Jaundice Flashcards
what issues can the liver have?
viral liver disease, jaundice, cirrhosis, liver failure
what is jaundice?
the accumulation of bilirubin in the skin
what are the signs of jaundice?
yellow/orange pigmentation, significant itch, yellow sclera of eye
how is bilirubin produced?
haem is converted to biliverdin and then bilirubin
describe the production and excretion of bilirubin
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
what does it mean if bilirubin goes through a circulatory system?
some passes into the kidney and some is passed as stool
what is the change in colour of stool and urine due to?
if bilirubin can be conjugated and pass into the intestine/kidney
what happens if bilirubin is not conjugated?
it cannot be excreted and accumulates in the blood which shows as yellow on the skin
what are the three classifications of jaundice?
pre-hepatic, hepatic, post-hepatic
what is pre-hepatic jaundice?
increased haem load, could be autoimmune, spleen, abnormal RBC’s
what is hepatic jaundice?
liver cell failure, could be cirrhosis or hepatitis
what is post-hepatic jaundice?
biliary, gall bladder and pancreatic disease
what does pale stool and dark urine suggest?
post hepatic jaundice as conjugated bilirubin is causing the jaundice
what is pre-hepatic jaundice caused by?
excessive quantities of red blood cell breakdown products - haemolytic anaemia, post-transfusion, neonatal
what is hepatic jaundice due to?
liver failure - cirrhosis or drug induced liver dysfunction
what does hepatic jaundice do?
prevents metabolism of RBC breakdown products
what is the cause of post-hepatic jaundice?
obstruction to bile outflow
what obstruction can be present in the intrahepatic biliary system?
primary biliary sclerosis
what obstruction can be present in the extrahepatic biliary system?
gall bladder - gall stones, common bile duct - pancreatic carcinoma, cholangiocarcinoma
what can gall stones do?
block the biliary tree and cause obstructive jaundice, cause inflammation
where are gall stones formed
in the gall bladder
what is acute cholecystitis?
inflammation of the gall bladder
what are the symptoms of gall bladder symptoms?
pain in shoulder tip, abdominal pain right side which radiates to the back, pain brought on by eating fatty food
what imaging can be used for jaundice patients?
ultrasound, plain radiographs, ERCP
what can ultrasounds detect?
detects dilated bile channels within the liver and the dilated biliary tree
what do plain radiographs show?
radiopaque gall stones
what happens if there is a cholangiocarcinoma at the head of the pancreas?
it obstructs the biliary flow
where are cholangiocarcinomas most troublesome?
at the lower end of the pancreas as they obstrucy secretions into the duodenum
what is pancreatitis?
repeated alcohol related liver and pancreas inflammation
what do cystic fibrosis patients need to take for pancreatitis?
oral pancreatic enzyme supplements
what consequence is there of chronic pancreatic disease
diabetes
how do you manage pre-hepatic jaundice?
identify and treat the cause
how do you manage post-hepatic jaundice?
remove obstruction
what is a biliary tree stent?
a stent placed into biliary duct so that it can allow fluid to flow
how do you prevent gall stone recurrence?
remove gall bladder, prevent build up of bile acid, prevent bile acid reabsorption from the GIT
what helps to prevent build up of bile acid?
ursodeoxycholic acid and low calori and low cholesterol diet
what is neonatal jaundice caused by?
increased haem breakdown and poor liver function
what can neonatal jaundice cause?
kernicterus - brain damage
what does kernicterus do?
damage neurological pathways
how do you treat neonatal jaundice?
blue light applied to the skin so that bilirubin breaks down and passes through the kidneys
