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Year 3 > Jaundice (oxford clin cases) > Flashcards

Jaundice (oxford clin cases) Flashcards

1
Q

What causes jaundice?

A

A build up of bilirubin in tissues

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2
Q

Where are RBCs broken down?

A

Spleen mainly

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3
Q

What breaks down RBCs

A

Macrophages

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4
Q

What are RBCs broken down into? (and what part of the RBC is broken down to give these products?)

A

Heamoglobin is broken down into:
Unconjugated bilirubin
Iron

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5
Q

How does unconjugated bilirubin circulate?

A

Bound to albumin

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6
Q

Where does unconjugated bilirubin go?

A

From the spleen to the liver

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7
Q

What happens to unconjugated bilirubin in the liver?

A

It is conjugated

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8
Q

What is conjugated bilirubin called? What are its characteristics?

A

Glucuronate, it is water soluble

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9
Q

Where is bilirubin secreted into from the liver?

A

Bile cancliculi (duct)

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10
Q

What happens to bilirubin in the gut?

A

It is metabolized by bacteria into urobilinogen and stercobilinogen which give faeces their colour

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11
Q

What will happen to urine if there is complete obstruction of the bile duct?

A

There will be no trace of urobilinogen in the urine

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12
Q

What are the 3 ways bilirubin can cause jaundice?

A

Problems with bilirubin production
Problems with bilirubin conjugation
Problems with bilirubin excretion

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13
Q

What is prehepatic jaundice?

A

Jaundice due to excess bilirubin production eg increased breakdown of RBC in vessels or spleen

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14
Q

What is hepatic jaundice?

A

Jaundice due to failures in the liver eg reduced uptake by hepatocytes, reduced conjugation of bilirubin by enzymes or damage to hepatocytes

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15
Q

What is post hepatic jaundice?

A

Problems with bile flow

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16
Q

What is obstructive jaundice?

A

Jaundice due to lack of bile flow into the gut

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17
Q

What will faeces and urine look like in obstructive jaundice?

A

Faeces will be pale due to lack of sterco/uro bilinogen amd urine will be dark in colour due to conjugated bilirubin in them

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18
Q

What is cholestatic jaundice?

A

Jaundice due to bilirubin not flowing out of the common bile duct

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19
Q

What are the 2 types of haemolysis?

A

Intra and extra vascular

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20
Q

What will intravascular haemolysis present with? Explain why

A

Dark urine due to free haemoglobin being excreted

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21
Q

What are congenital causes of intravascular haemolysis?

A

G6PDH deficiency
PK deficiency
Sickle cell
Thalassaemia

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22
Q

What are accquired causes of intravascular haemolysis?

A 
Heart valve replacement
Blood transfusion mismatch
DIC
Malaria
Medication
HELPP syndrome in pregnant women
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23
Q

What are congenital causes of extravascular haemolysis

A

Hereditary spherocytosis

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24
Q

What are acquired causes of extravascular haemolysis

A

Autoimmune spherocytosis

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25
Q

What will be seen on blood film in someone with intravascular haemolysis?

A

Schistocytes (fragmented blood cells)

26
Q

What will be seen on blood film in someone with extravascular haemolysis?

A

Spherocytes

27
Q

What are some congenital enzyme problems that may reduce conjugation of bulirubin

A

Gilbert’s syndrome (common)

Crigler-Naj-jar syndrome (rare)

28
Q

What acronym is used to remember acquired cuases of decreased bilirubin excretion?

A 
INVITED MD
Infection- viral/bacterial hepatitis etc
Neoplasia- tumors of the liver, pancreas, bile duct
Vascular- budd chiari syndrome (thrombosis in the hepatic vein)
Inflammation
Trauma- gallstones, stricture
Endocrine- due to hormones in pregnancy
Degenerative
Metabolic
Drugs
29
Q

What symptoms alongside jaundice would steer you towards a diagnosis of hepatits?

A

Right upper quadrant pain
Itching
Nausea and vomitting

30
Q

What does fever and diarhoea alongside jaundice make you think could be the cause?

