Jaundice Flashcards
Pre-hepatic causes of jaundice
Haemolytic anaemia (infective, congenital/AI, drugs, nutritional)
Pre-hepatic causes of jaundice
Infective: malaria, GBS
Congenital/AI: sickle cell, thalassaemia, G6PD, AI
Drugs: cephalosporins
Nutritional: megaloblastic anaemia, IDA anaemia
Pre-hepatic jaundice presentation investigation findings
Increased unconjugated (indirect) bilirubin
Normal conjugated (direct, soluble) bilirubin
High urobilinogen
No pruritis, pale stools or dark urine (not water soluble, bound to albumin)
Decreased haptoglobin (most is bound to Hb)
Increased LDH (breakdown product of RBCs)
Increased reticulocyte count (churning out new RBCs)
Decreased Hb
Management of pre-hepatic jaundice
Stop drugs that can cause haemolysis
Folic acid
IV fluids
Corticosteroids if AI
Causes of megaloblastic anaemia
B12 deficiency (causes folate deficiency because folate recycling is dependent on B12) Folate deficiency
Causes of B12 deficiency
Dietary insufficiency
AI gastritis
Gastrectomy
Terminal ileum resection
Hepatic causes of unconjugated bilirubinaemia
Gilbert’s syndrome
Crigler-Najjer
Drugs (e.g. antibiotics, paracetamol)
Hepatic causes of conjugated bilirubinaemia
Dubin-Johnson Viral hepatitis Alcoholic hepatitis Non-alcoholic fatty liver disease AI hepatitis Drugs (e.g. antibiotics, paracetamol)
Dubin-Johnson defect
C-MOAT (failure of bile secretion)
Post-hepatic causes of conjugated bilirubinaemia
Intraductal obstruction: choledocolithiasis, parasites (ascaris), stricture, sclerosing cholangitis, cholangiocarcinoma
Extraductal obstruction: pancreatic cancer, lymphoma, LN mets
Inflammation: pancreatitis
Hepatic jaundice due to PROBLEM WITH CONJUGATION (unconjugated bilirubinaemia) presentation and investigation findings
Increased conjugated (direct) bilirubin No conjugated bilirubin or urobilinogen in urine Normal haptoglobin Normal LFTs Normal stools, normal urine
Cause of dark urine
High conjugated (SOLUBLE) BILIRUBIN (NOT urobilin)
