Jaundice

Question 1

Most common cause of prehepatic jaundice

Answer 1

Gilbert’s syndrome - persistently high bilirubin with no other LFT abnormalities

Question 2

Causes of jaundice using vitamin D

Answer 2

Portal vein thrombosis, congestive HF
Hepatitis, EBV, CMV, malaria
Trauma post op
Autoimmune liver disease 
Gilbert's, haemochromatosis 
PBC, PSC
Mets, hepatocellular carcinoma
Alcohol, paracetamol

Question 3

What are haematinics

Answer 3

B12
Folate
Ferritin

Question 4

Danger of prescribing codeine in jaundice

Answer 4

It is an active metabolite

Question 5

Danger of prescribing NSAIDs in jaundice

Answer 5

Increases bleeding risk

Causes renal impairment and patients may already be hypovolaemic

Question 6

Danger of prescribing morphine in jaundice

Answer 6

Constipation can precipitate encephalopathy

Lowers GCS

Question 7

What is the best analgesia to give in jaundice

What precautions should be taken

Answer 7

Paracetamol

Avoid IV, use dry body weight, halve the dose

Question 8

What is the best sedative to give in jaundice

What precautions should be taken

Answer 8

Lorazepam as medium half life

Try to avoid drugs as far as possible, titration dose, contact ITU