Jaundice Flashcards
what is jaundice?
yellow discolouration of skin and sclera due to hyperbilirubinaemia - high bilirubin
how is a red blood cell broken down in the spleen?
- RBC
- haem + globin
- haem– biliverdin + FE2+
- biliverdin—- unconjugated bilirubin
what forms conjugated bilirubin in the liver?
unconjugated bilirubin and glucoronic acid
where is conjugated bilirubin formed?
in the liver
what happens in the colon with urobilinogen?
turns into stercobilin- which makes faeces brown
what does urobilin in urobilinogen do?
makes pee yellow
describe the pathology in pre-hepatic jaundice
- excessive RBC breakdown
- liver can’t conjugate bilirubin
- high unconjugated hyperbilirubinaemia
where is pre- hepatic jaundice often found in?
haemolytic anaemias
describe the pathology behind intra hepatic jaundice
- dysfunction of hepatic cells
- liver can’t conjugate bilirubin
- liver compresses biliary tree causing obstruction
- leads to both conjugated and unconjugated bilirubin in the blood
where is intra hepatic jaundice often found in?
parenchymal disease
describe the pathology behind post hepatic jaundice
- obstruction of billairy drainage
- any bilirubin not excreted is conjugated by liver
- conjugated hyperbilirubinaemia
what is post hepatic jaundice often found in?
biliary tree pathology
what would stool and urine look like in post hepatic jaundice?
pale stool
dark urine
what effects stool and urine?
conjugated bilirubin
in post hepatic jaundice- what would conjugated hyperbilirubinaemia look like in blood and intestine?
high in blood
low in intestine
so would have less effect on poo and pee
what effects poo?
stercobilin
what effects pee?
urobilin
what is the Courvoisier sign?
painless jaundice + palpable GB
- most likely pancreatic cancer
what is the chariots triad?
- fever
- RUQ pain
- jaundice
in billiary colic- which of chariots triad would you have?
RUQ pain
in cholecystitis-which of chariots triad would you have?
fever
RUQ pain
in ascending cholangitis- which of chariots triad would you have?
fever
RUQ pain
jaundice
what is Murphys sign?
RUQ tenderness
what is reynold pentad?
- ascending cholangitis- obstructive
- fever, RUQ pain, jaundice, confusion, hypotension
how is jaundice diagnosed?
1.bloods and LFT’S
2. IMAGING- USS
what bloods and LFTs are done to diagnose jaundice?
- bilirubin
-albumin
-PT/INR
-AST
-ALT
-GGT
-ALP
-urine bilirubin- normal -ve and if +ve then obstructive
urobilinogen- normal +ve
with no jaundice what would your urine bilirubin and urine urobilinogen look like?
urine bilirubin- -ve
urobilinogen- +ve
with billiary obstruction what would your urine bilirubin and urine urobilinogen look like?
urine bilirubin- +ve
urobilinogen- decrease
with hepatic disease what would your urine bilirubin and urine urobilinogen look like?
urine bilirubin- +ve
urobilinogen- decrease
with haemolysis what would your urine bilirubin and urine urobilinogen look like?
urine bilirubin- -ve
urobilinogen- increase
