jaundice Flashcards
what referred pain do liver issues cause?
diaphragm -> shoulder
what is jaundice?
accumulation of bilirubin in the skin
-yellow/orange pigmentation
-significant itch
sclera of eye most noticeable
what is pre-hepatic jaundice?
increased haem load -autoimmune- rapid destruction, spleen, due to factors before liver metabolism excessive quantities of RBC breakdown products -abnormal RBC from transfer -haemolytic anaemia -neonatal
what is hepatic jaundice?
liver cell failure
cirrhosis, hepatitis
drug induced
prevents metabolism of RBC breakdown products
what is post-hepatic jaundice?
obstruction to bile flow -intrahepatic biliary system -primary biliary sclerosis extrahepatic biliary system -gall bladder (Stones) -common bile duct (carcinoma) biliary, gall bladder & pancreatic disease excretion problem
what are the clinical features in jaundice?
conjugated bilirubin excreted in urine & faeces
colour changes w/ cause
pale stool/dark urine suggest post-hepatic
-conjugated bilirubin cause
normal in haemolytic
-excess bilirubin unconjugated
what are gall stones?
can block biliary tree-obstructive jaundice
form w/i gall bladder
can cause inflammation
can move out to biliary tree
what is acute cholecystitis?
inflammation of gall bladder
what are gall bladder symptoms?
pain in shoulder tip abdominal pain right side -radiates to back pain by eating fatty food -stimulates bile release by contraction of gall bladder usually gall stones -rarely cholangiocarcinoma
what imaging can be used for jaundice?
ultrasound -detects dilated bile channels in liver -also dilated biliary tree -no small vessels radiographs -show radiopaque gallstones ERCP -contrast radiograph of biliary tree
describe cholangiocarcinoma and pancreatic cancer
tumour in biliary tree/pancreas blocking biliary tree
secretions cant pass to duodenum
what is the management of pre-hepatic jaundice?
identify and treat cause
what is the management of post-hepatic jaundice?
remove obstruction
- gall stones via ERCP
- gall stones via lithotripsy
- force open channel with a stent
what is a biliary tree stent?
placed in bile duct
-channel down centre for bile to flow
framework on central passageway
what is the management of jaundice?
prevention of gall stone recurrence -cholecystectomy prevent build up of bile acid -ursodeoxycholic acid -low cal & low cholesterol diet prevent bile acid reabsorption from GIT -colestyramine
