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GI > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is it?

A

Increased circulating bilirubin

Caused by altered metabolism of bilirubin

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2
Q

What is the 3 step pathway of bilirubin metabolism?

A

Pre-hepatic
Hepatic
Post-hepatic

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3
Q

What happens in the pre-hepatic stage?

A

Breakdown of haemoglobin in spleen to form harm and globing
Haem converted to bilirubin
Release of bilirubin into circulation

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4
Q

What happens in the hepatic stage?

A

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into biliary system

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5
Q

What happens in the post-hepatic stage?

A

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption of bilirubin (entero-hepatic circulation of bilirubin)

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6
Q

When bilirubin is reabsorbed where does it go?

A

If it is not reabsorbed bilirubin is excreted in faeces

If reabsorbed, it is excreted in the urine or it goes back to the liver and is put into bile again

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7
Q

How is jaundice classified?

A

Pre-hepatic
Hepatic
Post-hepatic

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8
Q

What is the causes of pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells (haemolysis)

This therefore causes an increased quantity of bilirubin

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9
Q

What are the hepatic causes of jaundice?

A

Cholestasis

Intra-hepatic bile duct obstruction

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10
Q

What are the 3 things that can go wrong in the hepatic stage?

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

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11
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi (go onto form intrahepatic bile ducts)

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12
Q

What causes cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs: therapeutic, recreational

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13
Q

Drug-induced cholestasis may be predictable or unpredictable. What does this mean?

A

Predictable: dose related
Unpredictable: not dose related

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14
Q

What causes an intrahepatic bile duct obstruction?

A

Primary biliary cholangitis
Primary sclerosing cholangitis
Tumours of the liver

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15
Q

What are some tumours that can arise in the liver?

A

Hepatocellular carcinoma
Tumours of intra-hepatic bile ducts
Metastatic tumours

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16
Q

What do both primary biliary cholangitis and primary sclerosing cholangitis progress to?

A

Cirrhosis

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17
Q

What is hepatic cirrhosis?

A

End stage chronic liver disease: response of liver to chronic injury

18
Q

What are some causes of cirrhosis?

A

Alcohol
Hepatitis B, C
Immune mediated liver disease: auto-immune hepatitis, primary biliary cholangitis
Obesity: diabetes mellitus
Metabolic disorders: excess iron (primary haemochromatosis), excess copper (Wilson’s disease)

19
Q

What are some complications of cirrhosis?

A

Altered liver function: liver failure
Abnormal blood flow: portal hypertension
Increased risk of hepatocellular carcinoma

20
Q

What is hepatocellular carcinoma?

A

Malignant tumour of hepatocytes

21
Q

What is cholangiocarcinoma?

A

Malignant tumour of bile duct epithelium

22
Q

Are metastatic tumours common in the liver?

A

The liver is a common site of metastasis

23
Q

What are some causes of hepatocellular jaundice?

A

Hepatocellular liver damage: drugs
Hepatitis: viral, alcohol, non-alcoholic steatohepatitis
Cirrhosis

24
Q

What are some causes of post hepatic jaundice?

A 
Structural disorder of the bile ducts
Cholelithiasis
Pancreatic cancer
Pancreatitis
Congenital atresia of bile duct
Bile duct obstruction: cholangiocarcinoma/stricture
Primary sclerosing cholangitis
25
Q

What is cholelithiasis?

A

Gallstones

26
Q

What are the risk factors for gallstones?

A

Obesity

Diabetes

27
Q

What are the diseases of the gallbladder that can cause post-hepatic jaundice?

A

Inflammation of the gallbladder:
Acute cholecystitis
Chronic cholecystitis

28
Q

What are the complications of acute cholecystitis?

A

Empyema
Perforation of gallbladder: biliary peritonitis
Progression to chronic inflammation

29
Q

What are the complications of chronic cholecystitis?

A

Chronic inflammation and fibrosis of gallbladder

30
Q

What are some causes of common bile duct obstruction?

A

Gallstones
Bile duct tumours
Benign stricture
External compression: tumours

31
Q

What are the effects of common bile duct obstruction?

A

Jaundice
No bile excreted into duodenum
Infection of bile proximal to obstruction: ascending cholangitis
Secondary biliary cirrhosis if obstruction prolonged

32
Q

What does jaundice look like?

A

Yellow discolouration of mucous membranes, sclera and skin

Scratch marks from itching (pruritus)

33
Q

What is the urine and stool colour in each of the 3 types of jaundice?

A

Prehepatic: normal urine and stools
Hepatic: dark urine and slightly pale stools
Post hepatic: darkest urine and pale stools

34
Q

What type of hyperbilirubinaemia is each of the 3 types of jaundice?

A

Prehepatic: unconjugated
Hepatic: mixed (unconjugated and conjugated)
Post hepatic: conjugated

35
Q

Why does hepatic and post hepatic cause dark urine?

A

Conjugated bilirubin can be excreted via the urine (as it is water soluble), whereas unconjugated cannot

36
Q

What are some clues on history of prehepatic, hepatic and posthepatic jaundice?

A

Prehepatic: history of anaemia (fatigue, dyspnoea, chest pain)
Hepatic: risk factors for liver disease (IVDU, alcohol), decompensation (ascites, variceal bleed, encephalopathy)
Post hepatic: abdominal pain

37
Q

What are some clues on examination of prehepatic, hepatic and posthepatic jaundice?

A

Prehepatic: pallor, splenomegaly
Hepatic: signs of CLD
Post hepatic: palpable gall bladder

38
Q

When is jaundice detectable?

A

Detectable when total plasma bilirubin levels exceed 34 umol/L (normal is up to 20)

39
Q

What is the differential diagnosis of jaundice?

A

Carotenemia: caused by lots of carrots/beta carotene

40
Q

What are the investigations into the cause of the jaundice?

A 
Liver screen: hepatitis B + C serology, autoantibody profile and serum immunoglobulins
Ultrasound abdomen: most important test, differentiates extrahepatic and intrahepatic obstruction
CT
MRI
ERCP
MRCP
PTC
EUS
41
Q

How is jaundice treated?

A

Treat the underlying cause

GI (54 decks)

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