Jaundice Flashcards

1
Q

What are the congenital causes of intravascular haemorrhage?

A

Glucose-6-phosphate dehydrogenase deficiency

Pyruvate kinase deficiency

Sickle cell disease

Thalassemia

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2
Q

What are the acquired causes of intravascular haemorrhage?

A

Artificial heart valves

Blood mismatch

Disseminated intravascular haemorrhage

Malaria

Medications

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3
Q

What is extravascular haemolysis and why might it occur?

A

Extravascular haemolysis is when there is increased haemolysis in the spleen

This may be due to hereditary spherocytosis or autoimmune haemolysis

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4
Q

Why might be the cause of decreased conjugation be?

A

Reduced hepatocyte uptake - Cholecystographic contrast agents, portosystemic shunts to bypass a cirrhotic liver

Congenital enzymatic problems - Gilbert’s syndrome, Crigler-Najjar syndrome

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5
Q

What does steatorrhoea, dark urine pruritis suggest in the context of jaundice?

A

Obstruction to biliary flow

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6
Q

What does bronzed skin and signs of diabetes mellitus suggest in the context of jaundice?

A

Haemochromatosis

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7
Q

How can medications cause haemolysis?

A

Intravascular haemolysis

Autoimmune, extravascular haemolysis

Hepatitis

Cholestasis

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8
Q

What are reticulocytes?

Why are they important in diagnoses?

A

Precursor to RBCs

If bone marrow is struggling to keep up with RBC destruction then bone marrow will release these into circulation

Therefore raised reticulocytes suggests high RBC turnover

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9
Q

Jane is a 21-year-old female who attends her GP complaining of ‘yellow eyes’. For the past few days she has been feeling unwell with a cough and fever, but she is most distressed about the unusual colour of her eyes. She has never received blood or coagulation factors, denies any intravenous drug use, and she denies any sexual intercourse in the last 6 months.

Blood tests taken by the GP reveal:
Hb 13.7 g/dL
RBC 6.1 × 1012 cells/L
WCC 13 × 109 cells/L
Platelets 180 × 109 cells/L
Total bilirubin 60 μM
Conjugated bilirubin 2 μM

Markers for viral hepatitis are negative. Liver enzymes and reticulocyte count are within the normal range. A blood fillm is reported as unremarkable. A urine dipstick is normal.

A

Gilbert’s syndrome

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10
Q

What is Charcot’s triad? What does it suggest?

A

Febrile rigors, jaundice and right upper quadrant pain

Ascending cholangitis

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11
Q

What is PBC?

What is its pathology?

A

Primary biliary cirrhosis cholangitis

AI disease of liver characterised by T-cell mediated destruction of the biliary ducts (the autoantibodies are a secondary consequence)

9:1 ratio of females to males

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12
Q

What are the symptoms of PBC? (other than cirrhosis)

A

80% experience fatigue
70% experience itching

More severe disease leads to jaundice

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13
Q

What is PSC?

What is its pathology?

A

Primary sclerosing cholangitis

Idiopathic in origin. Although it is thought to be idiopathic in origin, it does not demonstrate a clear response to immunosupressants

Believed to be due to inflammation in the bile ducts, with consequent strictures and hardening of these ducts

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14
Q

What is the association of ulcerative colitis with PSC?

A

Approx 90% of patients with PSC have UC

but on 5% of patients UC develop PSC

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15
Q

Mr MacDonald is a 72-year-old gentleman referred to the surgical admissions unit by his GP. He is jaundiced and has noticed his trousers becoming looser over the past few months. He initially attributed his jaundice to excessive alcohol consumption, as he drinks 2 pints of Guinness every day before going to bed. He says that he is otherwise well, but on inspection you notice that he is severely cachectic, with the skin around his ribs and abdomen looking too big for him. Lymph nodes are palpable in his left
supraclavicular fossa, and on deep palpation of his abdomen a mass is noted in his epigastrium.

A

Pancreatic carcinoma

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16
Q

If a patient is visibly jaundiced, what is the minimum bilirubin they can have?

A

40uM

17
Q

What are the aspects of Hep B serology? What does each one represent?

A

HBs and HBc

HBsAG is present in the vaccination, therefore its presence either indicates very recent vaccination or active infection

IgG anti-HBs indicates vaccination or previous infection

IgG anti-HBc suggests infection (acute)

IgM anti-HBc indicates chronic infection