Jaundice harrison's

Question 1

Bilirubin level if you have scleal icterus

Answer 1

51 umol/L or 3mg/dL

Question 2

Green color is produced by oxidation of bilirubin to

Answer 2

Biliverdin

Question 3

Drug that causes skin discoloration in 4-37%

Answer 3

Quinacrine

Question 4

Yellowing of the skin that is concentrated on palms, soles, forehead, nasolabial fold and sparing of the sclerae

Answer 4

Carotenoderma

Question 5

Each day about 250/300mg of bilirubin is produced and ___% is from the breakdown of hemoglobin (heme)

Answer 5

70-80%

Question 6

Another name for heme

Answer 6

Ferroprotoporphyrin IX

Question 7

Formation of bilirubin occurs in which cellsnin which organs

Answer 7

Reticuloendorhelial cells

Spleen/liver

Question 8

First reaction in metabolism of bilirubin is the cleaving of the alpha bridge of the porphyrin group opening the heme ring prodicing 3:

Answer 8

Iron
Carbon monoxide
Biliverdin

Question 9

Converts biliverdin to bilirubin

Answer 9

Biliverdin reductase

Question 10

The conjugation of glucoronic acid to bilirubin is catalyzed by

Answer 10

UDPGT

uridine diphosphate glucoronyl transferase

Question 11

Where is bilirubin hydrolyzed to unconjugated bilirubin and by what enzyme

Answer 11

Distal ileum and colon

Bacterial beta glucuronidases

Question 12

Urobilirubin is reduced by normal gut bacteria to urobilinogens and this is excreted in three ways

Answer 12

80-90% feces
10-20 passiveley absorbed and are re excreted by the kiver
<3mg/dL escapes hepatic uptake and is excreted in urine

Question 13

Half life of bilirubin

Answer 13

4 h

Question 14

Drugs that cause problem with hepatic uptake or conjugation of bilirubin causing unconjugated hyperbilirubinemia

Answer 14

Rifampicin
Probenacid
Ribavirin

Question 15

Complete absence if UDPGT activity due to mutations in the critical 3’ domain of the UDPGT gene

Found in neonates
Kernicterus
Death in infancy or childhood

Answer 15

Crigler-Najjar Type I

Question 16

Reduction of UDPGT activity but patients survive into adulthood

Serum bilirubin of 6-25mgdL

Answer 16

Crigler-Najjar Type II

Question 17

Reduced UDPGT activity but serum lbilirubin usually <6 (mild hyperbilirubinemia) sue to impairment in transcription of bilirubin UDPGT gene

impaired conjugation of bilirubin due to reduced bilirubin UDPGT activity (typically 10–35% of normal).

Jaundice during periods of fasting, stress, alcohol

Answer 17

Gilbert’s syndrome

Question 18

Incidence of gilbert’s symptoms

Answer 18

3-7%

2-7:1 (Male to female)

Question 19

Asymptomatic jaundice

Altered excretion of bilirubin into the bile ducts

Answer 19

Dubin-Johnson syndrome

Question 20

Gene affected in dubin johnson

Answer 20

MRP2 gene mutation

Question 21

Asymptomatic jaundice with deficiency in major hepatic drug uptake transporters OATP1B1 and OATP1B3

Answer 21

Rotor Syndrome

Question 22

Alcoholic cirrhosis

Another name

Answer 22

Laennec’s

Question 23

Alcoholic hepatitis has an AST/ALT ratio of

Answer 23

2:1

Question 24

Screening for Wilson’s Disease

Answer 24

Ceruloplasmin

Question 25

Hepatoroxin in Jamaic bush tra or kava kava

Answer 25

Pyrrolizidine alkaloids

Question 26

Chronic Cholestasis associated with which drugs

Answer 26

Chlorpromazine and prochlorperazine

Question 27

autoimmune disease p inantly affecting middle-aged women and characterized by progressive Destruction of interlobar bile ducts
+ antimitochondrial antibody 95%

Answer 27

Promary biliary cirrhosis

Question 28

Destruction and fibrosis of larger bile ducts
Has pathognomonic segmental strictures
Associated with IBD and cholangiocarcinoma.

Answer 28

Prinary sclerosing cholangitis

Question 29

Percentage of patients with PSC eith IBD

Answer 29

75%

Question 30

Progressive familial intrahepatic cholestasis types 1 choldhood) and benign recurrent cholestasis (adulthood) has this gene mutation

Answer 30

ATP8B1 gene (encodes P type ATPases)

Question 31

PFIC2 gene mutation

Answer 31

ABCB11 gene

Question 32

PFIC3 mutation

Answer 32

P-glycoprotein 3

Question 33

Intrahepatic choletasis that is associated with renal cell cancer

Answer 33

Stauffer’s syndrome

Question 34

Most common cause of extrahepatic cholestasis

Answer 34

Choledocholithiasis

Question 35

Differentials for Yellowing of the skin

Answer 35

carotenoderma, the use of the drug quinacrine, and excessive exposure to phenols

Question 36

half life albumin

Answer 36

12-14 hours

Question 37

Unconjugated bilirubin is always bound to albumin in the serum, is not filtered by the kidney, and is not found in the urine.

