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Pre > Jaundice > Flashcards

Jaundice Flashcards

1
Q

yellow pigmentation of skin, sclerae and mucous membranes that results from accumulation of bilirubin within tissues

A

Jaundice

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2
Q

excessive red cell breakdown which overwhelms the liver’s ability to conjugate bilirubin

This causes an unconjugated hyperbilirubinemia

A

pre-hepatic (or hemolytic) jaundice

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3
Q

causes an unconjugated hyperbilirubinemia

A

pre-hepatic (or hemolytic) jaundice

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4
Q

dysfunction of the hepatic cells

liver loses the ability to conjugate bilirubin, but in cases where it also may become cirrhotic, it compresses the intra- hepatic portions of the biliary tree to cause a degree of obstruction

This leads to both unconjugated and conjugated bilirubin in the blood, termed a ‘mixed picture’

A

hepatocellular (or intrahepatic) jaundice

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5
Q

leads to both unconjugated and conjugated bilirubin in the blood, termed a ‘mixed picture’

A

hepatocellular (or intrahepatic) jaundice

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6
Q

both unconjugated and conjugated bilirubin in the blood, termed a …….

A

mixed picture

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7
Q

obstruction of biliary drainage

bilirubin that have been conjugated by the liver is not excretedwell,hence resulting conjugated hyperbilirubinemia

A

Post-hepatic (or obstructive) jaundice

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8
Q

resulting conjugated hyperbilirubinemia

A

Post-hepatic (or obstructive) jaundice

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9
Q

Ascites

A

evidence of complications of cirrhosis

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10
Q

Dilated periumbilical veins (‘caput medusae’)

A

evidence of complications of cirrhosis

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11
Q

Splenomegaly

A

evidence of complications of cirrhosis

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12
Q

Hepatic encephalopathy

A

evidence of complications of cirrhosis

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13
Q

Look for evidence of complications of cirrhosis, Especially ………

A

Portal HT

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14
Q

Risk for NAFLD are …. (2)

A

Obesity (Metabolic syndrome)

Abdominal USG

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15
Q

diagnostic for NAFLD and it can demonstrate morphologic features of cirrhosis

A

Abdominal USG

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16
Q

Abdominal USG demonstrate morphologic features of cirrhosis are …… (4)

A

▪ Coarse echotexture
▪ Increased nodularity
▪ Splenomegaly
▪ Reversed flow in the portal vein

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17
Q

Coarse echotexture

A

demonstrate morphologic feature of cirrhosis in Abdominal USG

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18
Q

Increased nodularity

A

demonstrate morphologic feature of cirrhosis in Abdominal USG

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19
Q

Splenomegaly

A

demonstrate morphologic feature of cirrhosis in Abdominal USG

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20
Q

Reversed flow in the portal vein

A

demonstrate morphologic feature of cirrhosis in Abdominal USG

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21
Q

To check for Risk for chronic viral hepatitis (B and C) do …….

A

hepatitis profile check

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22
Q

Screen for rare causes
(4) tests

A

Antinuclear antibody (ANA)

Antimitochondrial antibodies (AMA)

Anti-Smooth Muscle Antibody (ASM)

Copper

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23
Q

In difficult cases, …….. may be required to confirm the diagnosis and suggest an etiology

A

biopsy

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24
Q

hemolysis features (3)

A

↑Red cell breakdown (↓Hb, ↑LDH, ↓haptoglobin)

Blood film abnormalities e.g. red cell fragments

Evidence of ↑red cell production (↑reticulocytes, polychromasia)

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25
Q

No signs of CLD and Normal Liver enzymes with no features of hemolysis
the likely diagnosis is …….

A

Gilbert’s syndrome

26
Q

No signs of CLD and Normal Liver enzymes consider

A

hemolysis

27
Q

No signs of CLD
+ rise in ALP/GGT out of proportion to ALT/AST
Suggests ……..

A

cholestasis

especially with pale stools/dark urine

28
Q

No signs of CLD with evidence of cholestasis on LFT

Perform USG to look for …..

A

bile duct dilatation

and an underlying cause e.g. gallstones

29
Q

bile duct dilatation indicating …..

A

extrahepatic cholestasis

30
Q

If USG shows dilated bile ducts but not the underlying cause do …..

A

MRCP

31
Q

provides excellent definition of the biliary tree

A

MRCP

32
Q

No signs of CLD with no evidence of cholestasis on LFT but ALT >500 U/L, ↑PT or features of encephalopathy

A

acute liver failure/encephalopathy

33
Q

Identify patients with acute liver failure/encephalopathy use ……..

A

West Haven Grading

34
Q

To Seek cause of acute liver injury ask about …. (5)

A

alcohol and paracetamol intake

all recent drugs (prescribed or not)

possible exposure to environmental or occupational toxins

35
Q

To Seek cause of acute liver injury check ….. (5)

A

Check viral serology (IgM anti-HBc, anti-HAV, anti- HEV, anti- CMV, anti-EBV)

Serum ceruloplasmin

Autoantibodies (ANA, ASMA, LKM)

Full toxicology screen

Arrange abdominal USG

36
Q

Arrange abdominal USG to exclude …… (2)

A

Budd–Chiari syndrome

extensive malignant infiltration

37
Q

IgM anti-HBc

A

viral serology

38
Q

anti-HAV

A

viral serology

39
Q

anti-HEV

A

viral serology

40
Q

anti- CMV

A

viral serology

41
Q

anti-EBV

A

viral serology

42
Q

ANA

A

Autoantibodies

43
Q

ASMA

A

Autoantibodies

44
Q

LKM

A

Autoantibodies

45
Q

If all are normal then check for

A

Medications

46
Q

Paracetamol (in overdose) can cause ……….

A

Acute hepatitis

47
Q

Cocaine, ecstasy can cause ……….

A

Acute hepatitis

48
Q

Aspirin, NSAIDs can cause ……….

A

Acute hepatitis

49
Q

Halothane can cause ……….

A

Acute hepatitis

50
Q

Anti-tuberculous therapy: pyeazinamide, isoniazid, rifampicin
can cause ……….

A

Acute hepatitis

51
Q

Antifungals: ketoconazole can cause ……….

A

Acute hepatitis

52
Q

Anti hypertension: methyldopa, hydralazine
can cause ……….

A

Acute hepatitis

53
Q

Antibiotics: penicillins eg. flucloxacillin,
co-amoxiclav, ciproflocin,
macrolides eg. erthromycin
can cause ……

A

Cholestasis / cholestatic hepatitis

54
Q

Chlorpromazine can cause ……….

A

Cholestasis / cholestatic hepatitis

55
Q

Azathioprine can cause ……….

A

Cholestasis / cholestatic hepatitis

56
Q

Oestrogens (including oral contraceptive pill) can cause ……….

A

Cholestasis / cholestatic hepatitis

57
Q

Amitriptyline can cause ……….

A

Cholestasis / cholestatic hepatitis

58
Q

Carbamazepine can cause ……….

A

Cholestasis / cholestatic hepatitis

59
Q

ACE inhibitors can cause ……….

A

Cholestasis / cholestatic hepatitis

60
Q

Cimetidine/ ranitidine can cause ……….

A

Cholestasis / cholestatic hepatitis

61
Q

Sulphonamides can cause ……….

A

Cholestasis / cholestatic hepatitis

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