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DIG > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is the purpose of bile?

A

emulsification of fat in the intestine
Far soluble vitamin uptake
excretion of cholesterol and bilirubin

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2
Q

Stages of liver damage

A

Healthy Liver
Fatty Liver- deposits of fat- liver enlargement
Liver Fibrosis- scar tissues forms
Cirrhosis- growth of connective tissue destroys liver cells

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3
Q

What is jaundice?

A

yellow discolouration of the skin, eye and other tissues

build of of bilirubin in tissue fluids and bloodstream- in excess 2mg/ml

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4
Q

Why is jaundice not necessarily liver disease

A

neonatal jaundice

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5
Q

What is bilirubin a product of?

A

Haem catabolism

From RBC, myoglobin, cytochromes, peroxidase

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6
Q

How is bilirubin transported to liver?

A

Carried by albumin as it is insoluble

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7
Q

How does bilirubin enter the liver?

A

Active transport across the liver membrane

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8
Q

What happens to bilirubin in the liver?

A

it is conjugated with glucuronic acid by UDP glucoronyltransferrase

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9
Q

What happens to bilirubin after it is conjugated?

A

Bilirubin becomes water soluble and it is excreted into bile

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10
Q

Where is bile excreted into?

A

duodenum

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11
Q

What happens to bilirubin in the intestinal tract?

A

It is metabolised by b-glucuronidase in the gut ( bacterial or epithelial cells) to form unconjugated bilirubin

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12
Q

What happens to the unconjugated bilirubin in the gut

A

Chemical reduction into urobilinogen

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13
Q

What happens to urobilinogen?

A

Some is reabsorbed and sent back to the liver
some is excreted in urine
some is converted into stercobilinogen by bacteria

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14
Q

What are the three main causes of jaundice

A

Prehepatic
Intrahepatic
Extrahepatic

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15
Q

What is heamolytic anaemia?

A

red cell destruction

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16
Q

What is Paroxysmal nocturnal haemaglobulinurea (PNS)?

A

genetic, fragile RBCs

17
Q

What are the two main categories of pre-hepatic jaundice

A

Haemolysis

Gilbert’s syndrome

18
Q

What is sickle cell disease?

A

Genetic, varient forms of Hb present

19
Q

What are the three main examples of haemolysis

A

Haemolytic anaemia
Paroxysmal nocturnal haemoglobulinurea (PNS)
Sickle cell disease

20
Q

What other liver symptoms are present in anaemias

A 
gallstones, increased bilirubin, dark urine
hepatomegaly, splenomegly
elevated AST/ALT
thrombosis
iron overload
hepatic thrombosis
coagulation deficit
Altered MRI signal
21
Q

What is the treatment for sickle cell disease?

A

Agressive manual exchange RBC transfusion to reduce HbS

22
Q

What is Gilbert’s

A

mutation in UDP-glucoronyl transferase 1 gene
leads to deficiency in enzyme to conjugate bilirubin
therefore elevated unconjugated bilirubin

23
Q

What is the typical presentation of pre-hepatic jaundice

A 
increased unconjugated bilirubin
Normal AST/ ALT
Normal ALP/ Gamma GT
Bilirubin is not found in urine
urobilinogen is found in urine
normal colour stools and urine
24
Q

What is required for a differential diagnosis of gilbert’s?

A

Exclude haemolysis and other liver diseases

25
Q

What is the cause of neonatal jaundice?

A

Delays in clearance of bilirubin from red cell breakdown

26
Q

What is the treatment for neonatal jaundice?

A

phototherapy

27
Q

What are the hepatic cause for jaundice?

A 
Liver disease
Viral hepatitis
Toxic-alcohol
Cirrhosis
Liver injury- intrahepatic cholestasis
28
Q

What are the causes of intrahepatic cholestasis?

A

cancer
destruction of bile ductules due to drugs or autoimmunity
secondary to systemic injury, pregnancy, drug toxicity

29
Q

What is the typical presentation of hepatic jaundice?

A 
Raised AST/ALT
Mild increase ALP/ gamma GT
increased conjugated bilirubin
if complete bile duct obstruction- urobilinogen is not found in urine
pale stools 
dark urine

DIG (22 decks)

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