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Gastro > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is jaundice

A

Yellowing of skin, sclera and mucosae

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2
Q

At what level in the blood does plasma bilirubin have to be for jaundice to happen

A

Above 50-60 micromol per litre

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3
Q

What are the causes of jaundice in categories

A

Pre hepatic
Hepatic
Post hepatic

Unconjugated
Conjugated

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4
Q

What are the causes of pre hepatic jaundice

A 
They are unconjugated 
Haemolysis
Drugs and toxin
Thalassaemia 
Haemoglobunopathies 
Ineffective erythropoiesis
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5
Q

Causes of hepatic

A 
Can be both conjugated and unconjugated 
Viral hep
Toxic hep
Intrahepatic cholestasis 
Gilbert’s syndrome
Crigler-Nijjar syndrome
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6
Q

Post hep causes

A 
Conjugated 
Extra hep cholestasis 
Gall stones
Cholangiocarcinoma
Liver cancer/mets 
Carcinoma of pancreas
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7
Q

What is unconjugated bilirubin

A

Water insoluble
Produced from the break down of the RBC where normally it goes to the liver to become conjugated
In unconjugated hyperbilirubinaemia, the level is high due to inc production of it or not being able to be broken down by the liver

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8
Q

What is conjugated bilirubin

A

Water soluble
Excreted in urine making is dark
If high in blood dark urine and light faeces

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9
Q

Causes of unconjugated hyperbilirubinaemia

A 
Over production-haemolysis, ineffective erythropoiesis
Impaired hepatic uptake 
Drugs
Impaired conjugation- Gilbert’s
Physiological neonatal
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10
Q

Causes of conjugated hyperbilirubinaemia

A

Heptaocellular dysfunction
- viral hep, EBV, drugs, cirrhosis, alcohol, mets, AIH, sepsis
Impaired hepatic excretion - PBC, PSC, drugs, fall stones, cancers

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11
Q

What do you need u ask to patient about in the history

A 
Blood transfusion
IV drug use 
Body piercing
Tattoo
Travel
Jaundice contacts
FHx 
Alcohol
Meds
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12
Q

Courvosiers law

A

If there is a presence of a large gall bladder
No pain
Mild painless jaundice
Not gall stones

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13
Q

Tests

A 
Urine look for urobikinogen if absent =obstructive jaundice 
Bilirubin if absent pre hepatic 
FBC, clotting, film, reticulocytes, Coombs, haptoglobins, malaria, - haemolysis 
U+E LFTS, yGT
Albumin, protein 
Hepatitis serology
Culture 
USS
ERCP- dilated ducts gall stones 
MRCP 
biopsy
CR/MRI - look for other mets
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14
Q

Causes of ore hepatic drug induced jaundice

A

Haemolysis - antimalarial

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15
Q

Causes of hepatic jaundice

A 
Paracetamol OD
Isoniazid, rifampicin, pyrazinamide
MAOI
Sodium valproate
Halothane
Statin
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16
Q

Causes of cholestatic jaundice

A 
Fusidic acid, co Amox
Nitrofurantoin
Steroids
Sulfonylurea
Procholperazine 
Chlorpromazine

Gastro (21 decks)

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