Jaundice

Question 1

What is Jaundice?

Answer 1

• Yellow discolouration of skin and sclera
• Due to hyperbilirubinamia
• bilirubin > 50umol/L

Question 2

Why is bilirubin conjugated in liver?

Answer 2

• to make it water soluble to be excreted into GI tract via bile

Question 3

Bilirubin is the breakdown product of?

Answer 3

Haem

Question 4

What form of bilirubin is found in faeces?

Answer 4

• urobilinogen
• stercobilin

Question 5

How many percent of urobilinogen is reabsorbed into bloodstream and excreted in kidneys?

Answer 5

• 10%

Question 6

What types of jaundice are there? Briefly describe each of them

Answer 6

• Prehepatic jaundice
  
  • Excessive rbc breakdown - overwhelm’s liver ability to conjugate bilirubin
  • High unconjugated bilirubin
• Hepatocellular jaundice
  
  • dysfunction of hepatic cells
  • mixed conjugated and unconjugated bilirubin
• Posthepatic jaundice
  
  • Obstruction of biliary drainage

Question 7

What are the causes of prehepatic jaundice?

Answer 7

• Haemolytic anaemia
• Gilbert’s syndrome
• Criggler-Najjar syndrome

Question 8

What causes hepatocellular jaundice?

Answer 8

• Alcoholic liver disease
• Viral hepatitis
• Iatrogenic, e.g. medication
• Hereditary haemochromatosis
• Autoimmune hepatitis
• Primary biliary cirrhosis or primary sclerosing cholangitis
• Hepatocellular carcinoma

Question 9

What causes post hepatic jaundice?

Answer 9

• gallstones
• cholangiocarcinoma
• strictures
• drug-induced cholestasis
• pancreatic cancer
• lymphoma

Question 10

What does each of the following show

Dark-coloured urine

Bright coloured urine

Answer 10

• conjugated/mixed bilirubin
• unconjugated bilirubin

Question 11

What Ix would you order for jaundice pt?

Answer 11

• LFT
  
  • Bilirubin
  • Albumin
  • AST & ALT
  • ALP
  • Gamma GT
• Coagulation studies
• FBC & U&Es
  *

Question 12

When would you perform a liver screen?

Answer 12

• no initial cause for liver dysfunction

Question 13

What liver screening would you perform for acute liver injury?

Answer 13

• Virus serology
  
  • Hepatitis A,B,C,E, CMV and EBV
• Non infective markers
  
  • Paracetemol level
  • Caeruloplasmin
  • ANA
  • IgG

Question 14

What liver screening would you perform for chronic liver injury?

Answer 14

• Viral serology
  
  • Hep B&C
• Non-infective markers
  
  • Caeruloplasmin

Ferritin and transferrin saturation

Tissue Transglutaminase antibody

Alpha-1 antitrypsin

Autoantibodies*

Question 15

What imaging would you order for jaundice?

Answer 15

• USS abdo (first line)
• MRCP - to observe biliary tree
• liver biopsy

Question 17

How would you Mx jaundice?

Answer 17

• treat underlying cause
• Identify and manage complications ie
  
  • coagulopathy
  • hepatic encephalopathy
  • hypoglycaemia