Jaundice Flashcards
what is meant by jaundice?
- accumulation of bilirubin in the skin
how does a patient with jaundice present?
- skin has a yellow/orange tint
- itchy skin
what is meant by “icteric”
- the term used when a patient is jaundiced
what are the steps of Heam metabolism?
- haem is broken down into bilirubin
- bilirubin is conjugated in the liver
- conjugated bilirubin is excreted into bile
what is the difference between bilirubin and conjugated bilirubin?
the conjugated bilirubin is present in bile whereas the unconjuagted bilirubin is not present in bile
what are the different classifications of jaundice?
- pre-hepatic
- hepatic
- post-hepatic
what is pre-hepatic jaundice?
- in pre-hepatic jaundice there is an increased haem load that is broken down and causes an excess of bilirubin to be produced
- this excess bilirubin overwhelms the ability of the liver to produced conjugated bilirubin
what are causes of pre-hepatic jaundice?
- autoimmune disease
- splenomegaly
- haemolytic anaemia
what is hepatic jaundice?
- hepatic jaundice occurs due to liver cell failure
- the failing liver loses the ability to conjugate bilirubin
what causes hepatic jaundice?
- cirrhosis of the liver
- hepatitis
- scarring of liver
what is post-hepatic jaundice?
- post hepatic jaundice occurs when conjugated bilirubin cannot escape into the bile ducts & builds up
why does post-hepatic jaundice occur?
- gallstones
- pancreatic disease
- autoimmune disease that destroys bile ducts
what would pale stools and dark urine suggest?
post hepatic jaundice (conjugated bilirubin is causing the jaundice)
explain the urine and faeces of a patient suffering from pre-hepatic jaundice?
jaundice with normal urine & stool colour
what would pale stools and pale urine suggest a patient is suffering from?
hepatic jaundice
what is the function of the gall bladder?
its the accumulation & storage site for bile produced in liver
what can gall stones do?
- block the biliary tree
- can cause inflammation
- can move out to the biliary tree
what is inflammation of the gallbladder known as?
acute cholecystitis
what is the purpose of bile and pancreatic juices?
they help with emulsification and digestion
what are the symptoms of gallstones?
- pain in shoulder tip
- abdominal pain that radiates to the back (right side)
- pain brought on by eating fatty food
what is the name for bile duct cancer?
cholangiocarcinoma
what tests are used to image a jaundiced patient?
- ultrasound
- plain radiographs
- endoscopic retrograde cholangio pancreatography (ERCP)
where does a cholangiocarcinoma occur?
can arise anywhere in the biliary system
describe the outcome for a patient with an extra-hepatic tumour:
very difficult to manage and patient will have PERSISTENT JAUNDICE (low survival rate)
why is the outcome for pancreatic cancer so poor?
often discovered very late are there are little symptoms until later on in disease
how do you treat pre-hepatic jaundice?
identify and treat the cause
how is post-hepatic jaundice treated?
remove obstruction
• removal of gallstones
• force open channel with a stent
how can gall stone recurrence be presented?
- remove the gall bladder
- prevent build up of bile acid
- prevent bile acid reabsorption from the GIT
what is a baby with post-natal jaundice more at risk of?
KERNICTERUS
• brain damage from bilirubin
what occurs in a baby with neonatal jaundice?
- increased haem breakdown
* poor liver function in neonate
