Liver: Jaundice

Question 1

Earliest sign of jaundice

Answer 1

scleral icterus

Question 2

Biliruben metabolism

Answer 2

porphyrin converted to UCB
UCB to CB in liver
CB secreted into bile canaliculi
CB moved into bile, into gut lumen
gut bacteria convert CB to urobilinogen in lumen
makes feces brown
some urobilinogen reabsorbed –> yellow urine

Question 3

Extravascular hemolysis
etiology
labs
complications

Answer 3

UCB overwhelms conjugation ability of liver
high UCB
dark urine (elevated urobilinogen), pigmented stones

Question 4

Physiologic jaundice of newborn
etiology
labs
complications

Answer 4

transiently low UGT activity
high UCB
kernicterus is complication, need to treat

Question 5

Gilbert syndrome
etiology
labs
complications

Answer 5

recessive mildly low UGT activity
high UCB
jaundice during severe infection

Question 6

Crigler-Najjar syndrome
etiology
labs
complications

Answer 6

absence of UGT
CB
kernicterus, usually fatal

Question 7

Dubin-Johnson syndrome
etiology
labs
complications

Answer 7

recessive deficiency of biliruben canalicular transport protein
high CB
dark liver, benign

Question 8

Biliary tract obstruction
labs
complications

Answer 8

high CB, low urine urobilinogen

pruritis 2˚ to increased bile acids

Question 9

Viral hepatitis
labs
complications

Answer 9

high CB and UCB

dark urine due to high urine urobilirubin