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GASTROINTESITNAL SYSTEM > JAUNDICE AND LFTS > Flashcards

JAUNDICE AND LFTS Flashcards

1
Q

WHAT IS JAUNDICE?

A

Yellow discolouration of the sclera and skin

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2
Q

WHAT CAUSES THIS YELLOW DISCOLOURATION?

A

Due to hyperbilirubinaemia

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3
Q

AT WHAT LEVEL DO YOU CLASS HYPERBILIRUBINAEMIA?

A

> 50 micromole/l

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4
Q

HOW IS BILIRUBIN FORMED?

A

Destruction of red blood cells (specifically haem)

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5
Q

WHAT IS THE. NORMAL BILIRUBIN METABOLISM?

A

1) Bilirubin conjugated within the liver, making it water soluble
2) Excreted via bile into GI tract, majority of which edges red in faeces as urobilinogen and stercobilin.
3) Small percentage of urobilinogen is reabsorbed into bloodstream and excreted through the kidneys

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6
Q

WHAT ARE THE 3 TYPES IF JAUNDICE?

A

1) Pre-hepatic
2) Intra-hepatic
3) Post-hepatic

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7
Q

WHAT IS PRE-HEPATIC JAUNDICE?

A

Excessive red cell breakdown which overwhelms the livers ability to conjugate bilirubin.

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8
Q

WHAT IS ACCUMULATED IN PRE-HEPATIC JAUNDICE?

A

Unconjugated bilirubin

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9
Q

WHAT IS INTRA-HEPATIC JAUNDICE?

A

Dysfunction of the hepatic cells leads to liver losing the ability to conjugate bilirubin

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10
Q

WHAT ACCUMULATES IN INTRA- HEPATIC JAUNDICE?

A

Both conjugated and unconjugated bilirubin

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11
Q

WHAT IS POST-HEPATIC JAUNDICE?

A

Obstruction of biliary drainage

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12
Q

WHAT ACCUMULATES IN POST-HEPATIC JAUNDICE?

A

Conjugated bilirubin

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13
Q

WHAT ARE EXAMPLES OF PRE-HEPATIC JAUNDICE?

A
  • Haemolytic anaemia
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14
Q

WHAT ARE EXAMPLES OF INTRA-HEPATIC JAUNDICE?

A
  • Alcoholic liver disease
  • Viral hepatitis
  • Hepatocellular carcinoma
  • Iatrogenic - medication
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15
Q

WHAT ARE EXAMPLES OF POST-HEPATIC JAUNDICE?

A
  • Gallstones
  • Pancreatic cancer
  • Abdominal mass
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16
Q

WHAT TESTS SHOULD BE CONDUCTED FOR PATIENTS PRESENTING WITH JAUNDICE?

A

1) LFTs
2) Coagulation studies - prothrombin can be used as a marker of liver synthesis
3) FBC - anaemia
4) U + Es
5) Specialist blood tests - bilirubin, albumin, AST, ALT, ALP, GGT

17
Q

WHAT DOES BILIRUBIN LEVELS INDICATE?

A

Quantify degree of suspected jaundice

18
Q

WHAT DOES ALBUMIN LEVELS INDICATE?

A

Marker of lie synthesising function

19
Q

WHAT DOES AST (aspartame transaminase) AND ALT (alanine transaminase) INDICATE?

A

Markers of hepatocellular injury

20
Q

WHAT DOES ALKALINE PHOSPHATASE INDICATE?

A

Raised in biliary obstruction (in addition to bone disease, pregnancy)

21
Q

WHAT DOES GAMMA-GT INDICATE?

A

More specific for biliary obstruction than ALP

22
Q

WHAT IMAGING IS DONE FOR JAUNDICE?

A
  • US abdomen first line for obstructive pathology or gross liver pathology
  • MRCP used to visualise biliary tree and typically performed if jaundice is obstructive
23
Q

WHAT IS THE MANAGEMENT OF JAUNDICE?

A
  • Treat underlying cause i.e. gallstone with ERCP

- Symptomatic treatment for itching caused by hyperbilirubinemia

GASTROINTESITNAL SYSTEM (19 decks)

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