differences between Hep A&e, B and C when it comes to transmission, severity, duration and immunisation

A
  • A&C - transmitted through faeces, mild to severe, not chronic has a vaccine
  • B - transmitted through sex, mild to severe,
    chronic 30% of time, has a vaccine
  • C - transmitted through blood, very mild, chronic 90% of time, no vaccine/
29
Q

What can cause an interruption of bile flow as a result of liver damage

A
  • Liver cancer
  • Destruction of bile ductules
  • Cholestalsis
30
Q

What are some key features that indicate interruption of bile flow as a cause for intra-hepatic jaundice

A
  • Increased total bilirubin
  • Modest (hardly noticeable) increase in AST/ALT or ALP/gGT
31
Q

What are some key features that suggest post-hepatic jaundice

A
  • Normal levels of unconjugated Bilirubin
  • Increased conjugated bilirubin
  • Modest (hardly noticeable) increase in AST/ALT
32
Q

What causes post-hepatic jaundice

A
  • Blockage of bile ducts which transport bile containing conjugated bilirubin from the liver
33
Q

What causes blockages in bile ducts

A
  • Gallstones
  • Disease of bile ducts
  • Compression of ducts
34
Q

What causes gallstones and how common are they

A
  • Imbalance of chemical constituents of bile
  • 20%-30% of women, 20% of men 50-60 years old
  • Treated by surgical removal
35
Q

Give examples of disease of the bile duct

A
  • Cancer
  • Inflammation
36
Q

What are some features of swelling of biliary lymph nodes

A
  • Possibly pancreatic cancer
  • Painless jaundice
  • Weightloss (unintentional)
  • More common in older people
  • Poor prognosis

Digestive System (7 decks)

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