Jaundice

Question 1

Jaundice

Answer 1

Jaundice is the yellowing of the skin, sclerae, and other tissues caused by excess circulating bilirubin. It is detectable when the total plasma bilirubin levels are >34 μmol/l.

Question 2

Jaundice classification

Answer 2

Prehepatic (unconjugate)
Hepatic (conjug)
Posthepatic (conjug).

Question 3

Causes of Jaundice:

Answer 3

• Prehepatic = Haemolytic Anaemia, Spleenomegaly - Hepatic = Liver Tumour, Cirrhosis, Cholestasis, PBC, PSC, Alcohol Liver Disease - Posthepatic = Gallstones (Cholelithiasis), Gall Bladder diseases, Extrahepatic Duct Obstruction.

Question 4

Differential Diagnosis =

Jaundice:

Answer 4

Carotenemia.

Question 5

Investigations:
Jaundice:

Answer 5

Abdominal Ultrasound (most important test)
Endoscopic Ultrasound
CT
MRI
MRCP
Liver Biopsy
PTC
Liver Tests: 
Hepatitis B & C serology
Autoantibody profile
serum immunoglobulins
Caeruloplasmin and copper
Ferritin and transferrin saturation
Alpha 1 anti trypsin
Fasting glucose and lipid profile.

Question 6

Why is an abdominal Ultrasound important for Jaundice:

Answer 6

*Abdominal Ultrasound is the important test in Jaundice as it indicates the site of obstruction, indicates the cause of obstruction, differentiates extrahepatic and intrahepatic obstruction, can give a preliminary staging on the extent of disease, and documents evidence of portal hypertension.

Question 7

Treatment Jaundice:

Answer 7

Treat the underlying cause of Jaundice (eg. encourage Alcohol withdrawal, etc…)