L08: Jaundice

Question 1

What are the function test and imaging for the liver

Answer 1

Bilirubin 
Liver enzymes (AST/ALT)
Hepatobiliary enzymes (gGT, Alk Phos)
Albumin 
Total protein 
Autoantibodies 
Haematology
Viral markers 
Metabolic indicators 
Tumour markers

Question 2

Which liver cell makes bile

Answer 2

Hepatocytes

Question 3

How do we know when liver disease is present

Answer 3

Increased AST

Increased AP/gGT

Question 4

What does the increased levels of enzymes of the liver not tell us

Answer 4

What type of liver disease it is

Question 5

What is jaundice

Answer 5

Yellow skin, eye, tissues due to a build of bilirubin in blood and tissue fluid

Question 6

At what level is bilirubin considered to be excess

Answer 6

Higher than 2mg/ml

Question 7

What are the 3 causes of jaundice

Answer 7

Pre-hepatic
Intra-hepatic
Extra-hepatic

Question 8

What does pre-hepatic mean

Answer 8

Nothing to do with the liver but the full inside the sytem

Question 9

What does intra-hepatic mean

Answer 9

Liver condition in hepatocytes so bilirubin is excess

Question 10

What does extra-hepatic mean

Answer 10

Blockage

Question 11

What is bilirubin

Answer 11

A breakdown product of red blood cells of Haem

Question 12

What are the products that contain haem

Answer 12

Red blood cells
Myoglobin
Cytochromes
Peroxidase

Question 13

How does bilirubin get metabolised

Answer 13

1) macrophages degrade erythrocytes into haem and globin
2) globin is further Brocken down into amino acids and is used for erthyropoisesis (production of red blood cells from bone marrow)
3) haem is Brocken down into uncongugated bilirubin and iron
4) unconjugated bilirubin is carried to the liver by albumin as it is lipid soluble
5) kupffer cells break down more erythrocytes into haem and globin to give uncongugated bilirubin and iron
6) in the liver unconjugated bilirubin is congugated by gluconic acid and UDP enzyme
7) conjugated bilirubin is excerpted by the liver as bile
8) bile is stored and excerpted by the gallbladder into the ileum
9) at the end of the large intestine conjugated bilirubin is converted to urobillogen by intestinal bacteria
10) urobillogen is reabsorobed to the blood by binding to albumin which goes to the kidney to give for urines yellow colour
11) other urobillogen is oxidised by bacteria to give stercoblin which gives faeces its brown colour

Question 14

How do we diagnose pre-hepatic

Answer 14

High unconjugated bilirubin
Normal AST
Normal ALP

Question 15

With what condition will we see pre-hepatic liver disease

Answer 15

Haemolytic anaemia

Sickle cell disease

Question 16

What are the symptoms of pre-hepatic liver disease

Answer 16

Gallstones 
Large liver 
Splenomegaly 
AST/ALT high 
Thrombosis 
Iron overload 
Hepatic thrombosis

Question 17

What is the treatment for sickle cell disease

Answer 17

Agrressive manual exchange red blood cell transfusion

Question 18

What is Gilbert’s syndrome

Answer 18

Pre-hepatic condition due mutation in the bilirubin UDP glucuronyl transferase 1 gene so unconjugated levels increase

Question 19

For Gilbert’s syndrome what other condition do we need to exclude

Answer 19

Haemolysis

Question 20

Why is neonatal jaundice common

Answer 20

There is a delay in clearing bilirubin from red blood cells

Question 21

What is the treatment for neonatal jaundice

Answer 21

Phototherapy

Question 22

What does hepatic liver disease show

Answer 22

Increased bilirubin
High AST
Mild increase ALP

Question 23

Which conditions will you see hepatic liver disease

Answer 23

Alcohol
Viral hepatitis
Chronic hepatitis
Cirrhosis

Question 24

What does post-hepatic liver disease show

Answer 24

Increased bilirubin
Increased in AST
Increased ALP

Question 25

What are the causes of post-hepatic liver disease

Answer 25

Gallstone

Cancer of pancreas

Question 26

What do gallstones do

Answer 26

Block bile ducts

Question 27

What can pancreas cancer do

Answer 27

Compress the common bile duct

Question 28

What are the clinical features of a patient with extra hepatic jaundice

Answer 28

Pale stool and dark urine