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
What is the cause of neonatal jaundice?
Delays in clearance of bilirubin from red cell breakdown
26
What is the treatment for neonatal jaundice?
phototherapy
27
What are the hepatic cause for jaundice?
``` Liver disease Viral hepatitis Toxic-alcohol Cirrhosis Liver injury- intrahepatic cholestasis ```
28
What are the causes of intrahepatic cholestasis?
cancer destruction of bile ductules due to drugs or autoimmunity secondary to systemic injury, pregnancy, drug toxicity
29
What is the typical presentation of hepatic jaundice?
``` 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 ```