jaundice

Question 1

at what level is jaundice clinically detectable ?

Answer 1

when plasma bilirubin exceeds 40 umol/l or 2.5mg

Question 2

which type of bilirubin is soluble and which type is insoluble ?

Answer 2

unconjugated - insoluble
conjugated - soluble

Question 3

most of bilirubin is conjugated or unconjugated ?

Answer 3

unconjugated

Question 4

what is
unconjugated bilirubin bound to ?

Answer 4

albumin

Question 5

what enzyme is used for the conjugation of bilirubin in hepatocytes ?

Answer 5

UDPT

Question 6

where is conjugated bilirubin excreted into ?

Answer 6

the bile and passees to the duodenal lumen

Question 7

stercobilinogen vs urobilinogen ?

Answer 7

stercobilinogen is absorbed from the bowel and passes through the liver, through the kidneys to form urobilinogen

Question 8

what are the causes of conjugated hyperbilirubinemia ?

Answer 8

parenchymal liver disease
intrahepatic cholestasis
extrahepatic cholestasis

Question 9

what are the causes of unconjugated hyperbilirubinemia ?

Answer 9

too much bilirubin being produced extra-heaptically
impaired conjugation

Question 10

main three causes of jaundice ?

Answer 10

pre hepatic
hepatic
post hepatic

Question 11

other than pre and post hepatic what other broad classifications of jaundice are there ?

Answer 11

congenital hyperbilirubinemia
hemolytic jaundice
cholestatic ( whether intrahepatic or extrahepatic )

Question 12

what are examples of congenital hyperbilirubinemia that cause conjugated hyperbilirubinemia ?

Answer 12

Crigler- najjar syndrome
Gilbert’s syndrome

Question 13

what are the main causes of pre hepatic jaundice ?

Answer 13

caused mainly by haemolysis and congenital hyperbilirubinemia

Question 14

what are the expected lab results for prehepatic causes of jaundice ?

Answer 14

unconjugated hyperbilirubinemia (isolated)
normal LFTS
elevated urobilinogen

Question 15

jaundice due to hemolysis in adults vs newborns

Answer 15

in adults its mild
more aggressive in newborns

Question 16

what is the most common cause of non hemolytic hyperbilirubinemia ?

Answer 16

Gilberts syndrome ( inherited)

Question 17

what are the expected lab results in hepatic causes of hyperbilirubinemia ?

Answer 17

rise in both conjugated and unconjugated bilirubin
bilirubin in urine

Question 18

what is the pathway of urobilinogen ?

Answer 18

retakeen up in the portal vein by the liver and then excreted by the kidneys

Question 19

why is there dark urine in hepatic causes of hyperbilirubinemia ?

Answer 19

the liver loses the ability to re uptake the urobilinogen , so thee excess is excreted in the urine

Question 20

what are the causes of intrahepatic cholestasis ?

Answer 20

viral hepatitis
drugs
cirrhosis
pregnancy
autoimmune cholangitis

Question 21

what are the different causes of post hepatic hyperbilirubinemia ?

Answer 21

gall stones
tumor
biliary atresia

Question 22

what type of bilirubin is raised in post hepatic hyperbilirubinemia ?

Answer 22

conjugated

Question 23

eassociation of stercobilinogen and urobilinogen with post hepatic hyperbilirubinemia ?

Answer 23

low stercobilinogen
low urobilinogen
( clay coloured stool )

Question 24

what are the expected lab results in post hepatic hyperbilirubinemia ?

Answer 24

elevated conjugated bilirubin
raised ALP and GGT

Question 25

post hepatic jaundice is also called ?

Answer 25

obstructive jaundice

Question 26

what are the lab findings in obstructive jaundice ?

Answer 26

raised conjugated bilirubin
raised ALT
raised GGT

Question 27

what are the three labs used to assess liver function ?

Answer 27

Albumin
INR
Bilirubin