Jaundice Flashcards
What is jaundice
skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin
Normal values of serum bilirubin and its bilirubins
0.3-1 mg/dl
* Conjugated - 0.1 - 0.3
* Unconjugated - 0.2-0,7
What is bilirubin
Byproduct of the breakdown of hemoglobin
Unconjugated bilirubin
From the blood -> liver
Not soluble, Transported by albumin
Conjugated bilirubin
From the liver -> small intestine
Soluble
Metabolite that gives color to feces and urine
Urobilinogen
Causes of Hyperbilirubinemia from unconjugated bilirubin (2)
- There is increased production
- Decreased hepatic uptake / glucuronide conjugation - No transportation
Why is there Decreased hepatic uptake of indirect bilirubin (3)
○ Gilbert’s syndrome: deficiency of enzyme
○ Thalassemia: abnormal form of erythrocyte
○Drugs: damage the liver and hepatocyte works on something else
Causes of Hyperbilirubinemia from conjugated bilirubin (2)
- Hepatocellular disease: hepatocytes don’t work and don’t mix anything
- Cholestatic: there is a stone on the ducts
Why is there Hepatocellular disease? (4)
○ Viral: hepatitis - VHA - VHE
○ Alcohol
○ Drugs
○ Toxins
Hepatitis of fecal/oral route
A and E
Hepatitis of parenteral route
B, C and D
Why is there intrahepatic cholestatic jaundice? (2)
§ Primary biliary cirrhosis - you don’t find cause of jaundice
§ Non-hepatobiliary sepsis - portal vein may conduct sepsis from another place
Why is there extrahepatic cholestatic jaundice? (4)
§ Postoperative - something went wrong
§ Stones - pushes the duct from the inside
§ Primary sclerosing cholangitis
§ Tumor - pushes the duct from the outside
Charcot’s triad
Pain
Fever
Jaundice
Reynold’s pentad
Pain
Fever
Jaundice
Neurological impairment
Shock
Studies for jaundice
Complete blood count
Hepatic profile
Ultrasound
CT scan
When do you ask for an endoscopic retrograde cholangiopancreatography (ERCP)
If there is something in ducts
AST and ALT demonstrate if..
Hepatocyte is sick
GGT and AP show…
canaliculi damage
