JAUNDICE

Question 1

What is Jaundice

Answer 1

Jaundice refers to yellow pigmentation of skin, palms and the sclerae as a result of elevated levels of bilirubin in blood.

Question 2

At what bilirubin level is jaundice visible

Answer 2

35 micromol/L in adults and 100 micromol/L in children

Question 3

Hyperbilirubinemia may result in …………….. in adults and children

Answer 3

Hepatic encephalopathy

Question 4

Jaundice in neonates can results in ……….

Answer 4

Kernicterus

Question 5

What is kernicterus

Answer 5

Also called bilirubin encephalopathy, is bilirubin-induced neurological damage, which is most commonly seen in infants

Question 6

Causes of jaundice in adults

Answer 6

Hepatitis
Hemolysis
Chronic liver diseases
Liver malignancies
Hepatic congestion from heart failure
Gall bladder diseases
Carcinoma of head of the pancreas
Septicaemia

Question 7

Conditions that can cause hemolysis in adults

Answer 7

Malaria
G6PD deficiency
Sickle cell disease
Allopathic drugs
Herbal preparations

Question 8

Causes of jaundice in children

Answer 8

Hemolysis
Infections

Question 9

Infections in children that can cause jaundice

Answer 9

Malaria
Hepatitis
UTI
Typhoid fever
Septicemic illnesses

Question 10

Conditions that cause hemolysis in children

Answer 10

Sickle cell disease
G6PD deficiency
Drugs

Question 11

Symptoms of jaundice

Answer 11

Yellow or greenish discolouration of the eyes or skin
Deep yellow discolouration of urine
Itching
Pale stools

Question 12

Signs of jaundice

Answer 12

Pallor
Scratch marks
Stigmata of chronic liver disease
Hepatomegaly
Splenomegaly
Palpable gall bladder
Ascites
Bleeding
Hepatic flap

Question 13

Pallor in a jaundice patient indicates

Answer 13

Hemolysis
Chronic disease
Malignancy

Question 14

Scratch marks in a jaundice patient indicates

Answer 14

Cholestasis

Question 15

Signs of Stigmata of chronic liver

Answer 15

Palmar erythema
Clubbing
Spider naevi

Question 16

Forms of bleeding that can present in jaundice patients

Answer 16

Cephalhaematoma
Subgaleal haematoma
Upper gastrointestinal bleeding

Question 17

Hepatic flap is an indication of

Answer 17

Liver failure

Question 18

Investigations in jaundice

Answer 18

FBC
INR
Sickling status
G6PD status
Blood film for red cell anomalies, malaria parasites
Liver function tests
Blood Urea and electrolytes
Hepatitis screen
Blood culture
Urinalysis
Abdominal ultrasound
Abdominal CT scan

Question 19

Hepatitis screen parameters in jaundice

Answer 19

HBsAg
HCV Antibody
Hepatitis A IgM
Hepatitis E IgM

Question 20

Treatment objectives in jaundice

Answer 20

To identify and treat cause of jaundice
To relieve symptoms associated with jaundice
To prevent complications associated with elevated levels of bilirubin in the blood

Question 21

Non-pharmacological interventions in jaundice

Answer 21

Avoid alcohol and other hepatotoxic agents
Ensure adequate hydration

Question 22

Pharmacological treatment of cholestatic jaundice with severe pruritus

Answer 22

Cholestyramine, oral,
Adult
4 g 12 hourly (titrate dose to response and tolerance: max. 16 g/day)
Children and Adolescents
2-4 g 12 hourly (max. 8 g/day)