Jaundice

Question 1

What is Jaundice? What is normal total bilirubin and what would levels be if seen in sclera and skin?

Answer 1

Too much bilirubin in the blood.
Normal - <21 umol/L
Yellow Sclera - >30 umol/L
Yellow Skin - >100 umol/L

Question 2

Name the 3 types of Jaundice?

Answer 2

Pre-hepatic, Hepatic, Post-hepatic.

Question 3

Describe Pre-hepatic Jaundice?

Answer 3

Excessive RBC breakdown overwhelming the livers ability to conjugate bilirubin.
Increased Unconjugated bilirubin (everything else in pathway also increased).
E.g. Sickle cell anaemia, Yellow Fever.

Question 4

Describe Hepatic Jaundice?

Answer 4

Dysfunction of the liver affecting its ability to conjugate bilirubin - could be issue with uptake, transport, conversion etc.
Both conjugated and unconjugated can be increased, so can be a mixed picture.
E.g. Viral hepatitis, alcoholic liver disease, hepatocellular carcinoma.

Question 5

Describe Post-Hepatic Jaundice?

Answer 5

Obstruction of biliary apparatus.
Increased conjugated bilirubin, as it cant reach intestine to be converted - everything after is reduced.
E.g. Gall stones, Pancreatitis (swelling can block bile flow).