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DIG > L08 - Jaundice > Flashcards

L08 - Jaundice Flashcards

1
Q

What is bilirubin?

A

A yellow compound that occurs in the normal catabolic haem breakdown pathway in vertebrates

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2
Q

What can an elevated level of bilirubin indicate?

A

Liver damage or disease - liver isn’t clearing bilirubin properly

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3
Q

What would you expect to happen to serum albumin levels when liver disease is present?

A

They would decrease

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4
Q

What is jaundice?

A

Yellow discolouration of the skin, eye and other tissues due to a build up of BILIRUBIN in tissue fluids and bloodstream

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5
Q

What can cause neonatal bilirubin?

A

Delays in clearance of bilirubin from red cell breakdown

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6
Q

What proteins could you test for in a liver function test?

A
  1. Bilirubin
  2. Liver enzymes (AST/ALT)
  3. Hepatobiliary enzymes (gGT, alkaline phosphatase)
  4. Albumin
  5. Total protein
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7
Q

What would you expect to happen to AST/ ALT when liver disease is present?

A

Increased

- but could also mean dmg to another organ that prod it such as heart or kidneys

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8
Q

What other things could you test for to indicate liver disease (not in liver function test????) - not sure

A
  1. Auto antibodies
  2. Haematology
  3. Viral markers
  4. Metabolic indicators
  5. Tumour markers
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9
Q

How is bilirubin produced?

A 
Product of haem catabolism 
From: 
- RBC
- Myoglobin
-  Cytochromes 
- Peroxidases
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10
Q

Which cells produce bile and how much is produced per day?

A

0.5L prod per day by hepatocytes

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11
Q

What is bile and its function?

A
  • Contains bile acids
  • Involved in emulsification of fat in SI
    Fat soluble vit uptake (A, D, E, K)
  • Many waste products (bilirubin) are eliminated from body by secretion into bile –> elim in faeces
  • Excretion of some substances which can’t be cleared by kidneys; cholesterol, bilirubin
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12
Q

Where is bile stored?

A

Stored and concentrated in the gallbladder in between meals when no fat needs to be digested (approx 100ml)

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13
Q

Approximately how many times is bile recycled in a day and why?

A

6 - 8 times per day

- To recycle bile salts so that they can be used again

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14
Q

What is the enterohepatic cycle?

A

Substances metabolised in liver, excreted into the bile and passed into the intestinal lumen, they are then reabsorbed across the intestinal mucosa and returned to the liver VIA PORTAL CIRC

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15
Q

What stimulates bile secretion?

A

Cholecystokinin (CCK) secreted by cells of upper SI, stimulates the gallbladder to contract and release stored bile into the SI

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16
Q

What are the stages of liver failure?

A
  1. Inflammation - deposits of fat lead to liver enlargement (fatty liver disease - build ups of fat in liver)
  2. Liver fibrosis - scar tissues begin to form
  3. Cirrhosis - loss of liver cells and irreversible liver scarring (growth of CT destroys liver cells)
  4. End-stage liver disease (ESLD)
  5. Liver cancer
17
Q

How much excess does total bilirubin in serum need to be to indicate jaundice?

A

2mg/ml

  • Doesn’t necessarily indicate liver disease
  • Depends on country/ practice
18
Q

What is pre-hepatic disease? (Possible causes?)

A
  • Not related to liver
  • Haemolytic anaemia which causes excess haem breakdown
  • Acc of unconjugated bilirubin
19
Q

What is intra-hepatic disease? (Possible causes?)

A
  • Originates within the liver (liver condition)
    Bilirubin recycling pathway is abnormal
  • Leading to elevated bilirubin in circ
  • Can be caused by disease, infection, drug use, genetic abnormalities, hormonal effects
  • Cholestasis
20
Q

What is extra-hepatic disease? (Possible causes?)

A

Blockage/ smth after liver that has already conjugated bilirubin

  • Extrahepatic biliary tract obstruction - blockage of normal flow of bile from liver to intestinal tract
  • Cancer of pancreas, bile duct or intestine
  • Cholestasis
21
Q

How could you distinguish between intra/pre/extra - hepatic disease?

A

Measure whether the bilirubin has been conjugated or not

22
Q

What is cholestasis?

A

The red formation or secretion of bile or extrahepatic biliary obstruction
- Decrease in bile flow due to impaired secretion by hepatocytes or obstruction to bile flow

23
Q

What are some causes as to why a patient could be diagnosed with jaundice and not liver disease?

A
  1. Pre-hepatic
  2. Intra-hepatic
  3. Extra-hepatic
24
Q

Where is bilirubin prod and what are the cells collectively known as?

A
  • Mainly in spleen (macrophages)
  • Liver (Kupfer cells)
  • Renal tubular cells
  • All over body by macrophages
  • Collectively known as RETICULOENDOTHELIAL SYSTEM
25
Q

What is Gilbert’s syndrome?

A

A mild liver disorder that does nor properly process bilirubin

26
Q

Will the bilirubin be conjugated or unconjugated in pre-hepatic jaundice?

A

Unconjugated

27
Q

Will the bilirubin be conjugated or unconjugated in intra-hepatic jaundice?

A

Conjugated or unconjugated

28
Q

Will the bilirubin be conjugated or unconjugated in extra-hepatic jaundice?

A

Conjugated

29
Q

What disease other than Gilbert’s syndrome could cause high levels of bilirubin?

A

Sickle cell anaemia

- Sickle RBC broken down after 10-20 days rather than the normal 120 days

30
Q

How can Gilbert’s syndrome be passed?

A
  • Offspring
  • It is a genetic mutation (autosomal recessive) of the UGT1A1 gene
  • Cannot be trasmitted by human-human contact
31
Q

What are the different types of gallstones?

A
  1. Cholesterol
  2. Pigment
  3. Mix of both cholesterol and pigment

DIG (31 decks)

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