jaundice

Question 1

what would an isolated rise in bilirubin indicate

Answer 1

pre-hepatic jaundice eg gilberts // haemolysis

Question 2

what drugs commonly cause cholestasis liver disease

Answer 2

COCP // co-amox // steroids // sulphonylureas

Question 3

what is physiopathology PBC

Answer 3

liver bile ducts are chronically inflammed –> cholestasis –> cirrhosis

Question 4

who usually gets primary biliary cholangitis (PBC)

Answer 4

middle aged females

Question 5

what AI disorders is PBC assoc with

Answer 5

sjorgens // RA // systemic sclerosis // thyroid

Question 6

what are GI symptoms of PBC

Answer 6

cholestatic jaundice (raised ALP) + itch // RUQ pain // hyperpigmentation // clubbing // hepatosplenomegaly // xanthelasmas and xanthomas

Question 7

serology of PBC

Answer 7

AMA antibodies M2 // smooth muscle antibodes // raised IgM

Question 8

imaging for PBC

Answer 8

to exclude extrahepatic obstruction // USS or MRCP

Question 9

1st line mx PBC

Answer 9

ursodeoxycholic acid

Question 10

additional meds PBC

Answer 10

cholestryamine (for itch) + fat soluble vitamin supplements

Question 11

what is last resort mx in PBC and what would be an indication for it

Answer 11

liver transplant // bilirubin >100

Question 12

what cancer is assoc with PBC

Answer 12

hepatocellular carcinoma

Question 13

what extrahepatic complication is common in PBC

Answer 13

osteomalacia or porosis

Question 14

in pre-hepatic jaundice what will happen to bilirubin // ALT + AST // ALP

Answer 14

bili = normal or high // ALT + AST = normal // ALP = normal

Question 15

causes of prehepatic jaundice

Answer 15

haemolytic anaemia

Question 16

in hepatic jaundice what will happen to bilirubin // ALT + AST // ALP

Answer 16

bili = high // ALT + AST = V high // ALP = moderate

Question 17

causes of hepatic jaundice

Answer 17

hepatitis // alcohol // NAFLD // PBC // drugs

Question 18

in post-hepatic jaundice what will happen to bilirubin // ALT + AST // ALP

Answer 18

bili = V high // ALT + AST = moderate // ALP = v high

Question 19

causes of post-hepatic jaundice

Answer 19

gallstone in bile duct // pancreas carcinoma // PSC

Question 20

what feature is commonly seen in posthepatic jaundice

Answer 20

pale stools

Question 21

1st line invx in jaundice

Answer 21

USS of liver and biliary tree

Question 22

if jaundice is due to mets what mx is done

Answer 22

surgical stent

Question 23

what does UDP glucoronyly transferase do

Answer 23

conugates bilirubin in liver

Question 24

what causes build up of unconjugated bilirubin

Answer 24

pre-hepatic eg haemolytic anaemia

Question 25

what causes build up of conjugated bilirubin

Answer 25

damage to hepatocytes and cholestasis

Question 26

what symptom can usually differentiate unconjugated vs conjugated bilirubin

Answer 26

conjugated is water soluble to extreted in urine –> v dark brown urine

Question 27

inherited causes of unconjugated bilirubin (2)

Answer 27

Gilbert’s + crigler-najjar

Question 28

inhertied causes of conjugated bilirubin

Answer 28

dubin-Johnson + rotor

Question 29

what inheritence is gilbert’s + what deficiency is there

Answer 29

autosomal recessive // mild UDP gluc transferase deficiency

Question 30

what inheritence is crigler Najjar + what deficiency is there

Answer 30

recessive // absolute UDP gluco transferase def

Question 31

prognosis of type 1 vs type 2 crigler najjar

Answer 31

type 1 die in adulthood // type 2 less severe

Question 32

mx of crigler najjar type 2

Answer 32

phenobarbitol

Question 33

what inheritance is dubin johnson and what does it result in

Answer 33

recessive // defective hepatic excretion of bilirubin

Question 34

what happens to the liver in dubin johnson

Answer 34

it’s black

Question 35

inheritance of rotor syndrome

Answer 35

recessive

Question 36

what are symptoms of gilberts

Answer 36

unconjugated hyperbilirubinaemia (not in urine) // with otherwise normal LFTs

Question 37

invx of Gilberts

Answer 37

rise in bilirubin after fast or IV nicotinic acid