Jaundice Flashcards

1
Q

What is jaundice

A

Yellow pigmentation of the skin, sclerae and mucosa due to raised bilirubin

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2
Q

How is bilirubin normally produced

A

Created by the breakdown of haemoglobin
Conjugated with glucuronic acid by hepatocytes, making it water soluble.
Secreted in bile into the small intestine
Most bile is reabsorbed into the enterohepatic circulation, the rest converted by gut bacteria into urobilinogen

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3
Q

What normally happens to urobilinogen

A

Reabsorbed and excreted by kidneys

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4
Q

What happens to urobilinogen that isn’t reabsorbed

A

Converted to stercobilinogen

Excreted in faeces

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5
Q

How do you classify jaundice

A

Prehepatic jaundice
Hepatocellular jaundice
Obstructive jaundice

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6
Q

What are the features of prehepatic jaundice

A

Unconjugated hyperbilirubinaemia
Excess bilirubin production
Water insoluble so not in urine

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7
Q

What are some causes of prehepatic jaundice

A

Physiological (neonatal)
Haemolysis - sickle cell, thalassaemia
Gilbert’s syndrome - bilirubin increased on fasting

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8
Q

What are the features of hepatocellular jaundice

A

Due to hepatocyte damage

Usually some cholestasis

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9
Q

What are some causes of hepatocellular jaundice

A
Hepatitis - viral, alcoholic, drug-induced, ischaemic, autoimmune
Non-alcoholic steatohepatitis
Cirrhosis
Metastatic disease
Infection - septicaemia, liver abscesses
Haemochromatosis
Wilson's disease
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10
Q

What are the features of obstructive jaundice

A

Blockage of common bile ducts
Conjugated bilirubinaemia
Dark urine and pale stool - water soluble so more is excreted in urine than stool
Pruritus

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11
Q

What are some causes of obstructive jaundice

A

Biliary obstruction - gallstones
Malignancies - pancreatic, cholangiocarcinoma
Autoimmune - PBC, primary sclerosing cholangitis
Drugs - antibiotics (co-amoxiclav, chlorpromazine, prochlorperazine)

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12
Q

What is the differential for a patient with jaundice and signs of chronic liver disease?

A

ETOH, viral hepatitis, NAFLD

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13
Q

What is the differential for splenomegaly with jaundice?

A

Haemolysis
Chronic liver disease (causing portal hypertension)
Viral hepatitis e.g. EBV

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14
Q

What is the differential for hepatomegaly with jaundice?

A

hepatitis

CLD

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15
Q

What is the differential for jaundice without signs of CLD or organomegaly?

A

biliary obstruction
haemolysis
drugs: fluclox, OCP
Gilbert’s syndrome

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16
Q

What are the commonest causes of jaundice?

A

Haemolysis
CLD
Gallstones

17
Q

What is Courvoisier’s law?

A

A jaundiced patient presenting with a palpable gallbladder is unlikely to have a diagnosis secondary to gallstones