Jaundice

Question 1

Cause of jaundice

Answer 1

plasma bilirubin > 60µmol/L

Question 2

Classifications of jaundice

Answer 2

Pre-hepatic, hepatocellular or post-hepatic

Conjugated/unconjugated bilirubin

Question 3

Unconjugated hyperbilirubinaemia causes

Answer 3

Overproduction (haemolysis/ineffective erythropoiesis)
Impaired hepatic uptake (drugs, ischaemic hepatitis)
Impaired conjugation (Gilbert’s/p700/Crigler-Najjar)

Question 4

Conjugated hyperbilirubinaemia symptoms

Answer 4

Pale faeces
Dark urine (water soluble so enters urine, not in gut)
Pruritis when severe

Question 5

Conjugated hyperbilirubinaemia causes

Answer 5

Hepatocellular dysfunction (cirrhosis, hepatitis, Budd-Chiari etc)
Impaired hepatic excretion (cholestasis: PBC, PSC, gallstones, malignancy)

Question 6

Differentiating causes in jaundice from history

Answer 6

Pain - yes is more likely cholestatic
Hep virus risk factors
Family history for congenital conjugation disorders
Duration of illness for malignancy
Fevers/rigors suggest cholangitis/liver abcess

Question 7

Tests to perform for jaundice

Answer 7

Viral markers for hep viruses
US for bile duct size/ gall stones
Cytology for lesions
LFT, FBC, U and E
Urine - bilirubin absent in pre-hepatic, urobilinogen absent in obstructive