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Year 3 - Gastro > Jaundice - prof khan teaching > Flashcards

Jaundice - prof khan teaching Flashcards

1
Q

Where is bile made?

A

LIVER

from right lobe & left lobe -> flow through right and left hepatic duct

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2
Q

Explain the duct system from right hepatic duct

A 
RHD and LHD 
Common hepatic duct 
Cystic duct (from gall bladder) 
Common bile duct 
Via ampulla / sphincter of oddi
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3
Q

What is the function of the gall bladder?

A

STORAGE of bile

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4
Q

Which hormone is produced when someone eats fat? What happens when this hormone is produced?

A

Cholecystokinin hormone -> causes sphincter of oddi to relax, so ampulla opens
Also causes gall bladder to contract and squeeze
So bile is pumped into duodenum

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5
Q

What is another name for gall bladder pain?

A

Biliary colic

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6
Q

Where does bilirubin come from?

A

75% from RBC breakdown
22% from catabolism of other haem proteins
3% from ineffective bone marrow erythropoiesis

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7
Q

How is bilirubin transported from the spleen to the liver?

A

From the spleen, it is bound to albumin because it is insoluble

This is the UNCONJUGATED BILIRUBIN

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8
Q

How is bilirubin transported from the liver around the body? Explain the enzyme

A

As it’s dissociated from albumin in the liver, it has to be conjugated with glucoronic acid by UDPGT

Transported across concentration gradient into bile canaliculi

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9
Q

Where is the UDPGT made?

A

Smooth endoplasmic reticulum of hepatocytes

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10
Q

What is the resulting molecule that is water soluble when glucuronyl transferase conjugates bilirubin with glucoronic acid?

A

Diglucoronide bilirubin (water soluble)

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11
Q

What does diglucoronide bilirubin become when it is passed through urine?

A

Urobilinogens

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12
Q

What does diglucoronide bilirubin become when it is passed through stool?

A

Conjugated bilirubin in the colon is reduced by gut bacteria to stercobilinogen
oxidised to stercobilin (brown)

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13
Q

What do you call

A

Stercobilinogens (in stool)

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14
Q

At what point does a pt start looking yellow?

A

When bove 34

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15
Q

Prehepatic jaundice

A 
Haemolysis (they're dying quicker than 120 days) e.g. from sepsis, AHA 
Massive transfusion 
Haematoma 
Resorption 
Infective erythropoeisis e.g. leukemia
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16
Q

Prehepatic jaundice caues

A

Increased quantity

Haemolysis (they're dying quicker than 120 days) e.g. from sepsis, AHA 
Massive transfusion 
Haematoma 
Resorption 
Infective erythropoeisis e.g. leukemia
17
Q

What would you find on a blood investigations with prehaptic jaundcie?

A

Low hb levels due to haemolysis
High bilirubin but normal liver function tests because they don’t have to

Confirm via blood film to look for
Haptoglobins antibodies that cause haemolysis
Ask lab to do split bilirubin to work our conjugated vs unconjugated bilirubin

18
Q

Hepatic/hepatocellular jaundice mechanism

A

Hepatocytes not working

Defective uptake/conjugation/excretion

19
Q

Hepatic/hepatocellular jaundice causes

A 
Acute/fulminant liver disease
Acute on chronic decompensation 
Viral hepatitis 
Ethanol 
AID
PBC
PSC
Intrahepatic cholecysteee?
20
Q

Post hepatic jaundice causes

A

Obstruction

Defective transport of BR
Gall stones
Ca. cholangiocarcinoma, head of pancreas or hepatocellular carcinoma

21
Q

Investigation findings for post hepatic jaundice / what would you investigate?

A 
Negative haemolysis 
ALP and GGT high as they come mainly from biliary tree 
Dilated bile ducts on ultrasound 
CT or MRCP 
More conjugated bilirubin
22
Q

What type of jaundice does gilbert’s syndrome cause?

A

hepatic jaundice

23
Q

Inheritance pattern of Gilbert’s

A

Hereditary autosomal recessive condition

24
Q

What percentage of people have gilbert’s?

A

5% of people will have it

25
Q

What is the problem with Gilbert’s?

A

They’ve inherited an isoform of UDPGT that’s slow

UDPGT-1A1

26
Q

UDPGT

A

Uridine diphsophate glucoronosyltransferase isoform 1A1

27
Q

UDPGT full name

A

Uridine diphsophate glucoronosyltransferase isoform 1A1

28
Q

Is the bilirubin mainly conjugated or unconjugated?

A

Mainly unconjugated because the UDPGT is slow

29
Q

How would you diagnose Gilbert’s/what would you find on investigation

A

Liver disease screens negative, all normal

Predominantly unconjugated bilirubin

30
Q

What would cause splenomegaly and low platelets?

A

PORTAL HYPERTENSION

31
Q

What’s the normal size of the spleen?

A

Spleen should be normally around 12cm

32
Q

What does decompensation mean?

A

Jaundice
Ascites
Variceal bleeding
Encephalopathy

33
Q

What does decompensation mean?

A

Someone who has cirrhosis who develops:

Jaundice
Ascites
Variceal bleeding
Encephalopathy

34
Q

What does it mean if cirrhosis is compensated?

A

Someone has cirrhosis but they don’t have:

Jaundice
Ascites
Variceal bleeding
Encephalopathy

35
Q

What scan would you do to check for fibrosis?

A

Fibrescan

Year 3 - Gastro (42 decks)

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