Jaundice

Question 1

what is jaundice?

Answer 1

✅ Normal serum bilirubin 0.3-1.0 mg/dl
➡️ Conjugated 0.1-0.3
🔀 Unconjugated 0.2-0.7
🟡 Clinically evident > 3

Question 2

what are the causes unconjugated hyperbilirubinemia

Answer 2

• increased production (hemolysis)
• decreased hepatic uptake glucuroniede conjugation
• (gillbert’s syndrome & drugs)

Question 3

conjugated hyperbilirubinemia causes

Answer 3

1. hepatocellular disease
2. cholestatic (bile gets stucked)
   - intrahepatic
   - extrahepatic

Question 4

Hepatocellular disease causes

Answer 4

1. viral (VHA,B,C,D,E)
2. alcohol
3. drugs (acetaminophen, isoniazid)
4. toxins (vinyl chloride, jamaica bush tea, alkaoids, wild bushrooms)

Question 5

cholestatic causes

Answer 5

1. Intrahepatic (primary biliary cirrhosis y non-hepatobiliary sepsis)
2. Extrahepatic
   - (postoperative obstructive ducts=stuck bilis
   - stones
   - primary sclerosing cholangitis
   - tumor (compressing the ducts)

Question 6

where to look?

Answer 6

 Upper bulbar conjunctiva
 Base of tongue
 Mucous membrane of palate
 Palms and soles
 General skin surface

Question 7

what studies you should request?

Answer 7

CBC - complete blood count
Hepatic profile - IB, DB, TB

Question 8

when ____ its elevated we can suspect that the liver isn’t working well.

Answer 8

DB, IB

Question 9

what is Murphy’s sign?

Answer 9

Pain in the right upper quadrant of the abdomen
when positive indicates cholecystitis

Question 10

Charcot’s triad

Answer 10

indicates CHOLANGITIS
1. fever
2. RUQ pain (Murphy’s sign)
3. Jaundice

Question 11

difference between cholecystitis and cholangitis

Answer 11

both cholangitis and cholecystitis involve inflammation

cholecystitis involves inflammation of the gallbladder.
cholangitis specifically affects the bile ducts (because of a stone or tumor, bilirubin gets stucked)

The causes, symptoms, and treatments for these conditions are different, although both often involve an obstruction in the biliary system

Question 12

Reginald’s pental

Answer 12

Charcot’s triad
+
Shock
Neurological impairment

Question 13

Cholangioresonance

Answer 13

Cholangioresonance is the method of choice for the evaluation of obstructive pathology of the bile duct in comparison with other modalities, such as ultrasound
You can see the biliar tree inside of the liver

Question 14

cholangiography

what is, indication

Answer 14

imaging of the bile duct (also known as the biliary tree) by x-rays and an injection of contrast medium.
Only perfomed during surgery wben the CBD looks sus

Question 15

the ultrasound is useful to detect the cause, except when

Answer 15

the damage in the liver is caused by a virus like Hepatitis

Question 16

what happens if GGT and AP are elevated?

Answer 16

We can suspect there is canaliculi damage = blockage or inflamation of the bile ducts = extrahepatic cause

Question 17

list the image and studies you can request when investigating the cause of jaundice

5 & 5

Answer 17

Images:
1. ultrasound
2. cholangioresonance
3. endoscopic retrogade cholangiopancreatography (CREP)
4. CT-scan (transversal)
5. Cholangiography

studies
1. Complete Blood Count (CBC)
2. hepatic profile
3. blood chemistry
4. liver function test
5. biopsy

Question 18

imaging algorith

if we suspect that the cause is extrahepatic

Answer 18

Ultrasound (US)
if it the ducts look dilated:
1. suspect stones → ERCP
2. suspect tumor → 3-phase CT
if the ducts looks normal
1. Do a CT scan

Question 19

imaging algorithm

if we suspect that the cause is intrahepatic we request a

Answer 19

CT scan

Question 21

treatment algorithm

if it is unconjugated hyperbilirubinemia:

Answer 21

treat underlying cause

Question 21

treatment algorith

if it is unconjugated hyperbilirubinemia:

Answer 21

treat underlying cause

Question 22

treatment algorithm

if it is conjugated hyperbilirubinemia:

Answer 22

1. hepatocellular → treat underlying cause
2. cholestatic
   a) operable? → go to OR
   b) non-operable → treat symptoms and decompress if needed

Question 23

what does AF (AP) and GGT means or indicate?

Answer 23

Alkaline Phosphotase: (39-117 IU/L)
Gamma-glutamyl transferase: (<43)
posiible sign of blockage or inflamation of the bile ducts
abnormal levels means liver damage

Question 24

what does ALT and AST indicates?

Answer 24

Alanine AminoTransferase: 0-40 IU/L
Aspartate Aminotransferase: 0-37 IU/L

High levels indicate infected and inflamed liver