Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MC > Jaundice > Flashcards

Jaundice Flashcards

1
Q

____________- is a yellow discolouration of the skin and mucosal surfaces caused by the accumulation of excessive bilirubin.

A

Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Categories of jaundice

A 
• obstructive:
— extrahepatic
— intrahepatic
• hepatocellular
• haemolytic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Jaundice is defined as a serum bilirubin level exceeding____________

A

19 μ mol/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical jaundice manifests only when the bilirubin level exceeds_________

A

50 μ mol/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

It can be distinguished from yellow skin due to___________ (due to dietary excess of carrots, pumpkin, mangoes or pawpaw) and ___________ by involving the sclera.

A

hypercarotenaemia

hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q 
The most common causes of jaundice recorded in a general practice population are (in order) 
1
2
3
4
A

viral hepatitis, gallstones, pancreatic cancer, cirrhosis, pancreatitis and drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A ______________ can occur not only with alcohol excess but also with obesity, diabetes and starvation. There is usually no liver damage and thus no jaundice.

A

fatty liver (steatosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In the middle-aged and elderly group, a common cause is ____________-

A

obstruction from gallstones or cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Malignancy must always be suspected, especially in the elderly patient and those with a history of____________-

A

chronic active hepatitis (e.g. post hepatitis B or C infection).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A patient who has the classic Charcot triad of upper abdominal pain, fever (and chills) and jaundice should be
regarded as having _________________

A

ascending cholangitis until proved

otherwise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

__________, although rare, must be
considered in all young patients with acute hepatitis.

A history of neurological symptoms, such as a tremor or a clumsy gait, and a family history is important

A

Wilson syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If Wilson syndrome is suspected an ocular slit lamp examination, _____ and _____________should be performed

A

serum ceruloplasmin levels (low in 95%

of patients) and a liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_________is the commonest form of unconjugated hyperbilirubinaemia. It affects at least 3% of the population.

A

Gilbert syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Labs associated wtih CPC

A

Usually there is a moderate rise in
bilirubin and alkaline phosphatase and sometimes, in acute failure, a marked elevation of transaminase
may occur, suggesting some hepatocellular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

patterns of drug-related jaundice

A

The patterns of drug-related liver damage
include cholestasis, necrosis (‘hepatitis’), granulomas,
chronic active hepatitis, cirrhosis, hepatocellular
tumours and veno-occlusive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Drugs causing drug-related jaudice

A

Antibiotics, especially flucloxacillin,

amoxycillin + clavulanate and erythromycin, are commonly implicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The patient may present with the symptoms of underlying anaemia and jaundice with no noticeable
change in the appearance of the urine and stool

A

Haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

severe haemolytic crisis can be precipitated by drugs or broad beans (favism) in a patient
with an inherited ___________

A 
red cell deficiency of glucose-6-
phosphate dehydrogenase (G6PD).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Red flag pointers for jaundice

A
  • Unexplained weight loss
  • Progressive jaundice including painless jaundice
  • Oedema
  • Cerebral dysfunction (e.g. confusion, somnolence)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A palpable gall bladder indicates ____________, and splenomegaly may ________________, portal hypertension or _____________

A

extrahepatic biliary obstruction

indicate haemolytic anaemia

viral hepatitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Skin excoriation may indicate pruritus, which is associated with __________

A

cholestatic jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What to see in dipstick urine for pts with jaundice

A

bilirubin and urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diagnostic markers for hepatitis

1
2
3

A
  • Hepatitis A: IgM antibody (HAV Ab)
  • Hepatitis B: surface antigen (HBsAg)
  • Hepatitis C: HCV antibody (HCV Ab)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

_________________the most

useful investigation for detecting gallstones and dilatation of the common bile duct

A

Transabdominal ultrasound (US):

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

__________________: useful in diagnosis of acute cholecystitis

A

HIDA scintiscan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

________________-:

shows imaging of biliary tree

A

PTC: percutaneous transhepatic cholangiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

__________determine the cause of the obstruction and relieves it by sphincterotomy and removal of CBD
stones

A

ERCP: endoscopic retrograde

cholangiopancreatography; PTC and ERCP (best)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

__________

provides non-invasive planning for obstructive jaundice

A

MRCP: magnetic resonance cholangiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

