Jaundice Flashcards
Briefly describe the pathway of bilirubin metabolism
Breakdown of haemoglobin in spleen to haem and globin , haem gets broken down to unconjugated bilirubin - bound to albumin , conjugated in liver, excreted via kidneys ( urobilinogen ) or faeces ( stercobilin)
What are the causes of jaundice ? Give examples
Prehepatic
- haemolysis eg thalassaemia, sickle cell , G6PD
Intrahepatic
- hepatitis , drugs , alcohol/ cirrhosis
Posthepatic
Duct stones , carcinoma ( bile duct head of pancreas, ampulla )
Biliary stricture
Sclerosing cholangitis
What clinical features would you expect in intrahepatic damage ( e.g hepatitis , alcoholic liver, ) or extrahepatic conditions ( e.g bile stones , carcinoma ) ?
Dark urine
Pale faeces
Pruritus
High conjugated bilirubin
What clinical features would you expect in pre hepatic disease ? ( e.g malaria , Gilbert’s )
High unconjugated bilirubin
Dark stools
Which congenital condition can cause hyperbilirubinaemia , which is rather an incidental finding ?
What are the features ?
Gilbert’s syndrome
High unconjugated bilirubin
Liver function normal
Mild, no treatment required
Name 4 predisposing factors / risk factors in the development of jaundice
Alcohol, drugs, recent anaesthetics ( Halothane), hep risk factors : MSM, piercings , injection ( drug abuse ) , blood transfusion
Describe possible clinical findings in patients presenting with jaundice .
Steatorrhea Hepatomegaly Splenomegaly Ascites Cirrhosis
Name 3 investigations in patients with jaundice.
Which investigation needs to be performed before considering treatment ?
Bloods: bilirubin, liver function , infection
Viral markers for hepatitis
USS
- exclude obstruction
Name 3 drugs that can cause jaundice
Anti malaria meds ( haemolysis)
Paracetamol overdoes ( hepatitis ) Rifampicin Sodium valproate Flucoxacillin Nitrofurantoin Sulfonylureaa Steroids Co amoxiclav
Name 2 complications of jaundice
Kernicterus in neonates
Hepatomegaly ( bike backflow)
Name 2 types of primary cholangitis .
Primary sclerosing cholangitis
Primary biliary cholangitis
Name 3 features that both PSC and PBC may present with .
Jaundice Portal hypertension Liver cirrhosis Hepatomegaly Liver failure
What is primary sclerosing cholangitis commonly associated with?
Ulcerative colitis ( and other IBD )
A patient suspicious our primary biliary cholangitis should be screened for which conditions due to the high association with these types of diseases ?
Autoimmune disease
Such as rheumatoid arthritis
Sicca syndrome
Autoimmune thyroid disease
Name 3 differences between PSC and PBC
PSC
- ANCA positive
- involves extra and intra hepatic ducts
- middle aged men
PBC
- AMA positive
- intrahepatic ducts only
- middle aged women
