Upper GI Flashcards
What is jaundice and why does it occur?
Yellowish discolouration of the skin and sclera due to hyperbilirubinaemia.
Where does bilirubin come from and how is it dealt with?
Breakdown product of haem from RBCs, conjugated by the liver then moved into intestine via the bile where it is excreted through the bowel and kidneys and stercobilin and urobilinogen respectively.
What are the 3 types of jaundice?
Pre-hepatic
Hepatocellular
Post-hepatic
Causes of pre-hepatic jaundice?
What type of bilirubin builds up?
Haemolytic anaemia such as sickle cell
Unconjugated
Causes of hepatocellular jaundice?
What type of bilirubin builds up?
Viral hepatitis
Alcoholic liver disease
Medications -
Hepatocellular carcinoma
Autoimmune hepatitis
Primary sclerosing cholangitis
Both unconjugated and conjugated - mixed picture
Causes of post-hepatic jaundice?
What type of bilirubin builds up?
Anything that obstructs bile ducts
- gallstones
- pancreatic cancer
- cholangiocarcinoma
- cholestasis (drug-induced)
Conjugated
What to ask about in history of jaundice?
Urine colour - darker in Hepatocellular and post-hepatic (conjugated bilirubin can be excreted by kidneys due to being water soluble)
Stool colour - paler in post-hepatic (less stercobilin reaches the gut to give stool dark colour)
Investigations of jaundice
Bloods
- FBC - anaemia, raised MCV and thrombocytopenia - seen in liver disease
- LFTs - shows jaundice pattern
- coagulation tests
- U&Es
Imaging
- US abdomen
- MRCP - Magnetic resonance cholangiopancreatography (visualise biliary tree if suspecting obstructive jaundice)
How to analyse abnormal LFTs
Raised bilirubin - suggests jaundice
Albumin - marker of synthetic liver function
AST and ALT - markers of liver function (ALT more specific)
ALP and Gamma-GT - markers of biliary damage and obstruction
When would you do a liver screen?
When there is no obvious cause of liver dysfunction
What 2 things does a liver screen look at?
Viral serology
Non- infective markers
What viral serology is looked at on a liver screen?
Acute
- Hep A, B, C and E
- CMV and EBV
Chronic
- Hep B and C
