Jaundice

Question 1

what is meant by jaundice?

Answer 1

• accumulation of bilirubin in the skin

Question 2

how does a patient with jaundice present?

Answer 2

• skin has a yellow/orange tint

- itchy skin

Question 3

what is meant by “icteric”

Answer 3

• the term used when a patient is jaundiced

Question 4

what are the steps of Heam metabolism?

Answer 4

1. haem is broken down into bilirubin
2. bilirubin is conjugated in the liver
3. conjugated bilirubin is excreted into bile

Question 5

what is the difference between bilirubin and conjugated bilirubin?

Answer 5

the conjugated bilirubin is present in bile whereas the unconjuagted bilirubin is not present in bile

Question 6

what are the different classifications of jaundice?

Answer 6

• pre-hepatic
• hepatic
• post-hepatic

Question 7

what is pre-hepatic jaundice?

Answer 7

• 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

Question 8

what are causes of pre-hepatic jaundice?

Answer 8

• autoimmune disease
• splenomegaly
• haemolytic anaemia

Question 9

what is hepatic jaundice?

Answer 9

• hepatic jaundice occurs due to liver cell failure

- the failing liver loses the ability to conjugate bilirubin

Question 10

what causes hepatic jaundice?

Answer 10

• cirrhosis of the liver
• hepatitis
• scarring of liver

Question 11

what is post-hepatic jaundice?

Answer 11

• post hepatic jaundice occurs when conjugated bilirubin cannot escape into the bile ducts & builds up

Question 12

why does post-hepatic jaundice occur?

Answer 12

• gallstones
• pancreatic disease
• autoimmune disease that destroys bile ducts

Question 13

what would pale stools and dark urine suggest?

Answer 13

post hepatic jaundice (conjugated bilirubin is causing the jaundice)

Question 14

explain the urine and faeces of a patient suffering from pre-hepatic jaundice?

Answer 14

jaundice with normal urine & stool colour

Question 15

what would pale stools and pale urine suggest a patient is suffering from?

Answer 15

hepatic jaundice

Question 16

what is the function of the gall bladder?

Answer 16

its the accumulation & storage site for bile produced in liver

Question 17

what can gall stones do?

Answer 17

• block the biliary tree
• can cause inflammation
• can move out to the biliary tree

Question 18

what is inflammation of the gallbladder known as?

Answer 18

acute cholecystitis

Question 19

what is the purpose of bile and pancreatic juices?

Answer 19

they help with emulsification and digestion

Question 20

what are the symptoms of gallstones?

Answer 20

• pain in shoulder tip
• abdominal pain that radiates to the back (right side)
• pain brought on by eating fatty food

Question 21

what is the name for bile duct cancer?

Answer 21

cholangiocarcinoma

Question 22

what tests are used to image a jaundiced patient?

Answer 22

• ultrasound
• plain radiographs
• endoscopic retrograde cholangio pancreatography (ERCP)

Question 23

where does a cholangiocarcinoma occur?

Answer 23

can arise anywhere in the biliary system

Question 24

describe the outcome for a patient with an extra-hepatic tumour:

Answer 24

very difficult to manage and patient will have PERSISTENT JAUNDICE (low survival rate)

Question 25

why is the outcome for pancreatic cancer so poor?

Answer 25

often discovered very late are there are little symptoms until later on in disease

Question 26

how do you treat pre-hepatic jaundice?

Answer 26

identify and treat the cause

Question 27

how is post-hepatic jaundice treated?

Answer 27

remove obstruction
• removal of gallstones
• force open channel with a stent

Question 28

how can gall stone recurrence be presented?

Answer 28

• remove the gall bladder
• prevent build up of bile acid
• prevent bile acid reabsorption from the GIT

Question 29

what is a baby with post-natal jaundice more at risk of?

Answer 29

KERNICTERUS

• brain damage from bilirubin

Question 30

what occurs in a baby with neonatal jaundice?

Answer 30

• increased haem breakdown

* poor liver function in neonate