A

Infection of the liver

31
Q

What symptoms alongside jaundice would you suspect if there is an obstruction to bile outflow?

A

Steatorrhea
Dark urine
Itching

32
Q

What symptoms alongside jaundice would you suspect if they have haemochromatosis?

A

Bronzed skin and diabetes mellitus signs

33
Q

What are the 4 mechanisms by which medications can cause haemolysis?

A

Intravascular haemolysis
Extravascular haemolysis
Cholestasis
Hepatitis

34
Q

What should you ask about/ look for in past medical history when a patient has jaundice?

A 
History of gallstones
Pregnancy
Medication they're on
Liver disease (infection, alcohol)
Haemophilia
Recent blood transfusion
Ulcerative colitis
Emphysema
Psychosis
35
Q

What should you ask about/look for in family history when a patient has jaundice?

A 
Wilson's
Gilbert's syndrome
Haemophilia
Sickle cell
Thalassaemia
36
Q

What should you ask about/look for in social history when a patient has jaundice?

A 
IV drug use
Unprotected sex/multiple partners
Foreign travel
Alcohol consumption
Tattoos
37
Q

What is meant when a patient is described as jaundiced?

A

They have yellow skin

38
Q

What is the medical name for yellow eyes?

A

Icteric

39
Q

What may be seen on inspection when a patient has chronic liver disease?

A 
Spider naevi
Palmar erythema
Clubbing
Bruising
Gynaecomastia
40
Q

What is seen in the eyes that indicates Wilson’s disease?

A

Green rings (kayser-fleischer)

41
Q

What does right upper quadrant tenderness suggest when a patient has jaundice?

A

Hepatitis

Gallbladder disease

42
Q

When should you do a blood film to investigate jaundice?

A

If FBC shows anaemia

If serum unconjugated bilirubin is raised

43
Q

When should you do viral serology/ASMA/ANA to investigate jaundice?

A

If liver enzymes are raised

44
Q

When should you do ultrasound of the biliary tree if the patient has jaundice?

A

Raised gallbladder enzymes
Positive urine bilirubin
Positive serum amylase

45
Q

What are the 2 main liver enzymes vs 2 main gallbladder enzymes?

A 
Liver= ALT, AST
Gallbladder= ALP, GGT
46
Q

What investigation should be done if you suspect hepatocyte damage and what will results be?

A

Check liver enzymes, they will be raised

47
Q

What does AST>ALT suggest?

A

Excessive alcohol intake

48
Q

What does ALT>AST suggest?

A

Viral hepatitis

49
Q

What are causes of AST/ALT in the thousands?

A

Viral hep
Paracetamol overdose
Ischaemic hep

50
Q

What will serum bilirubin be if the problem is obstruction of bile flow? Why?

A

Conjugated bilirubin >20% of total bilirubin because this shows the liver is conjugating the bilirubin that goes through it

51
Q

Where is ALP released from?

A

Damaged biliary epithelial cells and the placenta

52
Q

Where is GGT released from?

A

Biliary epithelial cells

53
Q

What does high ALP and high GGT suggest?

A

Bile duct pathology

Could also be hepatitis

54
Q

What does high ALP but normal GGT suggest?

A

High bone turnover (mets in bone or hyperparathyroidsm) or pregnancy

55
Q

What does high GGT alone suggest?

A

Recent alcohol consumption

56
Q

What type of jaundice manifests as dark urine?

A

Posthepatic jaundice

57
Q

What does bilirubin in the urine suggest?

A

Posthepatic obstruction- the bilirubin has to be excreted via an alternate route

58
Q

Why is there no urobilinogen in the urine of patients with posthepatic jaundice?

A

Because bilirubin cannot reach the gut so it isn’t broken down into urobilinogen and excreted in the urine

59
Q

What might you look at in investigations if you suspect jaundice is due to haemolysis?

A

Haptoglobins- will be depleted
Lactate dehydrogenase- will be raised
Direct antiglobulin test (DAT)- if you suspect haemolysis
Blood film

60
Q

What disease increases risk of PSC?

A

Ulcerative colitis

Year 3 (104 decks)

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