___________: useful for liver cirrhosis,

especially of the left lobe

A

Liver isotopic scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Some specific tests include:

•_______for autoimmune chronic active
hepatitis and primary biliary cirrhosis
• ________ to detect liver
secondaries, especially colorecta

A

autoantibodies

carcinoembryonic antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Some specific tests include:

serum iron studies, especially transferrin
saturation—elevated in _____________

______—elevated in hepatocellular carcinoma; mild elevation with acute or chronic liver disease (e.g. cirrhosis

serum ceruloplasmin level—low in _____

A

haemochromatosis

alpha-fetoprotein

Wilson
syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Jaundice in the newborn is clinically apparent in ____ of term babies and more than ____of preterm

A

50%

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which type of bilirubin is always pathological?

A

conjugated

(always pathological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Jaundice occurring in the first 24 hours after birth is not due to immature liver function but is pathological and usually due to ____________

In primigravidas it is
usually due to ___________

A

haemolysis consequent
on blood group incompatibility

ABO incompatibility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

With increasing serum levels of bilirubin, an encephalopathy (which may be transient) can develop, but if persistent
can lead to the irreversible brain damage known as _______–

A

kernicterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

levels of bilirubin causing Rh Disease

A

unconjugated bilirubin of 340 μ mol/L (20 mg/dL).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Guidelines for treatment for hyperbilirubinaemia (at 24–36 hours)—
• >285 μ mol/L—____________
• >360 μ mol/L—____________

A

phototherapy

consider exchange transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

This mild form of jaundice, which is very common in infants, is really a diagnosis of exclusion

A

Physiological jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In a term infant the serum bilirubin rises quickly after birth to reach a maximum by day_______ then declines
rapidly over the next ____________before fading more slowly for the next ______________

A

3–5,

2–3 days

1–2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

This is antibody-mediated haemolysis (Coomb test positive):
• Mother is O
• Child is A or B

A

ABO blood group incompatibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Mx of ABO blood group incompatibility

A

• Perform a direct Coomb test on infant.
• Phototherapy is required immediately.
• These children require follow-up developmental
assessment including audiometry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If the secondary causes of prolonged jaundice are excluded, the baby is well and breastfeeding, the likely
cause of unconjugated elevated bilirubin is______

A

breast milk jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Patterns of breast milk jaundice

A

It usually begins late in the first week and peaks at 2–3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How to confirm dx of breast milk jaundice

A

Diagnosis is confirmed by suspending

(not stopping) breastfeeding for 24–48 hours

45
Q

Viral infection is the commonest cause of jaundice in the older child, especially _______

A

hepatitis A and hepatitis B

46
Q

Obstructive jaundice is the commonest form of jaundice in the elderly and may be caused by _____and_____

A

gallstones blocking the common bile duct (may be painless)
carcinoma

of the head of the pancreas, the biliary tract itself, the stomach or multiple secondaries for other sites.

47
Q

What law

painless obstructive jaundice is due to neoplasm—particularly
if the gall bladder is palpable

A

(Courvoisier’s law).

48
Q

_____ and _____ are the most commonly reported types of viral hepatitis with an onset that is more insidious and with a longer incubation period

A

hepatitis B and C

49
Q

hepatitis______ from faeco-oral transmission;

and hepatitis_______ from intravenous drugs and bodily fluids

A

A and E

B, C, D and G

50
Q

______ virus has been claimed to be

transmitted enterically while the newly designated ______ is transmitted parenterally

A

Hepatitis F

hepatitis G virus (HGV)

51
Q

In _____ liver damage is directly due to

the virus, but in _______it is due to an immunologic reaction to the virus

A

hepatitis A,

hepatitis B and C

52
Q

Two phases of Hep A infection

A
  1. Pre-icteric (prodromal) phase

2. Icteric phase (many patients do not develop jaundice):

53
Q

Recovery from hep A infection usually in _____

A

3–6 weeks.

54
Q

_______ antibodies, which means past

infection and lifelong immunity and which is common in the general population.

A

IgG

55
Q

Best way of prevention for Hep A infection

A

An active vaccine consisting of a two-dose primary course is the best means of prevention.

56
Q

In Hep B infection

______ per cent of subjects go on to become chronic carriers of the virus

A

Five

57
Q 
The serology of hepatitis B involves
antibody responses to the four main antigens of the virus 
1
2
3
4
A

(core, DNA polymerase, protein X and surface antigens).

