Liver

Question 1

Jaundice arises with

Answer 1

disturbances in bilirubin metabolism

Question 2

What is the normal bilirubin metabolism

Answer 2

Starts with RBCs–> then they are consumed by macrophages of the reticuloendothelial system.

The hemoglobin is broken down to heme and globin. Heme becomes Fe and Protoporphyrin.

Protoporphyrin becomes unconjugated bilirubin (UCB).

Albumin carries UCB to the liver.

In the liver it is conjugated and transferred to bile canaliculi to form bile, which goes to the bile duct to be stored in the gallbladder.

Question 3

Bile is released into

Answer 3

the small bowel to aid in digestion

Question 4

how is conjugated bilirubin converted to urobilinogen

Answer 4

intestinal flora convert CB to urobilinogen. It is oxidized to stercobilin (brown stool) and urobilin (partially reabsorbed into blood and filtered by kidney, making urine yellow).

Question 5

List the causes of jaundice.

Answer 5

1. Extravascular hemolysis or Ineggective erythropoiesis
2. Physiologic Jaundice of the newborn
3. Gilbert syndrome
4. Crigler-Najjar syndrome
5. Dubin-Johnson syndrome
6. Biliary tract obstruction (obstructive jaundice)
7. Viral Hepatitis

Question 6

HAV

Transmission?

Incubation?

Assessment?

Considerations?

Answer 6

Fecal Oral, ingestion of contaminated food

Incubation is 4 weeks

Assessment: Fever, Malaise, Hepatomegaly

Consideration: Self limiting, handwashing