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HPB > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is Jaundice?

A

Yellow discouloration of the sclera and skin due to hyperbilirubinemia

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2
Q

What Bilirubin level causes jaundice?

A

Greater than 50µmol/L

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3
Q

How is Bilirubin made?

A

It is a breakdown product of Haem and so it is formed from the destruction of red blood cells

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4
Q

Where is Bilirubin Conjugated?

A

The liver

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5
Q

What happens to bilirubin when it is conjugated?

A

It becomes water soluble

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6
Q

How is bilirubin normally excreted?

A

In bile via the GI tract

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7
Q

In what form is Bilirubin digested in faeces?

A

As urobiliogen and Stercobilin

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8
Q

How much of urobilogen reabsorbed into the blood stream?

A

10%

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9
Q

What happens to the Urobilogen reabsorbed into the blood stream?

A

Excreted via the kidneys

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10
Q

What causes Pre-Hepatic jaundice?

A

excessive red blood cell breakdown which will overwhelm the liver and its ability to conjugate bilirubin causing high levels of unconjugated bilirubin

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11
Q

What are some examples of Pre- Hepatic Jaundice? (3)

A

Haemolytic anaemia, Gilberts syndrome, Criggler Najjar Syndrome

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12
Q

What is Hepatocellular Jaundice?

A

dysfunction of the hepatic cells
The liver will lose the ability to conjugate bilirubin causing and increase in unconjugated bilirubin
If the liver is also cirrhotic it may compress the intra-hepatic portions of the biliary tree which will cause some obstruction
This will cause a mixture of conjugated and unconjugated bilirubin

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13
Q

What are some examples of Hepatocellular Jaundice? (8)

A

Alcoholic liver disease, Viral hepatitis, Latrogenic (medications) Hereditary haemochromatosis, Autoimmune hepatitis, Primary biliary cirrhosis or primary sclerosing cholangitis, Hepatocellular carcinoma

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14
Q

What is Post-hepatic Jaundice?

A

Obstruction of biliary drainage

Bilirubin is therefore not excreted leading to increased conjugated bilirubin

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15
Q

What are some examples of Post- hepatic Jaundice? (5)

A

Intraluminal causes e.g. gallstones, Mural causes e.g. Cholangiocarcinoma, strictures or drug induced cholestasis, Extra mural causes such as pancreatic cancer or abdominal masses e.g. lymphomas

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16
Q

Which type of jaundice causes dark urine and pale stools?

A

Post hepatic due to the high levels of conjugated bilirubin which is water soluble and excreted in urine and low levels of stercobilin entering the GI tract

17
Q

What blood test is most important in Jaundice?

A

LFTs

18
Q

What do Bilirubin levels show?

A

the degree of Jaundice

19
Q

What does Albumin show?

A

Liver synthesising function

20
Q

What does AST and ALT show?

A

Markers of hepatocellular injury

21
Q

What is the most likely cause if AST:ALT ratio >2?

A

Alcoholic liver disease

22
Q

What is the most likely cause if AST:ALT ratio is around 1?

A

Viral hepatitis

23
Q

What does Alkaline phosphatase show?

A

Raised in biliary obstruction but also bone disease, pregnancy and malignancy

24
Q

What does Gamma GT show?

A

Specific to biliary obstruction

25
Q

What is a liver screen for?

A

Used when no obvious cause of liver dysfunction and has acute and chronic liver injury mind.
Looks for viral serology and non infectious markers

26
Q

What imagining would you do first if a patient had Jaundice?

A

Ultrasound abdomen to look for obstruction and gross liver pathology

27
Q

What other imaging could you do for Jaundice?

A

MRCP- Magnetic Resonance Cholangiopancreatography is used to visualise the biliary tree- used in obstructive jaundice
Liver biopsy

28
Q

What is the management for Jaundice?

A

Depends on the underlying cause

29
Q

What is the symptomatic management for Jaundice?

A

Usually will cause itching so antihistamines or cholesytamine in obstructive causes as will increase biliary drainage

30
Q

What do you need to monitor with Jaundice and how would you treat a problem?

A

Coagulopathy and treat with vitamin K or fresh frozen plasma if evidence of bleeding
Also Hypoglycemia which you would treat orally or with 5% dextrose

31
Q

If there was hepatic encephalopathy what would you give the patient?

A

A laxative (lactulose or senna) and with maybe neomycin and rifaximin to reduce the number of ammonia- producing bacteria in the bowel

32
Q

How would you treat obstructive jaundice?

A

Endoscopic retrograde Cholangiopancreatography can be used in obstructive jaundice

HPB (13 decks)

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