jaundice Flashcards
what would an isolated rise in bilirubin indicate
pre-hepatic jaundice eg gilberts // haemolysis
what drugs commonly cause cholestasis liver disease
COCP // co-amox // steroids // sulphonylureas
what is physiopathology PBC
liver bile ducts are chronically inflammed –> cholestasis –> cirrhosis
who usually gets primary biliary cholangitis (PBC)
middle aged females
what AI disorders is PBC assoc with
sjorgens // RA // systemic sclerosis // thyroid
what are GI symptoms of PBC
cholestatic jaundice (raised ALP) + itch // RUQ pain // hyperpigmentation // clubbing // hepatosplenomegaly // xanthelasmas and xanthomas
serology of PBC
AMA antibodies M2 // smooth muscle antibodes // raised IgM
imaging for PBC
to exclude extrahepatic obstruction // USS or MRCP
1st line mx PBC
ursodeoxycholic acid
additional meds PBC
cholestryamine (for itch) + fat soluble vitamin supplements
what is last resort mx in PBC and what would be an indication for it
liver transplant // bilirubin >100
what cancer is assoc with PBC
hepatocellular carcinoma
what extrahepatic complication is common in PBC
osteomalacia or porosis
in pre-hepatic jaundice what will happen to bilirubin // ALT + AST // ALP
bili = normal or high // ALT + AST = normal // ALP = normal
causes of prehepatic jaundice
haemolytic anaemia
in hepatic jaundice what will happen to bilirubin // ALT + AST // ALP
bili = high // ALT + AST = V high // ALP = moderate
causes of hepatic jaundice
hepatitis // alcohol // NAFLD // PBC // drugs
in post-hepatic jaundice what will happen to bilirubin // ALT + AST // ALP
bili = V high // ALT + AST = moderate // ALP = v high
causes of post-hepatic jaundice
gallstone in bile duct // pancreas carcinoma // PSC
what feature is commonly seen in posthepatic jaundice
pale stools
1st line invx in jaundice
USS of liver and biliary tree
if jaundice is due to mets what mx is done
surgical stent
what does UDP glucoronyly transferase do
conugates bilirubin in liver
what causes build up of unconjugated bilirubin
pre-hepatic eg haemolytic anaemia
what causes build up of conjugated bilirubin
damage to hepatocytes and cholestasis
what symptom can usually differentiate unconjugated vs conjugated bilirubin
conjugated is water soluble to extreted in urine –> v dark brown urine
inherited causes of unconjugated bilirubin (2)
Gilbert’s + crigler-najjar
inhertied causes of conjugated bilirubin
dubin-Johnson + rotor
what inheritence is gilbert’s + what deficiency is there
autosomal recessive // mild UDP gluc transferase deficiency
what inheritence is crigler Najjar + what deficiency is there
recessive // absolute UDP gluco transferase def
prognosis of type 1 vs type 2 crigler najjar
type 1 die in adulthood // type 2 less severe
mx of crigler najjar type 2
phenobarbitol
what inheritance is dubin johnson and what does it result in
recessive // defective hepatic excretion of bilirubin
what happens to the liver in dubin johnson
it’s black
inheritance of rotor syndrome
recessive
what are symptoms of gilberts
unconjugated hyperbilirubinaemia (not in urine) // with otherwise normal LFTs
invx of Gilberts
rise in bilirubin after fast or IV nicotinic acid
