Jaundice

Question 1

What is jaundice?

Answer 1

Jaundice is a yellow discoloration of the skin, mucous membranes, and sclerae caused by elevated levels of bilirubin in the blood.

Question 2

What are the three main categories of jaundice based on its pathophysiology?

Answer 2

Pre-hepatic, hepatic (intrahepatic), and post-hepatic (extrahepatic) jaundice.

Question 3

What causes pre-hepatic jaundice?

Answer 3

Conditions that lead to increased haemolysis, resulting in excess production of unconjugated bilirubin, such as haemolytic anaemias.

Question 4

What is Gilbert’s syndrome?

Answer 4

A benign genetic condition characterized by intermittent jaundice due to reduced activity of the enzyme glucuronyl transferase, leading to impaired bilirubin conjugation.

Question 5

What is Crigler-Najjar syndrome?

Answer 5

A rare autosomal recessive disorder where there is a deficiency of the enzyme glucuronyl transferase, resulting in impaired bilirubin conjugation and severe unconjugated hyperbilirubinaemia.

Question 6

What are common causes of intrahepatic (hepatocellular) jaundice?

Answer 6

Viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, drug-induced hepatitis, and decompensated cirrhosis.

Question 7

What is the significance of elevated alanine aminotransferase (ALT) in jaundice?

Answer 7

Elevated ALT levels suggest hepatocellular injury, which can be associated with intrahepatic causes of jaundice.

Question 8

What are common causes of post-hepatic (obstructive) jaundice?

Answer 8

Common bile duct stones, cholangitis, bile duct strictures, malignancy (e.g., pancreatic cancer), and pancreatitis.

Question 9

What is Courvoisier’s law?

Answer 9

Courvoisier’s law states that in the presence of jaundice and a palpable gallbladder, the cause is unlikely to be gallstones; instead, it suggests malignant obstruction of the biliary tree.

Question 10

What is Mirizzi’s syndrome?

Answer 10

A rare condition where a gallstone becomes impacted in the cystic duct or neck of the gallbladder, causing compression of the common bile duct and leading to obstructive jaundice.

Question 11

What is the role of ultrasound in evaluating jaundice?

Answer 11

Ultrasound is useful in assessing the biliary tree for dilatation, gallstones, and other structural abnormalities that may cause obstructive jaundice.

Question 12

What is the significance of pale stools and dark urine in jaundice?

Answer 12

Pale stools and dark urine suggest obstructive jaundice, as conjugated bilirubin is unable to reach the intestines, leading to decreased stercobilin (which gives stools their brown color) and increased excretion of conjugated bilirubin in the urine.

Question 13

What is the first-line treatment for neonatal jaundice?

Answer 13

Phototherapy, which helps convert unconjugated bilirubin into water-soluble forms that can be excreted.

Question 14

What is kernicterus?

Answer 14

A form of bilirubin-induced brain dysfunction that occurs in severe cases of neonatal jaundice when unconjugated bilirubin crosses the blood-brain barrier.

Question 15

What is the role of liver function tests (LFTs) in jaundice evaluation?

Answer 15

LFTs help determine the underlying cause of jaundice by assessing levels of bilirubin, ALT, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT).

Question 16

What does an isolated rise in bilirubin with normal LFTs suggest?

Answer 16

It may suggest Gilbert’s syndrome, especially if the rise is in unconjugated bilirubin.

Question 17

What is the significance of elevated alkaline phosphatase (ALP) in jaundice?

Answer 17

Elevated ALP levels, especially when accompanied by elevated GGT, suggest cholestasis or biliary obstruction.

Question 18

How does haemolysis lead to jaundice?

Answer 18

Increased destruction of red blood cells leads to elevated levels of unconjugated bilirubin, which can accumulate and cause jaundice.

Question 19

What is the typical appearance of urine in pre-hepatic jaundice?

Answer 19

In pre-hepatic jaundice, urine typically appears normal in color because unconjugated bilirubin is not water-soluble and is not excreted in urine.

Question 20

What is the role of endoscopic retrograde cholangiopancreatography (ERCP) in jaundice?

Answer 20

ERCP is used both diagnostically and therapeutically to identify and treat biliary obstructions, such as common bile duct stones or strictures causing jaundice.

Question 21

What is the relationship between jaundice and pruritus?

Answer 21

Accumulation of bile salts in the skin due to cholestasis can lead to itching, commonly associated with jaundice.

Question 22

What is the significance of a positive Murphy’s sign in a jaundiced patient?

Answer 22

A positive Murphy’s sign, which is pain upon palpation of the right upper quadrant during inspiration, suggests acute cholecystitis, which can be associated with biliary obstruction and jaundice.

Question 23

What is the importance of assessing prothrombin time (PT) in jaundiced patients?

Answer 23

Prolonged PT can indicate impaired liver synthetic function, as the liver produces clotting factors; this is important in assessing the severity of liver disease in jaundiced patients.

Question 24

What is the role of the liver in bilirubin metabolism?

Answer 24

The liver conjugates unconjugated bilirubin, making it water-soluble (conjugated bilirubin), which can then be excreted into the bile and eliminated from the body.

Question 25

What is the difference between conjugated and unconjugated bilirubin?

Answer 25

Unconjugated bilirubin is lipid-soluble and not water-soluble, resulting from the breakdown of haemoglobin; conjugated bilirubin is water-soluble, formed in the liver by conjugation with glucuronic acid, and excreted into bile.

Question 26

What is the significance of jaundice presenting within the first 24 hours of life?

Answer 26

Jaundice appearing within the first 24 hours is always pathological and requires urgent investigation to determine the underlying cause.