58
Q

The main viral investigation for HBV is _______

(surface antigen), which is searched for routinely

A

HBsAg

59
Q

_______ is defined as the presence of HBsAg for at least 6 months.

A

Chronic hepatitis B (carriage)

60
Q

_______is a soluble protein from the pre-core and core

A

HBeAg

61
Q

HBsAg + ve, anti-HBcIgM + anti-HBs -ve

A

Acute hepatitis

62
Q

HBsAg + ve, anti-HBcIgG + anti-HBs -ve

A

Chronic hepatitis

63
Q

How to monitor progress of disease

A

Monitor progress with 6–12 monthly LFTs,

HBeAg and HBV DNA

64
Q

Negative HBsAg and HBV DNA (with anti-HBe)

A

resolving

65
Q

Negative HBsAg and HBV DNA (with anti-HBe), with anti-HBs

A

full recovery

66
Q

Positive HBsAg and HBV DNA =

A

replicating and

infective—refer

67
Q

Treatment of chronic hepatitis B infection (abnormal LFTs) is with the immunomodulatory and antiviral agents—

A

pegylated interferon alpha and entecavir or tenofir

68
Q

Remission rates for pts tx with pegylated interferon alpha and entecavir or tenofir

A

This is expensive but it achieves permanent remission in 25% of patients, and temporary remission in a further 25%.

69
Q

Outcomes of pts with chronic hep b and undergo liver transplant

A

Liver transplantation has been
performed, but is often followed by recurrence
of hepatitis B in the grafted liv

70
Q

If there is a negative antibody response

after 3 months of active immunization, what to do?

A

revaccinate with a double dose

71
Q

If the response is positive after 3 months of active immunization, what to do?

A

consider a test in 5 years with a view to a booster injection.

72
Q

Clinical symptoms of________are usually

minimal (often asymptomatic), and the diagnosis is often made after LFTs are found to be abnormal

A

hepatitis C

73
Q

there are at least _______major genotypes of HCV and treatment decisions are based
on the genotype;

A

six

74
Q

The severity of hepatic fibrosis from Hep C can be assessed by liver biopsy or, preferably, by a non-invasive device called a ______ that assesses ‘hardness or
stiffness’ of the liver via the technique of transient
elastography.

A

FibroScan

75
Q

In HCV infection,

A ________level that is tested
three times over the next 6 months implies disease activity.

A

raised ALT

76
Q

________(a PCR test) is present when the
ALT becomes abnormal while the anti-HCV rises more slowly and may not be detectable for several weeks.

If the PCR test is negative, the hepatitis C
infection has_______

A

HCV RNA

resolved.

77
Q

The current standard treatment for chronic hepatitis C is _______orally daily and _________ by weekly SCI—genotypes 1, 4, 5, 6 for 48 weeks; genotypes 2, 3 for 24 weeks

A

ribavirin

pegylated alphainterferon

78
Q

SE of combination Tx for HCV

A

The combination therapy, which can cure many cases of hepatitis C, has considerable side effects, ranging from flu-like
symptoms to depression to significant anaemia

79
Q

Vaccine for HCV

A

There is no vaccine yet available

80
Q

Those at increased risk of having

hepatitis B and C

A

Blood transfusion recipients (prior to HBV and HCV testing)
• Intravenous drug users (past or present)
• Male homosexuals who have practised unsafe sex
• Kidney dialysis patients
• Sex industry workers
• Those with abnormal LFTs with no obvious cause
• Tattooed people/body piercing

81
Q

_____ is a small defective virus that lacks a

surface coat.

A

Hepatitis D

82
Q

T or F

hepatitis D infection occurs only in patients with concomitant hepatitis B.

A

T

83
Q

Antibodies being measured for Hep D infection

A

Antibodies to the delta virus, both

anti-HDV and anti-HDV IgM (indicating a recent infection) as well as HDV Ag can be measured

84
Q

HEV behaves like________

with well-documented water-borne epidemics in areas of poor sanitation

A

HAV,

85
Q

HEV has high mortality in?

