Liver: Jaundice

Question 1

What is Jaundice? At what level of bilirubin do you get Jaundice?

Answer 1

Jaundice is a yellowing of the screen/yellowing of the sclera secondary to an increase in bilirubin in the blood that deposits in the skin and sclera. T bili >2.5 mg/dL

Question 2

Describe normal bilirubin metabolism

Answer 2

1) RBCs have a lifespan of 120days and are consumed by macrophages of the reticuloendothelual system
2) Hemoglobin in the RBC break into Heme and globin
3) Heme breaks into Iron and protoporphyrin
4) Protoporphyrin breaks down into unconjugated bilirubin (UCB)
5) Albumin transports UCB to the liver
6) Uridine glucuronyl transferase (UGT) in hepatocytes conjugates bilirubin (CB)
7) Conjugated bilirubin is transferred to bile and when released into the small bowel, aids in digestion
8) Intestinal flora converts CB to urobilinogen, which is oxygenized into stercobilin which makes stool brown and urobilin which is absorbed in the blood and filtered by the kidney making urine yellow

Question 3

What are causes of unconjugated bilirubinemia?

Answer 3

1) Extravascular hemolysis or ineffective erythropoiesis
2) Physiologic Jaundice of the Newborn
3) Gilbert syndrome
4) Crigler-Najjar Syndrome

Question 4

What are causes of conjugated bilirubinemia?

Answer 4

1) Dubin-Johnson syndrome
2) Rotor syndrome
3) Biliary tract obstruction
4) Viral hepatitis

Question 5

What are the serologic markers of acute Hep B infection?

Answer 5

HBsAg, HBeAG, HBV DNA, HBcAB (IgM)

Question 6

What are the serologic markers of window between acute and resolved Hep B infection?

Answer 6

HBcAB (IgM)

Question 7

What are the serologic markers of resolved Hep B infection?

Answer 7

HBcAB (IgG), HBsAB (IgG)

Question 8

What are the serologic markers of chronic Hep B infection?

Answer 8

HBsAg, +/-HBeAG, +/-HBV DNA, HBsAB (IgG)

Question 9

What are the causes of viral hepatitis?

Answer 9

Hepatitis virus, CMV, EBV

Question 10

Which hepatitis virus is associated with fulminant hepatitis (Liver failure with massive liver necrosis) in pregnancy?

Answer 10

Hep E Virus

Question 11

What Hep B serologic market indicates infectivity?

Answer 11

HBeAG

Question 12

What is more severe; coinfection of HepB and HepD or superinfection of HepD upon existting HepB?

Answer 12

Superinfection

Question 13

What are the symptoms of viral hepatitis?

Answer 13

Dark urine, jaundice, malaise, fever, nausea, elevated liver enzymes