Jaundice Flashcards
What are the four stages of liver damage?
Healthy liver
Fatty liver
Liver fibrosis
Cirrhosis
Why is diagnosis of liver diseases difficult?
Many disease cause the same symptoms of inflammation and fibrosis
What complications could come as a result of cirrhosis?
Portal hypertension
Splenomegaly
Renal failure
Varices in the oesophagus
What would indicate hepatocyte damage?
AST, ALT
Bilirubin
Albumin
What would indicate biliary damage?
ALP
GGT
What would indicted cholestasis?
Bilirubin
ALP
GGT
What tests other than liver function can be carried out?
Antibody titre
Viral markers
Tumour markers
Ultrasound
What happens to albumin levels in liver disease?
They decrease
What is jaundice?
Yellow discolouration of the skin, eye and other tissues due to a build up of bilirubin
What are the three kinds of jaundice?
Prehepatic
Intrahepatic
Extrahepatic
What is bilirubin?
A product of haem catabolism
What is the daily production of bilirubin?
250-300mg
What is the total bile salt pool?
3.5g
What carries unconjugated bilirubin from the spleen to the liver?
Albumin
What happens to unconjugated bilirubin in the liver?
It is conjugated to conjugated bilirubin with glucoronic acid
This is water soluble
Where is conjugated bilirubin excreted?
In bile
Is unconjugated bilirubin soluble?
No
What happens to conjugated bilirubin in the large intestine?
It is converted to urobilinogen
Lipid soluble
What happens to urobilinogen?
10% bound to albumin returns to blood
Remaining 90% converted to steroglobin, giving faeces its brown colour
What happens to the urobilinogen that is reabsorbed?
Returns to the liver
Half is resecreted into the bile
Half goes to the kidney and is converted to urobilin and excreted, giving urine its yellow colour
Where is bilirubin first formed?
In the spleen
Break down of red blood cells
What would high levels of unconjugated bilirubin indicate?
High levels of haemolysis
Not related to the liver
Prehepatic jaundice
What is Gilbert’s syndrome?
10% of caucasian population
Less effective at conjugation of bilirubin
Elevated unconjugated bilirubin
Benign
What would high levels of conjugated bilirubin indicate?
Failure of cellular mechanisms of excretion of conjugated bilirubin
Acute hepatitis
Intrahepatic jaundice
What is viral hepatitis?
Viruses selectively infect hepatocytes
Immune system kills infected hepatocytes
What can hepatitis B lead to?
Acute or chronic hepatitis
Liver failure
Cirrhosis
What can hepatitis C lead to?
Hepatitis
Cirrhosis, many years later
Which viral hepatitis will cause jaundice?
Definitely A&E
Maybe B&C
What is cholestasis?
Decreased bile flow, can cause jaundice
What can cause cholestasis?
Liver trauma
Liver cancer
What might cause post hepatic jaundice?
Obstruction of bile ducts
What might cause obstruction of bile ducts?
Gallstones
Cancer
Inflammation
What is the cause of neonatal jaundice?
Delay in clearance of bilirubin from red cell breakdown
Will stools be dark or light with jaundice?
Light, bilirubin not reaching the intestine via bile duct
Will urine be dark or light with jaundice?
Dark, liver producing conjugated bilirubin that is water soluble and moves to the kidneys. Overload of bilirubin
