Jaundice

Question 1

where is haemoglobin broken down?

Answer 1

the spleen

Question 2

What breaks down haemoglobin in the spleen?

Answer 2

macrophages

Question 3

What is haem broken down into?

Answer 3

biliverden

Question 4

What is biliverden converted to?

Answer 4

bilirubin

Question 5

How is bilirubin carried to the liver?

Answer 5

Albumin

Question 6

What conjugates bilirubin in the liver?

Answer 6

UDP-glucoronyl-transferase

Question 7

In the small intestine what do bacteria convert bile to?

Answer 7

urobilinogen

Question 8

How does the liver get rid of conjugated bilirubin?

Answer 8

Bile

Question 9

urobilinogen is _____ to form urobilin which gives faeces its brown colour

Answer 9

oxidised

Question 10

Some urobilinogen is reabsorbed and then re-excreted by the kidney. This does what to urine?

Answer 10

causes it to be yellow

Question 11

Prehepatic jaundice is caused by?

Answer 11

the haemolysis of RBCs

Question 12

Examples of conditions causing pre-hepatic jaundice?

Answer 12

haemolytic anemias, new born jaundice

Question 13

Jaundice from pre-hepatic causes is usually…?

Answer 13

mild

Question 14

Blood tests would show what levels of conjugated and unconjugated bilirubin in pre-hepatic jaundice?

Answer 14

normal conjugated, raised unconjugated (saturated enzyme)

Question 15

clinical features that may present with pre-hepatic jaundice?

Answer 15

anemia, splenomegaly, gall stones

Question 16

Potential causes of hepatic jaundice?

Answer 16

hepatitis, hepatotoxicity, cirrhosis, congenital disorders

Question 17

What two possibilities are the cause of hepatic jaundice (pathophysiological processes)?

Answer 17

1. disruption in the ability to uptake or conjugate bilirubin 2. oedema of the hepatocytes causing intrahepatic obstruction of the bile ducts

Question 18

Causes of disruption in ability to conjugate bilirubin in hepatic jaundice

Answer 18

reduced UDP enzyme: leads to increased unconjugated bilirubin but otherwise normal LFTs (Gilbert syndrome)

Question 19

Intrahepatic obstructive jaundice would potentially cause what blood abnormalities?

Answer 19

raised unconjugated and conjugated bilirubin - highest being conjugated as it is an obstructive issue

Question 20

LFTs in hepatic jaundice may show?

Answer 20

very raised AST and raised ALT, slightly raised GGT and ALP

Question 21

A low albumin in hepatic jaundice indicates?

Answer 21

ongoing chronic condition

Question 22

What is the process behind extrahepatic jaundice?

Answer 22

obstruction of bile drainage through the biliary system

Question 23

Main causes of extrahepatic jaundice?

Answer 23

gallstones, cancer of the head of the pancreas

Question 24

Hepatic jaundice may cause what changes to stools and urine?

Answer 24

Depending on obstruction may have paler stools and darker urine. depends on level and is not a diagnostic indicator

Question 25

Extrahepatic jaundice causes what changes to stools and urine? why?

Answer 25

pale stools and dark orange urine. Conjugated bilirubin isnt getting into the gut to be oxidised but may be excreted by the kidneys

Question 26

Blood results concerning bilirubin in extrahepatic jaundice?

Answer 26

normal unconjugated and increased conjugated as there is normal liver function, just issues in excretion.

Question 27

LFTs in extrahepatic jaundice?

Answer 27

slightly raised AST, ALT, ALP and GGT - more from back pressure through the biliary system than liver issues

Question 28

A history involving country of origin might point to what causes of jaundice?

Answer 28

Hep B and Hep C

Question 29

A history involving duration of illness might point to what causes of jaundice?

Answer 29

1. prolonged, weight loss - malignancy 2. short, prodromal - hepatitis

Question 30

A history involving outbreaks of jaundice in the community might indicate what causes of jaundice?

Answer 30

Hep A

Question 31

A history involving IVDU and tattoos might indicate what causes of jaundice?

Answer 31

Hep B or Hep C

Question 32

A history of alcohol with jaundice might indicate?

Answer 32

chronic liver disease

Question 33

A family history of jaundice might indicate?

Answer 33

hereditary conditions such as Gilbert’s syndrome (lack of enzyme UDP)

Question 34

A history of surgery with jaundice might indicate?

Answer 34

biliary tract surgery or carcinoma

Question 35

A history of fever and rigors with jaundice might indicate?

Answer 35

cholangitis

Question 36

A smooth hepatomegaly might indicate what causes of jaundice?

Answer 36

hepatitis, extrahepatic causes

Question 37

A knobbly, irregular hepatomegaly with jaundice?

Answer 37

metastases or cirrhosis

Question 38

Splenomegaly with jaundice might indicate?

Answer 38

Portal hypertension from chronic disease, viral hepatitis, or increased RBC lysis

Question 39

Ascites with jaundice might indicate?

Answer 39

cirrhosis

Question 40

A palpable gallbladder with jaundice may indicate?

Answer 40

blocked biliary tract or carcinoma of the pancreas

Question 41

Investigations for jaundice?

Answer 41

USS, Serology, FBC, LFTs, Auto-antibodies, Albumin, Pro-thrombin, WCC

Question 42

USS might indicate what causes of jaundice?

Answer 42

rules out obstruction, features of chronic liver disease, size of bile ducts, tumours and gallstones,

Question 43

Serology might indicate what causes of jaundice?

Answer 43

hepatitis, CMV, HIV

Question 44

Hepatitis might show what LFTs?

Answer 44

raised AST and ALT, small raise in ALP

Question 45

Extrahepatic jaundice might show what LFTs?

Answer 45

raised ALP and small raise AST and ALT

Question 46

Chronic liver disease associated jaundice might show what LFTs

Answer 46

increased pro-thrombin time, low serum albumin

Question 47

Raised WCC might indicate what causes of jaundice?

Answer 47

cholangitis, infection, abscesses

Question 48

Anti-AMA might indicate?

Answer 48

PBC