Jaundice Flashcards
What is obstructive jaundice?
It is a type of jaundice that occurs due to narrowing or obstruction of the extrahepatic biliary tract
- the blockage causes blockage of the bile and causes hepatitis
- the blockage of bile also prevents the bile from goimg into the intestines
What are the causes of obstructive jaundice?
- gallstones
- pancreatic CA of the head
- cholangitis
- pancreatitis
- cholangiocarcinoma
- choledochal cysts
- biliary stricture
What are the common symptoms that patients with obstructive jaundice present with?
- RUQ pain
- pale stools, dark urine
- pruritis
- nausea and vomiting
- decolouration of their skin and eyes
What is Courvoisiers Law?
-the presence of a palpable gallbladder that is non-tender with mild painless jaundice is unlikely to be gallstones but likely to be malignant
What do we look for in a patient with obstructive jaundice?
- vitals: check if patient has fever or haemodynamically stable
- inspection: jaundice, pallor
- abdo exam:ascites, hepatomegaly, abdominal scars,enlarged gallbladder, splenomegaly
- digital rectal exam
- cervical and supraclavicular LN
- bony tenderness
- respiratory exam
What clinical tests must be done?
1-LFT's to confirm obstructive jaundice typical picture is elevated bilirubin and ALP 2-FBC 3. U&E and CRP 4. Amylase 5.Tumour markers(CA19-9) 6.PT/PTT 7. Blood culture
What does hemoglobin break up into?
- heme
2. globin
What protein carries the unconjugated bilirubin around?
albumin
Is unconjugated bilirubin lipid soluble or not?
-lipid soluble
Is conjugated bilirubin water soluble?
Yes
What are the characteristics of pre-hepatic jaundice?
- the urine/stools are normal
- unconjugated hyperbilirubinaemia
- check stool for (ova, parasites, cysts)
- Direct Coombs test for autoimmune haemolytic anaemia
What are the causes of pre-hepatic jaundice?
- inherited anaemias-spherocytosis, sickle cell anaemia, thalassemia, G6DP
- acquired: malaria, SLE
What are the characteristics of hepatic jaundice?
- mixed picture with normal stools and dark urine sometimes
- decreased albumin
- increased AST and ALT
- On abdo exam: increased nodulariy and echogenicity in cirrhosis
What are the causes of hepatic jaundice?
- infective causes:
- viral hepatitis(HBV)
- CMV, TB, EBV - Liver cirrhosis
- alcoholic liver disease
- sarcoidosis/amyloidosis - Hepatotoxic drugs:
- alcohol. isoniazid, paracetamol, augmentin - inherited decreased unconjugated bilirubin
- gilberts syndrome
- crigler najjar 1 and 2
What is the presentation of cholestatic jaundice?
- dark urine, pale stools
- conjugated hyperbilirubinaemia
- increased ALP and GGT before ALT,AST
- Abdo ultrasound usually depicts dilated ducts >8mm which you then have to do ERCP,MRCP or PTC