Jaundice

Question 1

what is jaundice

Answer 1

A yellow discolouration of the skin caused by a highserum bilirubin level (detectable clinically when bilirubin is above 50micromol/L

Question 2

3 types of jaundice are

Answer 2

Pre-hepatic
Hepatic/Intra-hepatic
Post-hepatic/obstructive

Question 3

What are the causes of pre hepatic jaundice

Answer 3

Caused by; malaria, sickle cell anaemia, thalassaemia, physiological jaundice of the newborn (caused by the excess breakdown of foetal haemoglobin since its no longer required, meaning that there is an increase in unconjugated bilirubin and the liver cannot conjugate it fast enough since its not developed properly yet resulting in jaundice)

Question 4

What happens in pre hepatic jaundice

Answer 4

Increasedbreakdown of erythrocytes resulting in increased levels of unconjugated bilirubin

•Causes an increased serum unconjugated bilirubin without excess bilirubin in the urine

Question 5

What do patients with pre hepatic jaundice present

Answer 5

• Sufferers will have a raised serum unconjugated bilirubin - stools brown & urine normal
• Yellow skin
• Enlarged spleen (due to excess breakdown)

Question 6

What happens in hepatic jaundice (4)

Answer 6

• Result of hepatocellular swelling e.g. in parenchymal liver disease or abnormalities at a cellular level or the result of infection or exposure to a harmful substance
• Impaired cellular uptake, defective conjugation or abnormal secretion of bilirubin by the hepatocytes
• The is liver is damaged so is unable to metabolise the unconjugated bilirubin resulting in a buildup in serum unconjugated bilirubin
• Damage could also mean that conjugated bilirubin is unable to be secreted resulting in a raised serum conjugated bilirubin as well

Question 7

How does hepatic jaundice present

Answer 7

Increasedconjugated AND unconjugated bilirubin

Decreased urobilinogen

Question 8

How do patients present in hepatic jaundice

Answer 8

• Urine will be dark
• Stools can be pale or normal
• Enlargement of the spleen
• Yellow skin

Question 9

What can cause hepatic jaundice

Answer 9

Caused by; viral hepatitis, drugs, alcohol hepatitis, cirrhosis & jaundice of the newborn

Question 10

How does post hepatic jaundice occur

Answer 10

•Occurs when the biliary system is damaged, inflamed or obstructed

Elevated serum conjugated bilirubin
•Normal levels of unconjugated bilirubin
•Decreased urobilinogen

Question 11

How does patients present with post hepatic jaundice

Answer 11

• Dark urine
• Pale stools
• No enlargement of the spleen
• Yellow skin

Question 12

Causes of post hepatic jaundice

Answer 12

Causes; gallstones, pancreatic cancer, gallbladder cancer, bile duct cancer, pancreatitis (acute or chronic)

Question 13

Why can cancer or inflammation of the pancreas cause jaundice

Answer 13

The reason that cancer or inflammation of the pancreas can cause jaundice is because the head of the pancreas is situated in the duodenal loopwhich is near the common bile duct thus any inflammation or cancer of the pancreas can eventually cause obstruction to the duct resulting in jaundice

Question 14

Where does the pain from acute pancreatitis present

Answer 14

from the back

Question 15

What happens in levels of bilirubin with Gilberts syndrome

Answer 15

In gilbert syndrome (where there is shortage of UDP glycerol transferase, meaning only small amounts of conjugation occur) there will be a normal conjugated bilirubin level but a raised unconjugated bilirubin level