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Year 3 Conditions > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What are RBCs broken down into and each of their fates

A

Hb into unconjugated bilirubin that binds to albumin in blood
Iron stored in transferrin proteins

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2
Q

What is other name for conjugated bili

A

Glucuronate

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3
Q

What is conjugated bili converted to

A

Urobilinogen
Stercobilinogen
(colourless)

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4
Q

What are stercobilinogen and urobilinogen converted to

A

oxidised to stercobilin and urobilin

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5
Q

What does high conjugated bili in blood indicate about cause of jaundice

A

Obstructive

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6
Q

What does high unconjugated bili in blood indicate about cause of jaundice

A

Pre-hepatic and hepatic

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7
Q

Confusion over post hepatic and hepatic definitions

A

Post hepatic can include bilie canaliculi or it can be hepatic- confusion over PSC

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8
Q

What is cholestatic jaundice

A

Jaundice from obstruction of common bile duct

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9
Q

2 causes of cholestatic bile duct

A

Gallstones

Ileus of commmon bile duct- drug induced

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10
Q

Two categories of increased production of bili

A

Intra and extravacular in spleen

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11
Q

How can urine be dark in pre hepatic jaundice

A

Haemoglobin can be broken down an alternative route into haemosiderin which is very dark

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12
Q

How to confirm if jaundice pre hepatic

A

Blood film see schistocytes or spherocytes

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13
Q

Congenital causes of intravascular heamolysis

A

SCD
Thalassaemia
PK deficiency
G6PDH deficiency

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14
Q

Acquired causes of intravascular haemolysis

A

DIC
Blood group mismatch
Malaria
Artificial heart valves

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15
Q

Where does extravascular haemolysis occur

A

Spleen- macrophages nibble at blood cells causing spherocytes

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16
Q

How does intravascular haemolysis appear on blood film

A

Schistocytes

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17
Q

Examination finding of extravascular haemolysis

A

Splenomegaly

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18
Q

Congenital cause of extravascular haemolysis

A

Hereditary spherocytosis

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19
Q

Acquired cause of extravascular spherocytosis

A

AI haemolysis

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20
Q

What drugs can induce cholestasis of common bile duct

A

Co-amoxiclav, the pill, nitrofuarontin

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21
Q

What do fever and diarrorhoea indicatea bout jaundice cause

A

abcess or infection

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22
Q

What does steatorrhoea indicate about jaundice

A

Cholestatic

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23
Q

What do signs of diabetes indicate about jaundice

A

Haemochromatosis

Pancreatic insufficiency

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24
Q

Patient presents with liver problems and also polyuria and polydipsia

A

Haemochromatosis

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25
Q

What does emphysema suggest about jaundice

A

Anti-trypsin

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26
Q

What drug can cause extravascular haemolysis

A

Methyldopa

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27
Q

What drug can cause intravascular aemolysis

A

Aspirin

Sulphonamides

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28
Q

Must asks in relation to jaundice

A 
Sexual 
Travel 
All drugs
Transfusions
Tattoos
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29
Q

What happens to pulse pressure in dehydration

A

Narrow

30
Q

What are signs of stable chronic liver disease

A 
Spider naevi
Clubbing
Bruising
Palmar erythema
Gynaecomastia
31
Q

What does RUQ tenderness indicate about jaundice

A

Gall bladder inflammations

Acute hepatitis

32
Q

What to look for in FBC jaundice and further investigation if necessary

A

Anaemia suggesting haemolysis so do blood film

33
Q

What to look for in levels of bilirubin

A

Elevated unconjugated bilirubin suggesting prehepatic

Elevated conjugated suggesting post hepatic

34
Q

What does elevated AST and ALT suggest and further investigation

A

Viral serology

Autoantibodies screen- ASMA, AMA, ANA,ANCA

35
Q

What does elevated GGT and ALP suggest and further investigation

A

Biliary tree problem so US biliary tree

36
Q

First line investigations for jaundice

A 
FBC
LFTs
Van der begh
Urinalysis for bilirubin
Serum amylase
37
Q

Jaundice with high reticulocytes

A

Pre hepatic haemolysis

38
Q

Microcytic anaemia with jaundice

A

Thalassaemia

39
Q

When will you see ALT and AST in thousands

A

Ischaemic hepatitis
Paracetemol OD
Viral

40
Q

Why cant use ALP exclusively

A

Produced in many other cells such as placenta and bones- use GGT as exclusive to biliary tree

