Jaundice Flashcards
Three classifications
Prehepatic
Hepatic
Post hepatic
Explain the clinical sign of prehepatic jaundice
Elevated UNCONJUGATED bilirubin because it hasn’t reached the liver yet to be conjugated
Causes of prehepatic jaundice
Intravascular haemolysis -infections -DIC -Sickle cell anaemia -RBC metabolic defects such as G6PDH Deficienc or pyruvate kinase deficiency Thalassemia
Extravascular causes
Autoimmun e haemolytic anaemia
HELLP syndrome
Blood transfusions
Haemolytic drugs
Explain hepatic jaundice
There is a decreased capacity to conjugate
e.g. reduced ability to take in unconjugated bilirubin OR due to enzyme problems
Damaged hepatocytes leak out conjugated/unconjugated bilirubin
Causes of hepatic jaundice
Cirrhosis Hepatitis Hepatocellular carcinoma Gilbert's Crigler-Najjar syndrome Dubin Johnson syndrome Wilson's disease
What is Crigler-Najjar syndrome and what is the sign?,
A rare genetic disorder where the pt is unable to conjugate bilirubin due to lack of a liver enzyme that normally metabolises the bilirubin. Hence the patient has hyperbilirubinaemia (unconjugated).
What is Gilbert’s?
Defect in uridine glucuronide transferase therefore patients can’t conjugate the bilirubin
What is Wilson’s disease?
An autosomal recessive condition where excess copper is not excreted due to a defective transport protein, ATP7B.
What is prehepatic jaundice?
Excessive production of bilirubin, unconjugated
What is hepatic jaundice?
The pathology is in the liver; unconjugated or conjugated
What is post hepatic jaundice?
Problem with biliary flow; conjugated
What other types of jaundice are there?
Obstructive and cholestatic
What is courvosier’s law?
Jaundice with a painless palpable gallblader is a risk factor for pancreatic cancer
What is the AST to ALT ratio for alcoholic liver disease?
AST>ALT 2:1
S = spirits
When is sickle cell disease exacerbated?
Dehydration
Infection
