Jaundice Flashcards
What are some things that can happen when the liver stops working
Jaundice
Ascites
Variceal bleeding
Hepatic Encephalopathy
What is jaundice and what is it caused by
Yellowing of the skin, sclera etc
Caused by excess circulating bilirubin
At what level does total plasma bilirubin need to be at for jaundice to be detectable
> 34 umol/L
What is a differential diagnosis of jaundice
Carotenaemia
- this doesn’t cause yellowing of sclera
What is a pre-hepatic cause of jaundice
Increased Haemolysis
= increased quantity of bilirubin
Pre-hepatic jaundice history and examination
History of anaemia (Fatigue , Dyspnoea, Chest pain)
Pallor, splenomegaly
What is a cause of hepatic jaundice
Dysfunctional parenchyma, Defective:
- bilirubin uptake
- conjugation
- excretion
Hepatic jaundice H&E
Drug user
Other liver problems: ascites, variceal bleed, encephalopathy
Spider naevi, gynaecomastia, ascites, asterixis
Post-hepatic cause of jaundice
Defective transport of bilirubin by the bile ducts
- i.e. obstruction
Post-hep H&E
Abdominal pain
Cholestasis: Pruritus, pale stool, dark urine
Palpable gallbladder
Most important investigation for jaundice and why
Abdominal USS
- differentiates extra hepatic and intrahepatic obstruction
Liver screen tests for jaundice
Hep B&C serology
Alpha 1 anti-trypsin
Fasting glucose profile
How can ERCP be used therapeutically
View visible stones or tumours
View acute gallstone pancreatitis
Stent biliary tract obstruction
Use post-op in biliary complications
What complications can occur with ERCP
Sedation related problems with respiratory / CVS
Procedure related - pancreatitis, cholangitis, bleeding, perforation
When may a percutaneous trans hepatic cholangiogram be used but what is its disadvantage
When ERCP is not possible due to duodenal obstruction or previous surgery
For Hilar stenting
More invasive than ERCP
