Jaundice Flashcards
what bilirubin is present in the urine of prehepatic jaundice?
Urobilinogen
what bilirubin is present in the urine of hepatic jaundice?
Urobilinogen
what bilirubin is present in the urine of posthepatic jaundice?
No urobilinogen
what serum bilirubin is present in prehepatic jaundice?
Unconjugated bilirubin
what serum bilirubin is present in hepatic jaundice?
Conjugated and Unconjugated
what serum bilirubin is present in posthepatic jaundice?
Conjugated bilirubin
what are the levels of ALT and AST in prehepatic jaundice?
Normal
what are the levels of ALT and AST in hepatic jaundice?
Raised
what are the levels of ALT and AST in posthepatic jaundice?
Normal or moderately raised
what is the level of ALP in prehepatic jaundice?
Normal
what is the level of ALP in hepatic jaundice?
Normal or moderately raised
what is the level of ALP in posthepatic jaundice?
raised
what is the blood glucose level in prehepatic jaundice?
normal
what is the blood glucose level in hepatic jaundice?
low if liver failure
what is the blood glucose level in posthepatic jaundice?
raised in pancreatic tumour
what is the reticulocyte count in prehepatic jaundice?
raised in haemolysis
what is the reticulocyte count in hepatic jaundice?
normal
what is the reticulocyte count in posthepatic jaundice?
normal
what is the haptoglobin level in prehepatic jaundice?
Low due to haemolysis
what is the haptoglobin level in hepatic jaundice?
Normal or low if liver failure
what is the haptoglobin level in posthepatic jaundice?
Normal
what is the prothrombin time in prehepatic jaundice?
Normal
what is the prothrombin time in hepatic jaundice?
Prolonged due to poor synthetic function
what is the prothrombin time in posthepatic jaundice?
Prolonged due to vitamin K, malabsorption; corrects with vitamin K
what will US show in prehepatic jaundice?
Normal
what will US show in hepatic jaundice?
May be abnormal liver texture, e.g. cirrhosis
what will US show in posthepatic jaundice?
dilated bile ducts
what are the causes of prehepatic jaundice?
haemolysis (e.g. spherocytosis or incompatible blood transfusion)
what is the pathophysiology of prehepatic jaundice?
Increased production of (unconjugated) bilirubin by the reticuloendothelial system exceeds the ability of the liver to conjugate; therefore, the unconjugated bilirubin accumulates in the blood. There is no increase in conjugated bilirubin in the blood, so none is found in the urine
what are the causes of hepatic jaundice?
o Hepatitis – (A, B, C, E), leptospirosis, glandular fever (infectious mononucleosis)
o Cirrhosis
o Cholestasis from drugs – flucloxacillin, chlorpromazine
o Liver poisons – paracetamol overdose, chlorinated hydrocarbons,
o Liver tumours
o Sepsis
what are the classification of causes of post hepatic jaundice?
location related to bile duct - within the lumen, within the wall, external compression
what are the lumen obstructive causes of post hepatic jaundice?
gall stones
what are wall pathology causes of post hepatic jaundice?
Congenital atresia of the common bile duct
Traumatic stricture
Primary or secondary scleorisng cholangitis
Tumour of the bile duct (cholangiocarcinoma)
what are the external compression causes of post hepatic jaundice?
Pancreas
Tumour of the head of the pancreas
Tumour of the ampulla of Vater
Hilar lymphadenopathy
what is the pathophysiology of hepatic jaundice?
In the presence of hepatocellular damage, the liver is unable to conjugate bilirubin efficiently, and less is excreted into the canaliculi. Thus, both unconjugated and conjugated bilirubin accumulate in the blood.
what is the pathophysiology of posthepatic jaundice?
Obstruction prevents excretion of conjugated bilirubin
what is the clinical features of post hepatic jaundice?
pale stools
dark urine
