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Jaundice Flashcards

1
Q

How are the causes of Jaundice classified?

A

Pre-hepatic, hepatic and post-hepatic

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2
Q

How can the pre-hepatic causes of jaundice be classified?

A
  1. Congenital cell issues
  2. Drugs
  3. Infections
  4. Autoimmune
  5. Mechanical
  6. Transfusion reactions
  7. Paroxysmal nocturnal haemoglobinuria
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3
Q

What are the congenital cell issues that may cause pre-hepatic jaundice? (group into cell shape, enzymes and haemoglobin)

A
  1. Cell shape
    - Sickle cell disease
    - Hereditary spherocytosis
    - Hereditary elliptocytosis
  2. Enzyme
    - G6PD deficiency
    - Pyruvate kinase deficiency
  3. Haemoglobin
    - Thalassemia
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4
Q

What drugs can cause pre hepatic jaundice?

A

Penicillins and Sulphasalazine

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5
Q

What infection can cause pre hepatic jaundice?

A

Malaria

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6
Q

What mechanical issues can cause pre hepatic jaundice

A
  1. Metallic valve prostheses

2. DIC

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7
Q

What are 2 main classifications of the cases of hepatic jaundice?

A

Conjugated and unconjugated

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8
Q

Give examples of the different things that can cause conjugated hepatic jaundice

A
  1. Cirrhosis
  2. Malignancy
  3. Viral hepatitis
  4. Drugs
  5. Enzymes
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9
Q

What are the 2 classifications of diseases do drugs cause in relation to jaundice?

A
  1. cholestasis

2. Hepatitis

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10
Q

What drugs cause hepatitis?

A

Isoniazid, rifampicin, atenolol, enalapril, verapamil, nifedipine, amiodarone, ketoconazole, cytotoxics, halothane

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11
Q

What drugs cause cholestasis?

A

Ciclosporin, azathioprine, chlorpromazine, cimetidine, erythromycin, nitro, ibuprofen, hypoglycaemics

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12
Q

What 2 enzyme related syndromes cause hepatic jaundice?

A

Dubin-Johnson syndrome and Rotor syndrome

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13
Q

What is Dubin-Johnson syndrome?

A
  • Autosomal recessive (cMOAT gene) with excretion of conjugated bilirubin.
  • Leads to pigmented liver.
  • Increase in conjugated bilirubin with no other enzyme changes
  • High coproporphyrin
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14
Q

What is Rotor syndrome?

A
  • Similar to DJS
  • Liver not pigmented
  • Normal coproporphyrin
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15
Q

What are the 2 syndromes that cause unconjugated hepatic jaundice?

A
  1. Gilbert’s syndrome

2. Crigler-Najar syndrome

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16
Q

What is Gilbert’s syndrome?

A

Congenital hypo-activity of conjugation enzyme UGT-1. Benign and common (5%)
Normal LFTs except mildly elevated bilirubin, especially in times of physiological stress/illness
Normal life expectancy

17
Q

What is Crigler-Najar syndrome?

A 
Autosomal recessive (I) or dominant (II). Severe unconjugated hyperbilirubinaemia.
Congenital absence (I) or decrease (II) of glucoronyl transferase.
Normal liver histology.
Treatment is liver transplant (only type II survive to adulthood)
18
Q

What are the 3 post hepatic causes of jaundice?

A
  1. Biliary tree obstruction
  2. Primary biliary cirrhosis
  3. Primary sclerosing cholangitis
19
Q

What are the causes Biliary tree obstruction?

A
  1. Gallstones
  2. Compression e.g. pancreatitis, pancreatic tumour, lymph nodes Biliary atresia
  3. Cholangiocarcinoma
  4. Post-operative stricture
20
Q

What is primary biliary cirrhosis?

A

Primary biliary cirrhosis (PBC) is a progressive disease of the liver caused by a buildup of bile within the liver (cholestasis) that results in damage to the small bile ducts that drain bile from the liver.

  • M:F = 1:9
  • ANA and Anti- mitchondrial antibodies
  • And anti-centromere for prognosis (though more association with CREST)
21
Q

What is primary sclerosing chlangitis

A
  • 80% of PSC have UC
  • ANCA, anti-smooth muscle antibodies
  • Association with cholangiocarcinoma
22
Q

What tests are in a routine liver screen?

A
  • Assuming FBC, U&E, liver function (ALP, ALT, AST, GGT) and clotting has already been done
  • Autoimmune screen (ENA, ANA, ANCA)
  • Viral screen (Hep A,B,C)
  • Alfafetoprotein (AFP)
  • Serum caeruloplasmin
  • Ferritin
  • Consider
23
Q

What three blood tests examine synthetic liver function

A
  • Clotting (PT)
  • Examining vitamin-K dependent clotting factors
  • Platelets
  • Albumin
  • The rest of the LFTs reflect liver processing ability. The synthetic function tests are the most important in assessing how well the liver is working. Note, for example, that ALT and AST can be normal or low in advanced liver failure.
24
Q

What would the liver function tests of pre hepatic jaundice show?

25
Q

What would the liver function test results of hepatic jaundice show?

26
Q

What would the liver function tests of post hepatic jaundice show?

27
Q

What colour are stools in post hepatic jaundice?

A

In post hepatic jaundice the stools are often of pale colour and this feature should be specifically addressed in the history

Gastroenterology (9 decks)

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