Jaundice Flashcards
What is jaundice?
Clinical manifestation of raised bilirubin
What is bilirubin?
Breakdown product of haem
How is bilirubin excreted?
In faeces/urine as urobiligen
In bile
What are the 3 broad causes of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
What is the mechanism of pre-hepatic jaundice?
Increased degradation of haemoglobin
What is the pattern of bilirubin levels in pre-hepatic jaundice?
Raised bilirubin - unconjugated
What causes pre-hepatic jaundice?
Haemoglobinopathies
- sickle cell
- thalassaemia
- spherocytosis
Haemolysis
What is the mechanism of hepatic jaundice?
Reduced conjugating ability of the liver due to damage to hepatocytes
What is the pattern of bilirubin levels in hepatic jaundice?
Raised bilirubin - mixed
What are causes of hepatic jaundice?
Cirrhosis
Hepatitis
Acute liver damage
- paracetamol OD
- viral hepatitis
What is the mechanism of post-hepatic jaundice?
Obstruction to the excretion pathway of bilirubin
What is the pattern of bilirubin level in post-hepatic jaundice?
Raised bilirubin - conjugated
What can cause post-hepatic jaundice?
Gallstones
Biliary strictures
Pathology at head of pancreas
What are clinical signs of high levels of conjugated bilirubin?
Jaundice
Pale stools
Dark urine
What are the main liver function tests?
Bilirubin Albumin ALT AST ALP
What is albumin?
Major serum protein
What id the role of albumin in LFTs?
Assesses synthetic function of liver
What can low levels of albumin lead to?
Ascites
What is ALT?
Alanine transaminase - hepatic enzyme
What is AST?
Aspartate transaminase - hepatic enzyme
What do ALT/AST show?
Raised in hepatocyte damage
What does ALT>AST mean?
Acute liver damage
What does AST>ALT mean?
Cirrhosis
Alcoholic hepatitis
What is ALP?
Alkaline phosphatase
Where is ALP found?
Cells lining bile ducts
What does a raised ALP show?
Post-hepatic cause