A

There is a high case fatality

rate (up to 20%) in pregnant females

86
Q

Researchers claim to have identified HGF virus, which is spread _______

A

enterically

87
Q

_______ has been identified as a transfusion-spread virus. It has subsequently been found to be prevalent
among Queensland blood donors

A

HGV

88
Q

________ refers to the syndrome of biliary
obstructive jaundice whereby there is obstruction to the flow of bile from the hepatocyte to the duodenum,
thus causing bilirubin to accumulate in the blood

A

Cholestasis

89
Q

Classification of cholestasis

A

• intrahepatic cholestasis—at the hepatocyte or intrahepatic biliary tree level

• extrahepatic cholestasis—obstruction in the
large bile ducts by stones or bile sludge

90
Q

Causes of Intrahepatic cholestasis

A

Alcoholic hepatitis/cirrhosis
Drugs
Primary biliary cirrhosis
Viral hepatitis

91
Q

Causes of Extrahepatic cholestasis

A

Cancer of bile ducts
Cancer of pancreas
Other cancer: primary or secondary spread
Cholangitis
Primary sclerosing cholangitis (? autoimmune)
Common bile duct gallstones
Pancreatitis
Post-surgical biliary stricture or oedema

92
Q

Location of gallstones

\_\_\_\_\_\_\_(asymptomatic up to 75%)—the
majority remain here
\_\_\_\_\_\_\_\_\_ (biliary ‘colic’ or acute
cholecystitis)
\_\_\_\_\_\_\_\_ (biliary ‘colic’ or acute cholecystitis)
\_\_\_\_\_\_\_\_\_\_—may cause severe biliary
‘colic’, cholestatic jaundice or chola
A

gall bladder

  • neck of gall bladder
  • cystic duct
  • common bile duct
93
Q

The investigations of choice for cholestatic

jaundice are ____ and _______

A

ultrasound and ERCP

94
Q

This is due to bacterial infection of the bile ducts secondary to abnormalities of the bile duct, especially gallstones in the common duct. Other causes are neoplasms and biliary strictures

A

Acute cholangitis

95
Q

Presentation of Acute cholangitis in the eldely?

A

Older patients can present with circulatory

collapse and Gram-negative septicaemia

96
Q

_______is the fourth commonest cause of

cancer death in the UK and US

A

Pancreatic cancer

97
Q

jaundice + constitutional symptoms
(malaise, anorexia, weight loss) + epigastric
pain (radiating to back) ______

A

pancreatic cancer

98
Q

pancreatic cancer prognosis

A

Prognosis is very poor: 5-year survival is 5%.

99
Q

Diagnosis is made by abnormal LFTs, positive smooth muscle antibodies, a variety of other autoantibodies and a typical liver biopsy

A

Autoimmune chronic active

hepatitis (ACAH)

100
Q

Autoimmune chronic active
hepatitis (ACAH)

If untreated, most patients die within________

A

3–5 years

101
Q

Autoimmune chronic active
hepatitis (ACAH)

Treatment is with ______ orally, monitored according to serum ______

A

prednisolone

alanine aminotransferase levels,

102
Q

This uncommon inflammatory disorder of the biliary tract presents with progressive jaundice and other features of cholestasis such as pruritus. It is often
associated with ulcerative colitis

A

Primary sclerosing cholangitis

103
Q

This is an uncommon cause of chronic liver diseases that often presents with pruritis, malaise and an obstructive pattern of liver biochemistry.

Treatment is with ursodeoxycholic acid orally

A

Primary biliary cirrhosis

104
Q

The main effects of alcohol excess on the liver are:

A 
• acute alcoholic liver disease
• fatty liver
• alcoholic hepatitis (progresses to cirrhosis if
alcohol consumption continues)
• alcoholic cirrhosis
105
Q

Alcohol can cause ________, which is almost universal in obese alcoholics

A

hepatic steatosis (fatty liver)

106
Q

The overseas traveller presenting with jaundice may have been infected by any one of the viruses— hepatitis ___________

A

A, B, C, D or E.

107
Q

Important hepatic disorders in pregnancy leading to jaundice are

A

cholestasis of pregnancy, acute fatty

liver of pregnancy and severe pre-eclampsia

108
Q

There are many possible causes of postoperative jaundice

A 
• post-transfusion hepatitis
• coincident viral hepatitis
• drugs, including anaesthetics
• transfusion overload (haemolysis)
• sepsis
• unmasked chronic liver disease and biliary tract
disease
• cholestasis: post major abdominal surgery

MC (90 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions