JAUNDICE

Question 1

Bilirubin is potentially toxic and is formed by the breakdown of _______ present in haemoglobin, myoglobin, and other haemoproteins (such as cytochromes, catalase, peroxidase and tryptophan pyrrolase).

Answer 1

haem

Question 2

_________ percent of the daily bilirubin production (250 to 400 mg in adults) is derived from haemoglobin; the remaining _____% from other haemoproteins

Answer 2

Eighty

20

Question 3

The normal serum bilirubin concentration is ______ mg/dL ( ____ micromol/L)

Answer 3

<1 ; 17

Question 4

Jaundice is detected clinically when serum bilirubin is at least ____mg/dL

Answer 4

3

Question 5

STEPS IN BILIRUBIN FORMATIO N

Hence - ________ by ________ - ________ by _________ to _________ to ________ by ________

Answer 5

Bilverdin; heme oxygenase

Un conjugated bilirubin; bilverdin reductase

Conjugated bilirubin

Urobilinogen; intestinal bacteria

Question 6

Jaundice can be classified as:
 Unconjugated jaundice: characterised by ____________ hyperbilirubinaemia, __________ urobilinogen, _____ bilirubinuria.

 Conjugated jaundice: characterised by ________ hyperbilirubinaemia, _________ urobilinogen, _____ bilirubinuria.

Answer 6

unconjugated; raised; no

conjugated; normal ; yes

Question 7

Jaundice can also be classified as
 Prehepatic jaundice: characterised by _________.
 Intrahepatic jaundice: characterised by ___________________.
 Posthepatic jaundice: characterised by _________.

Answer 7

UCB

a mixture of both UCB and CB.

CB

Question 8

CAUSES OF UNCONJUGATED HYPERBILIRUBINAEMIA

Increased ________________
Decreased _________________
Defective —————

Answer 8

bilirubin production

hepatic clearance

bilirubin conjugation

Question 9

Crigler-Najjar syndrome is a very rare autosomal recessive disorder characterised by a ________________ (type I) or a _________________ (type II) of _______________

Answer 9

complete loss of function

very low level of function

UGT

Question 10

UGT ( ___________________________).

Answer 10

uridine diphosphate glucuronyltransferase

Question 11

Gilbert syndrome is characterised by ________________ (typically 10%-33% of normal).

Answer 11

decreased UGT activity

Question 12

Dubin-Johnson syndrome is an autosomal ________ disease characterised by a mutation in the gene responsible for the __________________(___________)

Answer 12

recessive

canalicular transport protein (multidrug resistance protein 2).

Question 13

Gilbert syndrome is characterised by ______________ activity (typically 10%-33% of normal).

Answer 13

decreased UGT

Question 14

Benign recurrent intrahepatic cholestasis: A rare autosomal recessive or sporadic disorder with recurrent episodes of ________ and __________ that resolves spontaneously without ______________.

Answer 14

intense pruritus and jaundice

significant liver damage

Question 15

AIDS cholangiopathy: a syndrome of _____________ that results from _______-induced strictures of the biliary tract most commonly associated with ________________.

Answer 15

biliary obstruction

infection

Cryptosporidium parvum

Question 16

Wilson disease: an autosomal recessive disease involving ___________ in multiple tissues, including the brain and liver.

Answer 16

copper deposition

Question 17

CLINICAL FEATURES
• Jaundice can be detected as a ___________ of the sclerae, skin and mucous membranes.
• Other clinical features will depend on the underlying cause.

• Infection: ______,________,_________ , and flu-like symptoms.
•Noninfectious jaundice:__________,________,___________
(pancreatic or biliary tract cancers).

Answer 17

yellowish discolouration

fever, chills, abdominal pain

weight loss, pruritus, abdominal pain

Question 18

INVESTIGATIONS to be done in jaundice

___________ is the first investigation to be done.

Answer 18

Urinalysis

Question 19

INVESTIGATIONS to be done in jaundice

Urinalysis

______________ indicates conjugated hyperbilirubinaemia.
 Confirm the type of hyperbilirubinaemia by testing for _________ (total and direct).

FBC, blood film: haemolysis (_________ RBC and increased ___________); infection ( ________________ ).

Liver function tests: the pattern of LFT abnormalities can be _________ or _________

Answer 19

Bilirubinuria; serum bilirubin

fragmented; reticulocytes

leukocytosis

hepatocellular or cholestatic

Question 20

INVESTIGATIONS to be done in jaundice

Liver function tests: the pattern of LFT abnormalities can be hepatocellular or cholestatic:

 Hepatocellular:_______ and _______ are raised, while _____ and _______ are normal.
 Cholestatic picture: _____,______are raised, while _______ and ______ may be normal..

Answer 20

AST and ALT

ALP and GGT

ALP, GGT

ALT and AST

Question 21

INVESTIGATIONS to be done in jaundice

Acute hepatitis (viral, drugs, ischaemia) may cause the levels of _______ to rise several thousand U/L. In alcoholic liver disease, the ratio of ______/_____ is > 1.

Answer 21

ALT

AST/ALT

Question 22

INVESTIGATIONS to be done in jaundice

Tests for liver disease eg hepatitis viruses (HAV IgM, HBsAg, antiHBc Ab, antiHCV); autoimmune markers (antinuclear, antimitochondrial antibodies), iron and genetic studies, copper studies, alpha-1 antitrypsin .
Raised serum _________ may suggest pancreatitis

Answer 22

amylase

Question 23

INVESTIGATIONS
• Imaging: abdominal USS and CT scanning are useful in distinguishing an ____________ from ___________.

______________ is typically the first test ordered, because of its lower cost, wide availability, and lack of radiation exposure.

• Endoscopic retrograde cholangiopancreatography
• Liver biopsy: may be done if serum and imaging studies do not lead to a diagnosis.

Answer 23

obstruction from hepatocellular disease.

Ultrasonography

Question 24

A bedside urinalysis can differentiate unconjugated from conjugated hyperbilirubinaemia.

T/F

Answer 24

T