Jaundice

Question 1

what bilirubin is present in the urine of prehepatic jaundice?

Answer 1

Urobilinogen

Question 2

what bilirubin is present in the urine of hepatic jaundice?

Answer 2

Urobilinogen

Question 3

what bilirubin is present in the urine of posthepatic jaundice?

Answer 3

No urobilinogen

Question 4

what serum bilirubin is present in prehepatic jaundice?

Answer 4

Unconjugated bilirubin

Question 5

what serum bilirubin is present in hepatic jaundice?

Answer 5

Conjugated and Unconjugated

Question 6

what serum bilirubin is present in posthepatic jaundice?

Answer 6

Conjugated bilirubin

Question 7

what are the levels of ALT and AST in prehepatic jaundice?

Answer 7

Normal

Question 8

what are the levels of ALT and AST in hepatic jaundice?

Answer 8

Raised

Question 9

what are the levels of ALT and AST in posthepatic jaundice?

Answer 9

Normal or moderately raised

Question 10

what is the level of ALP in prehepatic jaundice?

Answer 10

Normal

Question 11

what is the level of ALP in hepatic jaundice?

Answer 11

Normal or moderately raised

Question 12

what is the level of ALP in posthepatic jaundice?

Answer 12

raised

Question 13

what is the blood glucose level in prehepatic jaundice?

Answer 13

normal

Question 14

what is the blood glucose level in hepatic jaundice?

Answer 14

low if liver failure

Question 15

what is the blood glucose level in posthepatic jaundice?

Answer 15

raised in pancreatic tumour

Question 16

what is the reticulocyte count in prehepatic jaundice?

Answer 16

raised in haemolysis

Question 17

what is the reticulocyte count in hepatic jaundice?

Answer 17

normal

Question 18

what is the reticulocyte count in posthepatic jaundice?

Answer 18

normal

Question 19

what is the haptoglobin level in prehepatic jaundice?

Answer 19

Low due to haemolysis

Question 20

what is the haptoglobin level in hepatic jaundice?

Answer 20

Normal or low if liver failure

Question 21

what is the haptoglobin level in posthepatic jaundice?

Answer 21

Normal

Question 22

what is the prothrombin time in prehepatic jaundice?

Answer 22

Normal

Question 23

what is the prothrombin time in hepatic jaundice?

Answer 23

Prolonged due to poor synthetic function

Question 24

what is the prothrombin time in posthepatic jaundice?

Answer 24

Prolonged due to vitamin K, malabsorption; corrects with vitamin K

Question 25

what will US show in prehepatic jaundice?

Answer 25

Normal

Question 26

what will US show in hepatic jaundice?

Answer 26

May be abnormal liver texture, e.g. cirrhosis

Question 27

what will US show in posthepatic jaundice?

Answer 27

dilated bile ducts

Question 28

what are the causes of prehepatic jaundice?

Answer 28

haemolysis (e.g. spherocytosis or incompatible blood transfusion)

Question 29

what is the pathophysiology of prehepatic jaundice?

Answer 29

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

Question 30

what are the causes of hepatic jaundice?

Answer 30

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

Question 31

what are the classification of causes of post hepatic jaundice?

Answer 31

location related to bile duct - within the lumen, within the wall, external compression

Question 32

what are the lumen obstructive causes of post hepatic jaundice?

Answer 32

gall stones

Question 33

what are wall pathology causes of post hepatic jaundice?

Answer 33

 Congenital atresia of the common bile duct  Traumatic stricture  Primary or secondary scleorisng cholangitis  Tumour of the bile duct (cholangiocarcinoma)

Question 34

what are the external compression causes of post hepatic jaundice?

Answer 34

 Pancreas  Tumour of the head of the pancreas  Tumour of the ampulla of Vater  Hilar lymphadenopathy

Question 35

what is the pathophysiology of hepatic jaundice?

Answer 35

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.

Question 36

what is the pathophysiology of posthepatic jaundice?

Answer 36

Obstruction prevents excretion of conjugated bilirubin

Question 37

what is the clinical features of post hepatic jaundice?

Answer 37

pale stools | dark urine