41
Q

How can bilirubin in urine appear

A

Brown

42
Q

How is jaundice specific to pregnancy

A

Acute fatty liver
HELLP syndrome
Intrahepatic cholestasis

43
Q

Secind line investigations for jaundice

A

Haemolysis screen
Viral screen
Autoimmune screen
Congential screen

44
Q

What would be tested in haemolysis screen for jaundice

A

Coombs- autoimmune haemolysis
Blood film for spherocytes, reticulocytes and schistocytes
Haptoglobins
LDH

45
Q

What would be tested for viral screen for jaundice

A

Hep A-C
CMV
HIV
EBV

46
Q

What would be tested for in autoimmune screen for jaundice

A

ANA- AIH
ASMA- AIH
AMA- PBC
ANCA- PSC

47
Q

What would be tested for in congenital screen for jaundice

A

Haemochromatosis- high ferritin, high transferrin sats
Wilsons- high copper- low caeruplasmin
Antitrypsin- low antitrypsin

48
Q

What can be picked up by US of liver

A 
Cancer
Cirrhosis
Cholangiocarcinoma
Choledochal cyst
Gallstone
Vascular causes
49
Q

If US isnt clear what do you use

A

MRCP
CT
Endoscopic US

50
Q

What would consider if biliary outflow a problem but bile duct not dilated

A

Drugs
PSC
PBC

51
Q

How long does it take albumin to drop and what are 3 causes

A

Nephrotic syndrome
Reduced diet
Liver synthesis problems

52
Q

What is tested for in Hep B serology

A

Surface and core antigen anitbody
Surface antigen
Just surface suggests vaccine

53
Q

Prognosis options for Hep B infection

A

Full recovery- self limiting however can persist in blood and if immunosuppressed can cause infection
Chronic hep b
Carrier status- asymptomatic carrier
Fulminant Hep B- 0.5% get this but 80% mortality

54
Q

Acute phase management of Hep B

A

Contact tracing partners and vaccinating them
Safe sex
Avoid toothbrush and razor shaving
Minimise alcohol

55
Q

Investigation findings for gilberts

A

Bilirubin lower than 100micros

Low conjugated bili

56
Q

Management of gallstones

A

Ultrasound to prove gallstone but if unsure do MRCP

Most pass themselves but if are jaundiced do ERCP

57
Q

What must be excluded in gallstones

A

Cholestytitis

Ascending cholangitis

58
Q

How is cholecystitis differentiated from gallstones

A

Constant pain and fever

59
Q

Treatment of cholecystitis

A

Abx
Analgesia
IV fluids
Cholecystectomy after a few weeks when recovered

60
Q

Management of ascending cholangitis

A

Blood cultures
Close monitoring
Abx broad spectrum
ERCP to drain duct of pus

61
Q

Pathophysiology of PBC

A

T cell destruction of biliary tree which results in speapage of contents

62
Q

Imaging to confirm PBC and PSC

A

MRCP

If strongly suspected would do first before US

63
Q

FBC finding of someone with cancer

A

Anaemia

64
Q

First line imaging for pancreatic cancer

A

CT

65
Q

Procedure to remove pancreatic cancer

A

Whipple

66
Q

Jaundice with lethargy and tiredness

A

Haemolysis

67
Q

What is risk of HIV infection in needlestick injury

A

0.3

68
Q

Risk of Hep C infection in needlestick infection

A

3

69
Q

Risk of Hep B infection after needlestick infection

A

30

70
Q

How to differentiate between chronic and acute Hep B

A

Chronic will be IgG positve whereas acute IgM

71
Q

Most common tumours causing obstructive jaundice

A

Pancreatic
Lymph nodes at porta hepatis
Cholangiocarcinoma much rarer

72
Q

What is nutritional consequence of obstructice jaundice

A

Vit ADEK deficiency

Year 3 Conditions (33 decks)

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