Answer 37

t

Question 38

A false-negative result is possible in patients with prolonged cholestasis due to the predominance of delta bilirubin, which is covalently bound to albumin and therefore not filtered by the renal glomeruli.

Answer 38

t

Question 39

In evaluating jaundice in patients with chronic hemolysis, it is important to remember the high incidence of pigmented (calcium bilirubinate) gallstones found in these patients,

Answer 39

t

Question 40

Impaired bilirubin conjugation occurs in three genetic conditions:

Answer 40

Crigler-Najjar syndrome types I and II and Gilbert’s syndrome.

Question 41

Bilirubin UDPGT activity can be induced by the a tration of phenobarbital, which can reduce serum bilirubin levels in these patients.

Answer 41

phenobarbital,

Question 42

dRUGS Causing indirect hyperbole

Answer 42

1. Rifampin
2. Probenecid
3. Ribavirin
4. Protease inhibitors (Atazanavir, Indinavir)

Question 43

Dubin Johnson and Rotor syndrome both have asymptomatic jaundice

Answer 43

TRUE

Question 44

. A history of arthralgias and myalgias predating jaundice suggests hepatitis, either viral or drug-related.

Answer 44

true

Question 45

Stigmata of chronic liver disease

Answer 45

spider nevi, palmar erythema, gynecomastia, caput medusae, Dupuytren’s contractures, parotid gland enlargement, and testicular atrophy, are commonly seen in advanced alcoholic (Laennec’s) cirrhosis and occasionally in other types of cirrhosis

Question 46

vThe absence of biliary dilation suggests intrahepatic cholestasis, while its presence indicates extrahepatic cholestasis.

Answer 46

t

Question 47

CT scanning and MRCP are better than ultrasonography for assessing the head of the pancreas and for identifying choledocholithiasis in the distal common bile duct, particularly when the ducts are not dilated.

Answer 47

t

Question 48

the “gold standard” for identifying c holedocholithiasis

Answer 48

ERCP

Question 49

. Both hepatitis B and C viruses can cause cholestatic hepatitis (fibrosing cholestatic hepatitis) seen in which population

Answer 49

patients who have undergone solid organ t plantation

Question 50

anabolic and contraceptive steroids cause what kind of drug toxicity

Answer 50

Pure cholestasis

Question 51

chlorpromazine, imipramine, tolbutamide, sulindac, cimetidine, and erythromycin estolate, trimethoprim; s azole;; and penicillin-based antibiotics such as ampicillin, dicloxacillin, and clavulanic acid

Answer 51

Cholestatic hepatitis

Question 52

Chronic cholestasis

Answer 52

chlorpromazine and prochlorperazine

Question 53

rare conditions in which a decreased number of bile ducts are seen in liver biopsy specimens
This picture is seen in patients who develop chronic rejection after liver transplantation and in those who develop graft-versus-host disease after bone marrow transplantation.
also occurs in rare cases of sarcoidosis,

Answer 53

vanishing bile duct syndrome and adult bile ductopenia

Question 54

characterized by episodic attacks of pruritus, cholestasis, and jaundice beginning at any age, which can be debilitating but does not lead to chronic liver disease. Serum bile acids are elevated during episodes, but serum γ-glutamyltransferase (γ-GT) activity is normal.

Answer 54

benign recurrent i hepatic cholestasis (BRIC) types 1 and 2.

Question 55

d orders begin at childhood and are progressive in nature. All three types of PFIC are associated with progressive cholestasis, elevated levels of serum bile acids, similar phenotypes but different genetic mutations. Only type 3 PFIC is associated with high levels of γ-GT

Answer 55

progressive f ial intrahepatic cholestasis (PFIC) types 1–3

Question 56

occurs in the second and third trimesters and resolves after delivery. Its cause is unknown, but the condition is probably inherited, and cholestasis can be triggered by estrogen administration.

Answer 56

Cholestasis of pregnancy

Question 57

Other causes of intrahepatic cholestasis paraneoplastic syndrome associated with a number of different malignancies

Answer 57

number of different malignancies, including Hodgkin’s disease, medullary thyroid cancer, renal cell cancer, renal sarcoma, T cell lymphoma, prostate cancer, and several gastrointestinal malignancies.

Question 58

cholestasis in the intensive care unit, the major considerations should be

Answer 58

sepsis, ischemic hepatitis (“shock liver”), and TPN jaundice

Question 59

Jaundice occurring after bone marrow transplantation is most likely due to

Answer 59

eno-occlusive disease or graft-versus-host disease.

Question 60

Plasmodium falciparum malaria

Answer 60

The jaundice in these cases is due to a combination of indirect hyperbilirubinemia from hemolysis and both cholestatic and hepatocellular jaundice.

Question 61

has the highest surgical cure rate of all the tumors that present as painless jaundice

Answer 61

Ampullary carcinoma

Question 62

is the most common cause of extrahepatic cholestasis.

Answer 62

Choledocholithiasis

Question 63

is a condition that is usually due to infection of the bile duct epithelium with CMV or cryptosporidia and has a cholangiographic appearance similar to that of PSC. The affected patients usually present with greatly elevated serum alkaline phosphatase levels (mean, 800 IU/L), but the bilirubin level is often near normal. These patients do not typically present with jaundice.

Answer 63

AIDS cholangiopathy