Obstructive Jaundice

Question 1

A 43-year-old female presented with epigastric pain , nausea, vomiting &
diarrhea. Labs showed increase bilirubin, ALT ,ALP,GGT & Urobilinogen is undetected in urine .

Q1. What’s the type of jaundice this patient is having ?

Answer 1

Obstructive jaundice

Question 2

Q2. In what form does the bilirubin circulate within the plasma?

Answer 2

Unconjugated or conjugated bilirubin

Question 3

Q3. How urobilinogen formed & how does it circulate?

Answer 3

Formed as a product of bilirubin and then metabolised by gut flora then some excreted in stool as stercobilingoen and some get back through enterohepatic circulation and small will be excreted in urine as urobilnigin

Question 4

Q4. Why it’s absent in urine?

Answer 4

As there is obstruction in biliary system so it doesn’t reach the colon.

Question 5

Q6. What is bilirubin conjugated to?

Answer 5

Glucorohnic acid

Question 5

Q5. What’s the physiological rule of bile salts & how they achieve this function?

Answer 5

Important for fat digestion and absorption by ambulsificstion of fat which is transformed into micel and providing surface area for pancreatic enzymes to work on it.

Question 6

Q7. Talk about bilirubin metabolism?

Answer 6

Bilirubin Metabolism

• Conjugated Bilirubin: Transported into bile and released into the small intestine. Unlike bile acids, it is not reabsorbed but moves to the colon.
• In the Colon : Colonic bacteria convert conjugated bilirubin to colorless urobilinogen, which can be further oxidized to stercobilin, giving stool its brown color.
• Urobilinogen Reabsorption: About 10% of urobilinogen is reabsorbed into the enterohepatic circulation, with some processed by the kidneys, giving urine its yellow color.

Question 7

Q8. Which clotting studies is deranged?

Answer 7

PT, INR

Question 8

Q9. How to correct clotting abnormality?

Answer 8

IV VIT K // FFP // Cryopreciptate
Q10. How enterohepatic circulation of bile maintain the bile salts pool in a healthy adult / Define enterohepatic circulation?
Absorption of bile salts from ileum and returning back to the liver which present 90% of bile salts and 5% excreted in feces.
Q. What are the sources of Vit K?
Found in Milk, Liver, Dark green vegetables and grains and olive oil.
also can be synthesized in body by gut flora
Q11. What could be the cause of silent obstructive jaundice?
Ca Head of pancreas
Q12. What other investigation you want to do if you find a CBD stone in US?
Ercp As it’s diagnostic and therapeutic

Q13. If the patient has fever, pain and chills. What is the cause / diagnosis & how to manage if?

Ascending cholangitis
CCRISP PROTOCOL AND SEPSIS SIX
Q14: Can oesophagoscope be used to perform an ERCP? Why?
NO, because it’s anterior scope and cannot cannulate ampulla of vater

Question 9

Q10. How enterohepatic circulation of bile maintain the bile salts pool in a healthy adult / Define enterohepatic circulation?

Answer 9

Absorption of bile salts from ileum and returning back to the liver which present 90% of bile salts and 5% excreted in feces.

Question 10

Q12. What other investigation you want to do if you find a CBD stone in US?

Answer 10

Ercp As it’s diagnostic and therapeutic

Question 10

Q11. What could be the cause of silent obstructive jaundice?

Answer 10

Ca Head of pancreas

Question 10

Q. What are the sources of Vit K?

Answer 10

Found in Milk, Liver, Dark green vegetables and grains and olive oil.
also can be synthesized in body by gut flora

Question 11

Q13. If the patient has fever, pain and chills. What is the cause / diagnosis & how to manage if?

Answer 11

Ascending cholangitis
CCRISP PROTOCOL AND SEPSIS SIX

Question 12

Q14: Can oesophagoscope be used to perform an ERCP? Why?

Answer 12

NO, because it’s anterior scope and cannot cannulate ampulla of vater