Jaundice Flashcards
What is jaundice?
yellow discolouration of sclera and skin due to hyperbilirubinaemia
How can we classify jaundice?
Pre-hepatic
hepatocellular
post-hepatic
What is pre-hepatic jaundice?
excessive red cell breakdown
liver cant conjugate all bilibrubin = unconjugated hyperbilirubinaemia
What is hepatocellular (intrahepatic) jaundice?
Dysfunction of hepatic cells
Liver cant conjugate bilirubin/becomes cirrhotic and compressies intra-hepatic portions of biliary tree causing some obstruction
Both unconjugated and conjugated bilirubin occurs (mixed)
What is post-hepatic jaundice?
Obstruction of biliary drainage= conjugated hyperbilirubinaemia
(water-soluble so can be excreted
dark ‘coca-cola’ urine)
Causes of pre-hepatic jaundice?
Haemolytic anaemia
Gilbert’s syndrome
Criggler-Najjar syndrome
Causes of hepatocellular jaundice?
Alcoholic liver disease Viral hepatitis Iatrogenic, e.g. medication Hereditary haemochromatosis Autoimmune hepatitis Primary biliary cirrhosis or primary sclerosing cholangitis Hepatocellular carcinoma
Causes of post-hepatic jaundice?
Intra-luminal causes, such as gallstones
Mural causes, such as cholangiocarcinoma, strictures, or drug-induced cholestasis
Extra-mural causes, such as pancreatic cancer or abdominal masses (e.g. lymphomas)
What type stool to expect in an obstructed picture?
pale stool and dark urine
due to reduced stercobilin
What LFT result would you expect in an obstructive picture?
significant raised ALP
What LFT result would you expect in an hepatitic picture?
over 10x raise in ALT
ALT > AST is seen in chronic liver disease
AST > ALT is seen in cirrhosis and acute alcoholic hepatitis
What do high levels of IgM indicate?
existing infection
What do high levels of IgG indicate?
past infection, immunity
