Jaundice

Question 1

What is jaundice?

Answer 1

Yellow pigmentation of skin, mucous membranes and sclerae. It is caused by high levels of bilirubin in the body - clinically starts appearing at levels of 50 uM/L.

Question 2

What are causes of conjugated hyperbilirubinemia?

Answer 2

Obstructive jaundice - Blockage of flow of bile through bile ducts or intrahepatic or extrahepatic ducts

Hepatocellular Jaundice - due to hepatocyte damage

Question 3

What does biochemistry show in hepatocellular jaundice?

Answer 3

• Raised plasma bilirubin + conjugated bilirubin
• Complex biochemical picture is common as hepatic injury may also prevent conjugated bilirubin reaching gut. 

• Liver biochemistry will show an elevation in transaminases (ALT/AST)

Question 4

What are signs of obstructive jaundice?

Answer 4

• pale stool, dark urine and pruritus
• Raised ALP
• Raised conjugated bilirubin

Question 5

What causes unconjugated hyperbilirubinaemia?

Answer 5

Haemolysis, Gilbert’s Syndrome

Question 6

What imaging is carried out in a patient presenting with jaundice?

Answer 6

Trans-abdominal USS - look for obstruction and duct dilatation

followed by a CT scan

ERCP - look for stones