Sketchy Path: Lab Eval of Liver Injury and Hyperbilirubinemia

Question 1

How does unconjugated billirubin move in the blood?

Answer 1

Albumin

not water soluble

Question 2

Conjugation is done by what enzyme?

Answer 2

UDP- glucoronyltransfurase

Question 3

Conjugation does what to bilirubin?

Answer 3

Makes it more soluble

Question 4

What is responsible for the brown color of poop?

Answer 4

Sterocobilin

Question 5

What are the fates of urobillinogen?

Answer 5

Return to the liver or be excreted in urine

Question 6

Hemolysis what cause what type of hyperbillirubinemia?

Answer 6

Unconjugated Hyperbilirubinemia

Question 7

AR syndrome caused by a decrease activity of UDP-glucoronyltransferase is called?

Answer 7

Gilbert Syndrome

Question 8

AR syndrome caused by a inactivaton of the UDP-G enzyme in the liver

Answer 8

Crigler-Najjar

cricket in a jar

Question 9

What is kernicterus?

Answer 9

Irreversible neurologic dysfunction caused by bilirubin deposition in the brain

Question 10

What is pysiologic jaundice of the newborn?

Answer 10

Infants have less capacity to conjugate billirubin and have less developed intestinal flora in order to create urobillinogen for hepatic recycling
Newborns also produce more conjugated billirubin due to RBC hemolysis

Question 11

What is the treatment for physiologic jaundice of the newborn?

Answer 11

Photo therapy which create a more soluble form of billirubin (cis-billirubin)

Question 12

What is breast feeding jaundice?

Answer 12

lack of enteral feeding leads to slow bile excretion and high UC bilirubin

Question 13

What is breast milk jaundice?

Answer 13

A substance in milk inhibits UDP-glucoronyltransferase leading to increased UC bilirubin and jaundice; usually in the 2nd week of life
(LPL)

Question 14

If a patient develops jaundice after breast feeding before one week of life what type of jaundice is this?

Answer 14

Breast Feeding Jaundice

Question 15

What are the two most common cause of mixed hyperbillirubinemia?

Answer 15

Viral Hepatitis

Alcoholic Hepatitis

Question 16

Conjugated bilirubin should not be where?

Answer 16

Urine

Question 17

AST>ALT?

Answer 17

Alcoholic hepatitis

Question 18

Almost all cases of conjugated hyperbilirubinemia are caused by what?

Answer 18

Blockage of bile outflow - choledocholithiasis/

cholestatis

Question 19

How does bile get into the serum when a blockage of the bile duct occurs?

Answer 19

Backs up the biliary tree and into the hepatocytes

Question 20

If conjugated billirubin is found in the urine what should you suspect?

Answer 20

Billiary disease

Question 21

If there is a blockage of billirubin entering the gut what will happen to the stool?

Answer 21

Stool will be pale

Question 22

Why is urine dark in conjugated disease?

Answer 22

conjugated billirubin is water soluble so it can enter the urine and create dark stool

Question 23

Increase Alk Phos and GGT should clue you to?

Answer 23

Biliary disease

Question 24

Dubin Johnson is described as?

Answer 24

AR; Impaired excretion of conjugated billirubin

Question 25

What is the pathopneumonic finding in dubin johnson syndrome?

Answer 25

BLACK pigmented liver

Question 26

AR disease with impaired transport of CB but no black liver

Answer 26

Rotor syndrome

Question 27

Billiary Atresia

Answer 27

Fibrosis of the bile ducts leading to cholestasis and conjugated hyperbilirrubinemia

Question 28

Histology of billiary atresia?

Answer 28

Inflammation and fibrosis of the portal tract, cholestasis, and intrahepatic bile duct proliferation

Question 29

Conjugated billirubin disorders with have what kind of urine and what kind of stool?

Answer 29

Dark Urine

Pale Stools

Question 30

Is conjugated billirubinemia in a newborn ever normal?

Answer 30

no