jaundice Flashcards

1
Q

what would an isolated rise in bilirubin indicate

A

pre-hepatic jaundice eg gilberts // haemolysis

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2
Q

what drugs commonly cause cholestasis liver disease

A

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

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3
Q

what is physiopathology PBC

A

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

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4
Q

who usually gets primary biliary cholangitis (PBC)

A

middle aged females

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5
Q

what AI disorders is PBC assoc with

A

sjorgens // RA // systemic sclerosis // thyroid

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6
Q

what are GI symptoms of PBC

A

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

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7
Q

serology of PBC

A

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

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8
Q

imaging for PBC

A

to exclude extrahepatic obstruction // USS or MRCP

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9
Q

1st line mx PBC

A

ursodeoxycholic acid

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10
Q

additional meds PBC

A

cholestryamine (for itch) + fat soluble vitamin supplements

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11
Q

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

A

liver transplant // bilirubin >100

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12
Q

what cancer is assoc with PBC

A

hepatocellular carcinoma

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13
Q

what extrahepatic complication is common in PBC

A

osteomalacia or porosis

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14
Q

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

A

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

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15
Q

causes of prehepatic jaundice

A

haemolytic anaemia

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16
Q

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

A

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

17
Q

causes of hepatic jaundice

A

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

18
Q

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

A

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

19
Q

causes of post-hepatic jaundice

A

gallstone in bile duct // pancreas carcinoma // PSC

20
Q

what feature is commonly seen in posthepatic jaundice

A

pale stools

21
Q

1st line invx in jaundice

A

USS of liver and biliary tree

22
Q

if jaundice is due to mets what mx is done

A

surgical stent

23
Q

what does UDP glucoronyly transferase do

A

conugates bilirubin in liver

24
Q

what causes build up of unconjugated bilirubin

A

pre-hepatic eg haemolytic anaemia

25
what causes build up of conjugated bilirubin
damage to hepatocytes and cholestasis
26
what symptom can usually differentiate unconjugated vs conjugated bilirubin
conjugated is water soluble to extreted in urine --> v dark brown urine
27
inherited causes of unconjugated bilirubin (2)
Gilbert's + crigler-najjar
28
inhertied causes of conjugated bilirubin
dubin-Johnson + rotor
29
what inheritence is gilbert's + what deficiency is there
autosomal recessive // mild UDP gluc transferase deficiency
30
what inheritence is crigler Najjar + what deficiency is there
recessive // absolute UDP gluco transferase def
31
prognosis of type 1 vs type 2 crigler najjar
type 1 die in adulthood // type 2 less severe
32
mx of crigler najjar type 2
phenobarbitol
33
what inheritance is dubin johnson and what does it result in
recessive // defective hepatic excretion of bilirubin
34
what happens to the liver in dubin johnson
it's black
35
inheritance of rotor syndrome
recessive
36
what are symptoms of gilberts
unconjugated hyperbilirubinaemia (not in urine) // with otherwise normal LFTs
37
invx of Gilberts
rise in bilirubin after fast or IV nicotinic acid