L2: Jaundice

Question 1

Def of Jaundice

Answer 1

Yellow discoloration of the skin and mucous membrane due to hyperbilirubinemia.

Question 2

where is Jaundice Best observed?

Answer 2

in the sclera since elastin in the sclera binds bilirubin.

Question 3

Sites of Jaundice

Answer 3

appears first in soft palate (frenulum of the tongue), sclera (2-2.5 mg/dl), then skin (7 mg/dl) and mucous membranes

Question 4

what is the normal Bilirubin level?

Answer 4

Normal bilirubin level < 1 mg/dl

Question 5

when does jaundice appear?

Answer 5

Jaundice > 2.5 mg/dl.

Question 6

What is PseudoJaundice

Answer 6

hypercarotenemia, the skin may turn yellowish due to the presence of beta-carotene.

Question 7

Sources of Bilirubin

Answer 7

• 85% from the breakdown of old RBCs-the normal RBC survives 120 days, so every day 1/120 of blood is turning over.
• 15% from other heme containing enzymes, cytochromes, myoglobin, and immature RBCs in the bone marrow.

Question 8

Bilirubin Metabolism

Answer 8

Question 9

Compare between Conjugated & Unconjugated Bilirubin in terms of:

• Solubility?
• Normal Site
• Filtration by Kidney?

Answer 9

Question 10

Normal Bile Composition

Answer 10

Question 11

Major causes of Jaundice

Answer 11

Question 12

Pre-Hepatic Causes of Jaundice

Answer 12

Question 13

Hepatic Causes of Jaundice

Answer 13

Question 14

Post-Hepatic Causes of Jaundice

Answer 14

Question 15

Causes of Recurrent jaundice

Answer 15

Question 16

DDx of Jaundice

Answer 16

• Carotenemia
• Atabrine toxicity
• Diffuse Xanthomatosis

Question 17

pathogenesis of Hemolytic jaundice

Answer 17

Question 18

Etiology of Hemolytic jaundice

Answer 18

Question 19

CP of Hemolytic jaundice

Answer 19

Question 20

Investigations of Hemolytic jaundice

Answer 20

Question 21

Pathogenesis of Hepatocellular Jaundice

Answer 21

Question 22

Etiology of Hepatocellular Jaundice

Answer 22

Question 23

CP of Hepatocellular Jaundice

Answer 23

Question 24

Investigations for Hepatocellular Jaundice

Question 25

Pathogenesis of Obstructive Jaundice

Answer 25

Question 26

Etiology of Obstructive Jaundice

Answer 26

Question 27

CP of Obstructive Jaundice

Answer 27

Question 28

Investigations for Obstructive Jaundice

Answer 28

Question 29

what Causes elevated Indirect Bili?

Answer 29

Question 30

What causes elevated Direct Bili?

Answer 30

Question 31

Causes of elevated uncojugated hyperbilirubinemia

Question 32

what is the Most common cause of unconjugated hyperbilirubinemia?

Answer 32

Gilbert’s syndrome

Question 33

Gilbert’s syndrome

Answer 33

• Most common cause of unconjugated hyperbilirubinemia; an inborn error of metabolism affecting bilirubin uptake as well as conjugation in
  the liver; totally asymptomatic: mild hyperbilirubinemia.

Question 34

Crigler-Najjar Syndrome (Types I and II)

Answer 34

Usually lethal, pediatric illness; congenital total or relative deficiency of glucuronyl transferase.

Question 35

Neonatal jaundice

Answer 35

• In infants, the liver may be unable to function at full capacity, therefore there is decreased conjugation.
• The high levels of bilirubin may cause seizures (kernicterus).
• Treatment is phototherapy, which makes bilirubin more water soluble to be excreted into the bile.

Question 36

Compare between Hereditary causes of Isolated hyperbilirubenemia in terms of:

• genetic Status
• deficit
• CP
• TTT

Answer 36

Question 37

what are causes of isolated hyperbilirubenemia?

Question 38

Hx

Approach to jaundice

Answer 38

Question 39

General Ex

Approach to jaundice

Answer 39

Question 40

Local Ex

Approach to jaundice

Answer 40

Question 41

Investigations

Approach to jaundice

Answer 41

Question 42

Compare between approach of Calcular Obstruction & malignant obstruction

Answer 42

Question 43

Compare between approach of intra & extra hepatic cholestasis

Answer 43

Question 44

• Jaundice with fever
• Isolated hyperbilirubenemia
• Jaundice with pain
• Recurrent jaundice
• 3 types of jaundice
• Painless jaundice