Jaundice

Question 1

What are the four stages of liver damage?

Answer 1

Healthy liver
Fatty liver
Liver fibrosis
Cirrhosis

Question 2

Why is diagnosis of liver diseases difficult?

Answer 2

Many disease cause the same symptoms of inflammation and fibrosis

Question 3

What complications could come as a result of cirrhosis?

Answer 3

Portal hypertension
Splenomegaly
Renal failure
Varices in the oesophagus

Question 4

What would indicate hepatocyte damage?

Answer 4

AST, ALT
Bilirubin
Albumin

Question 5

What would indicate biliary damage?

Answer 5

ALP

GGT

Question 6

What would indicted cholestasis?

Answer 6

Bilirubin
ALP
GGT

Question 7

What tests other than liver function can be carried out?

Answer 7

Antibody titre
Viral markers
Tumour markers
Ultrasound

Question 8

What happens to albumin levels in liver disease?

Answer 8

They decrease

Question 9

What is jaundice?

Answer 9

Yellow discolouration of the skin, eye and other tissues due to a build up of bilirubin

Question 10

What are the three kinds of jaundice?

Answer 10

Prehepatic
Intrahepatic
Extrahepatic

Question 11

What is bilirubin?

Answer 11

A product of haem catabolism

Question 12

What is the daily production of bilirubin?

Answer 12

250-300mg

Question 13

What is the total bile salt pool?

Answer 13

3.5g

Question 14

What carries unconjugated bilirubin from the spleen to the liver?

Answer 14

Albumin

Question 15

What happens to unconjugated bilirubin in the liver?

Answer 15

It is conjugated to conjugated bilirubin with glucoronic acid
This is water soluble

Question 16

Where is conjugated bilirubin excreted?

Answer 16

In bile

Question 17

Is unconjugated bilirubin soluble?

Answer 17

No

Question 18

What happens to conjugated bilirubin in the large intestine?

Answer 18

It is converted to urobilinogen

Lipid soluble

Question 19

What happens to urobilinogen?

Answer 19

10% bound to albumin returns to blood

Remaining 90% converted to steroglobin, giving faeces its brown colour

Question 20

What happens to the urobilinogen that is reabsorbed?

Answer 20

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

Question 21

Where is bilirubin first formed?

Answer 21

In the spleen

Break down of red blood cells

Question 22

What would high levels of unconjugated bilirubin indicate?

Answer 22

High levels of haemolysis
Not related to the liver
Prehepatic jaundice

Question 23

What is Gilbert’s syndrome?

Answer 23

10% of caucasian population
Less effective at conjugation of bilirubin
Elevated unconjugated bilirubin
Benign

Question 24

What would high levels of conjugated bilirubin indicate?

Answer 24

Failure of cellular mechanisms of excretion of conjugated bilirubin
Acute hepatitis
Intrahepatic jaundice

Question 25

What is viral hepatitis?

Answer 25

Viruses selectively infect hepatocytes

Immune system kills infected hepatocytes

Question 26

What can hepatitis B lead to?

Answer 26

Acute or chronic hepatitis
Liver failure
Cirrhosis

Question 27

What can hepatitis C lead to?

Answer 27

Hepatitis

Cirrhosis, many years later

Question 28

Which viral hepatitis will cause jaundice?

Answer 28

Definitely A&E

Maybe B&C

Question 29

What is cholestasis?

Answer 29

Decreased bile flow, can cause jaundice

Question 30

What can cause cholestasis?

Answer 30

Liver trauma

Liver cancer

Question 31

What might cause post hepatic jaundice?

Answer 31

Obstruction of bile ducts

Question 32

What might cause obstruction of bile ducts?

Answer 32

Gallstones
Cancer
Inflammation

Question 33

What is the cause of neonatal jaundice?

Answer 33

Delay in clearance of bilirubin from red cell breakdown

Question 34

Will stools be dark or light with jaundice?

Answer 34

Light, bilirubin not reaching the intestine via bile duct

Question 35

Will urine be dark or light with jaundice?

Answer 35

Dark, liver producing conjugated bilirubin that is water soluble and moves to the kidneys. Overload of bilirubin