Jaundice Flashcards
what is jaundice?
✅ Normal serum bilirubin 0.3-1.0 mg/dl
➡️ Conjugated 0.1-0.3
🔀 Unconjugated 0.2-0.7
🟡 Clinically evident > 3
what are the causes unconjugated hyperbilirubinemia
- increased production (hemolysis)
- decreased hepatic uptake glucuroniede conjugation
- (gillbert’s syndrome & drugs)
conjugated hyperbilirubinemia causes
- hepatocellular disease
- cholestatic (bile gets stucked)
- intrahepatic
- extrahepatic
Hepatocellular disease causes
- viral (VHA,B,C,D,E)
- alcohol
- drugs (acetaminophen, isoniazid)
- toxins (vinyl chloride, jamaica bush tea, alkaoids, wild bushrooms)
cholestatic causes
- Intrahepatic (primary biliary cirrhosis y non-hepatobiliary sepsis)
- Extrahepatic
- (postoperative obstructive ducts=stuck bilis
- stones
- primary sclerosing cholangitis
- tumor (compressing the ducts)
where to look?
Upper bulbar conjunctiva
Base of tongue
Mucous membrane of palate
Palms and soles
General skin surface
what studies you should request?
CBC - complete blood count
Hepatic profile - IB, DB, TB
when ____ its elevated we can suspect that the liver isn’t working well.
DB, IB
what is Murphy’s sign?
Pain in the right upper quadrant of the abdomen
when positive indicates cholecystitis
Charcot’s triad
indicates CHOLANGITIS
1. fever
2. RUQ pain (Murphy’s sign)
3. Jaundice
difference between cholecystitis and cholangitis
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
Reginald’s pental
Charcot’s triad
+
Shock
Neurological impairment
Cholangioresonance
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
cholangiography
what is, indication
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
the ultrasound is useful to detect the cause, except when
the damage in the liver is caused by a virus like Hepatitis
what happens if GGT and AP are elevated?
We can suspect there is canaliculi damage = blockage or inflamation of the bile ducts = extrahepatic cause
list the image and studies you can request when investigating the cause of jaundice
5 & 5
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
imaging algorith
if we suspect that the cause is extrahepatic
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
imaging algorithm
if we suspect that the cause is intrahepatic we request a
CT scan
treatment algorithm
if it is unconjugated hyperbilirubinemia:
treat underlying cause
treatment algorith
if it is unconjugated hyperbilirubinemia:
treat underlying cause
treatment algorithm
if it is conjugated hyperbilirubinemia:
- hepatocellular → treat underlying cause
- cholestatic
a) operable? → go to OR
b) non-operable → treat symptoms and decompress if needed
what does AF (AP) and GGT means or indicate?
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
what does ALT and AST indicates?
Alanine AminoTransferase: 0-40 IU/L
Aspartate Aminotransferase: 0-37 IU/L
High levels indicate infected and inflamed liver
