Jaundice

Question 1

What is the concentration of plasma bilirubin that will cause jaundice?

Answer 1

35 micromole

Question 2

What is the first tissue to change colour with jaundice?

Answer 2

sclera

Question 3

What carries unconjugated bilirubin in the cytosol of hepatocytes?

Answer 3

ligandin

Question 4

What are the three categories of causes of jaundice?

Answer 4

pre-hepatic, hepatic and post hepatic

Question 5

What are the pre-hepatic causes of jaundice?

Answer 5

haemolysis and failed erythropoesis

Question 6

What are the hepatic causes of jaundice?

Answer 6

rifampicin (interferes with bilirubin uptake), viral hepatitis, drug induced hepatitis, gilbert’s syndrome, Crigler-Najjar syndrome, Dubin-Johnson syndrome, cirrhosis, tumours

Question 7

What are the post-hepatic causes of jaundice?

Answer 7

gallstones, carcinoma of pancreas or biliary tree, cholangitis

Question 8

What are some causes of haemolytic anemia?

Answer 8

hypersplenism, autoimmunity, toxin made by bacteria, trauma, copper, G6PD deficiency, sickle cell anemia

Question 9

What type of bilirubin is found in pre-hepatic jaundice?

Answer 9

unconjugated bilirubin over 60 micromole

Question 10

What is the normal amount of plasma unconjugated bilirubin?

Answer 10

<20 micromole

Question 11

What happens to urine urobilinogen in pre-hepatic jaundice?

Answer 11

increased

Question 12

What are the causes of neonatal jaundice?

Answer 12

increased haem catabolism, immaturity of the liver, different blood type to mum, G6PD deficiency, birth trauma, premature birth, breast feeding, hepatic inflammation

Question 13

How is neonatal jaundice treated?

Answer 13

phototherapy

Question 14

What is the serum total bilirubin in newborns?

Answer 14

100 micromole

Question 15

What key elements of hepatocytes to newborns not have sufficient levels of increasing their jaundice?

Answer 15

ligandin and UDPGT

Question 16

What is Gilbert’s syndrome?

Answer 16

a decreased conjugation of bilirubin - poor action of UDPGT

Question 17

What are the symptoms of Gilbert’s syndrome?

Answer 17

some hyperbilirubinemia but normal liver biopsy and normal lifespan - often sub clinical

Question 18

What is rotor disease?

Answer 18

an inherited cause of hyperbilirubinemia with unknown defect

Question 19

How do G6PD deficiency cause jaundice?

Answer 19

causes haemolytic anemia due to the unstable enzyme causing oxidative damage in red blood cells

Question 20

How do you diagnose the cause of jaundice?

Answer 20

(Flow chart in Evernote)