Jaundice

Question 1

what issues can the liver have?

Answer 1

viral liver disease, jaundice, cirrhosis, liver failure

Question 2

what is jaundice?

Answer 2

the accumulation of bilirubin in the skin

Question 3

what are the signs of jaundice?

Answer 3

yellow/orange pigmentation, significant itch, yellow sclera of eye

Question 4

how is bilirubin produced?

Answer 4

haem is converted to biliverdin and then bilirubin

Question 5

describe the production and excretion of bilirubin

Answer 5

bilirubin is made by the breakdown of haem. it needs to be added to a molecule for excretion (conjugated). it is excreted from the liver cells into the biliary tube in the conjugated form, this forms bile which can be stored in the gall bladder. the small intestine receives conjugated bilirubin and the large intestine reabsorbs it into the kidney (now called urobilinogen) which is passed out as urine

Question 6

what does it mean if bilirubin goes through a circulatory system?

Answer 6

some passes into the kidney and some is passed as stool

Question 7

what is the change in colour of stool and urine due to?

Answer 7

if bilirubin can be conjugated and pass into the intestine/kidney

Question 8

what happens if bilirubin is not conjugated?

Answer 8

it cannot be excreted and accumulates in the blood which shows as yellow on the skin

Question 9

what are the three classifications of jaundice?

Answer 9

pre-hepatic, hepatic, post-hepatic

Question 10

what is pre-hepatic jaundice?

Answer 10

increased haem load, could be autoimmune, spleen, abnormal RBC’s

Question 11

what is hepatic jaundice?

Answer 11

liver cell failure, could be cirrhosis or hepatitis

Question 12

what is post-hepatic jaundice?

Answer 12

biliary, gall bladder and pancreatic disease

Question 13

what does pale stool and dark urine suggest?

Answer 13

post hepatic jaundice as conjugated bilirubin is causing the jaundice

Question 14

what is pre-hepatic jaundice caused by?

Answer 14

excessive quantities of red blood cell breakdown products - haemolytic anaemia, post-transfusion, neonatal

Question 15

what is hepatic jaundice due to?

Answer 15

liver failure - cirrhosis or drug induced liver dysfunction

Question 16

what does hepatic jaundice do?

Answer 16

prevents metabolism of RBC breakdown products

Question 17

what is the cause of post-hepatic jaundice?

Answer 17

obstruction to bile outflow

Question 18

what obstruction can be present in the intrahepatic biliary system?

Answer 18

primary biliary sclerosis

Question 19

what obstruction can be present in the extrahepatic biliary system?

Answer 19

gall bladder - gall stones, common bile duct - pancreatic carcinoma, cholangiocarcinoma

Question 20

what can gall stones do?

Answer 20

block the biliary tree and cause obstructive jaundice, cause inflammation

Question 21

where are gall stones formed

Answer 21

in the gall bladder

Question 22

what is acute cholecystitis?

Answer 22

inflammation of the gall bladder

Question 23

what are the symptoms of gall bladder symptoms?

Answer 23

pain in shoulder tip, abdominal pain right side which radiates to the back, pain brought on by eating fatty food

Question 24

what imaging can be used for jaundice patients?

Answer 24

ultrasound, plain radiographs, ERCP

Question 25

what can ultrasounds detect?

Answer 25

detects dilated bile channels within the liver and the dilated biliary tree

Question 26

what do plain radiographs show?

Answer 26

radiopaque gall stones

Question 27

what happens if there is a cholangiocarcinoma at the head of the pancreas?

Answer 27

it obstructs the biliary flow

Question 28

where are cholangiocarcinomas most troublesome?

Answer 28

at the lower end of the pancreas as they obstrucy secretions into the duodenum

Question 29

what is pancreatitis?

Answer 29

repeated alcohol related liver and pancreas inflammation

Question 30

what do cystic fibrosis patients need to take for pancreatitis?

Answer 30

oral pancreatic enzyme supplements

Question 31

what consequence is there of chronic pancreatic disease

Answer 31

diabetes

Question 32

how do you manage pre-hepatic jaundice?

Answer 32

identify and treat the cause

Question 33

how do you manage post-hepatic jaundice?

Answer 33

remove obstruction

Question 34

what is a biliary tree stent?

Answer 34

a stent placed into biliary duct so that it can allow fluid to flow

Question 35

how do you prevent gall stone recurrence?

Answer 35

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

Question 36

what helps to prevent build up of bile acid?

Answer 36

ursodeoxycholic acid and low calori and low cholesterol diet

Question 37

what is neonatal jaundice caused by?

Answer 37

increased haem breakdown and poor liver function

Question 38

what can neonatal jaundice cause?

Answer 38

kernicterus - brain damage

Question 39

what does kernicterus do?

Answer 39

damage neurological pathways

Question 40

how do you treat neonatal jaundice?

Answer 40

blue light applied to the skin so that bilirubin breaks down and passes through the kidneys