Jaundice

Question 1

What are the 2 types of bilirubin

Answer 1

Conjugated & unconjugated

Question 2

What are the 3 types of causes of unconjugated bilirubin and give examples

(all pre-hepatic)

Answer 2

Decreased liver uptake of bilirubin

Gilbert’s syndrome

Rifampicin (for TB)

Decreased conjugation

Hepatocellular cancer

Neonatal Jaundice

Increased bilirubin production

Heamolytic anaemia

Question 3

What are the 3 types of jaundice

Answer 3

Pre-hepatic

Hepatic

Post-hepatic

Question 4

What are the 3 types of causes of conjugated bilirubin and give examples

Answer 4

Increased bilirubin secretion (hepatic)

Hepatitis

Sepsis

Amlyodosis

Paracetamol

Biliray obstruction (post hepatic)

Gallstones

Tumours

Strictors

Cholescystitis

Cholestasis (OCP and pregnancy)

Question 5

What is cholestasis and what can cause it

Answer 5

Decreased bile flow

Causes

OCP

Paracetamol

Question 6

What is jaundice

Answer 6

Increased bilribin production

Question 7

What are some of the signs of jaundice

Answer 7

Yellow skin discoluration

Yellow sclera

Pale stools

Dark urine

Abomdinal pain

Fatigue

Question 8

What are the components of bile

Answer 8

Bile salts (bile acids and taurine/glycine)

Water

Lecithin

Cholesterol

Conjugated bilirubin

Question 9

What are bile salts made up of

Answer 9

Bile acid

+

Taucine or glycine

Question 10

When is bile released and why

Answer 10

Fat in the duodenum

V

CCK released

V

Sphincter of Oddi relaxes & gallbladder contracts

V

Bile is released

V
Fat is digested

Question 11

What is the funtion of bile

Answer 11

To digest fat

Question 12

When is bilirubin released (3 examples)

Answer 12

RBC destruction

Heme catabolism

Bone marrow erythopoiesis

Question 13

What is bound to unconjucated bilirubin and why

Answer 13

Albumin

Binds in order to make the unconjugated bilribuin water soluble so it can be transported to the liver

Question 14

Which organ conjucates bilirubin

Answer 14

Thy liver

Question 15

What is the pathway of conjugated bilirubin

Answer 15

Liver

V

Bile duct

V

Gallbladder

V

Entero-hepatic circulation

V

Small intestine & urine

Question 16

Describe the metabolism of bilriubin

Answer 16

Unconjucated bilirubin is released after RBC destruction, heme catabolism or bone marrow erythopoeies

V

Unconjugated bilirubin binds to albumin to become water soluble so it can travel to the liver

V

Bilibrubin becomes conjugated in the liver

V

Conjucated bilirubin travels to the gallbladder via bile ducts

V

Conjucated bilirubin enters the entero-hepatic circulation

V

Conjuctaed bilirubin spreads to the small intestine and urine