03.05 Jaundice in Adults Flashcards Preview

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Flashcards in 03.05 Jaundice in Adults Deck (83)
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1

Scleral icterus, presence of at least ____

3mg/dl serum bilirubin

2

Most visible manifestation of liver and biliary tract disease

Jaundice

3

D/dx for yellowing of skin

Jaundice
Carotenoderma/carotenemia
Quinacrine use
Excessive exposure to phenols

4

Becomes clinically evident when total serum bilirubin ____

>3mg/dL

5

Helps in determining cause of jaundice or hyperbilirubinemia

Fractionation of bilirubin

6

Most commonly available technique of bilirubin measurement

Spectrophotometeric method (van der Bergh reaction)

7

Bilirubin reaction that directly reacts wth diazotized sulfanilic acid that is initially added (even in the absence of alcohol)

Direct bilirubin (conjugated)

8

Suspect liver disease or injury if conjugated bilirubin ____

> 0.3 mg/dL

9

The difference between the total and the direct bilirubin levels measured

Indirect bilirubin

10

Bilirubin formation occurs in ____

Reticuloendothelial system

11

Focus of history

Exposure to any chemicals or medications
Parenteral exposure
Risk-taking behaviour
Recent travel history
Exposure to people with jaundice and contaminated foods
Alcohol
Accompanying s/sx (antralgia, myalgia, rash, anorexia, weight loss, abdominal pain, fever, pruritus, urine or stool changes)

12

PE in assessing jaundice

Nutritional status
Muscle wasting (long-standing)
Stigmata of chronic liver disease: spider nevi, palmar erythema, gynecomastia, caput medusa, testicular atrophy
Abdominal examination: size and consistency of liver, palpation of the spleen for enlargement, presence or absence of ascites

13

Initial steps in evaluation

Liver-associated tests (total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, ALT, AST, albumin, prothrombin time)
Determine if hyperbilirubinemia is direct or indirect
Other tests

14

Three main causes of jaundice

Isolated disorders of bilirubin metabolism
Liver diseases (hepatic disorder with prominent cholestasis, hepatocellular dysfunction)
Obstruction of the bile ducts

15

Both liver disease and obstruction of the bile ducts manifest with:

Elevated bilirubin
Abnormal liver test
Jaundice

16

Isolated elevation in bilirubin
Other liver tests are normal

Isolated disorder of bilirubin metabolism

17

Causes of IDBM

Hemolysis
Drugs (rifampicin)
Inherited disorders of metabolism

18

Unconjugated hyperbilirubinemia

Gilbert's syndrome
Crigler-Najjar syndrome

19

Due to impairment in the conjugation of bilirubin

Gilbert's syndrome

20

Not compatible with life

Crigler-Najjar syndrome

21

Conjugated hyperbilirubinemia

Dublin-Johnson syndrome
Rotor syndrome

22

Due to impairment in the export of bilirubin from the hepatocyte

Rotor syndrome

23

Decrease in bile flow due to impaired secretion by hepatocytes

Cholestasis

24

Clinical manifestations of cholestasis

Scleral icterus
Dark urine
Cutaenous jaundice (5 mg/dL)
Severe pruritus (inc. bile acids)

25

Lab tests of choletastic jaundice

Inc bilirubin
Abnormal ALT, AST, AlkPhos, albumin, PT)
ALP>ALT

26

In obstruction (extrahepatic cholestasis), the biliary tree is ____

Dilated

27

In hepatic disorder with prominent cholestasis (intrahepatic cholestasis), the biliary tree is ___

Not dilated

28

Causes of obstruction of bile duct

Choledocholithiasis
Diseases of the bile duct
Extrinsic compression of the bile ducts

29

Diseases of the bile duct

Primary sclerosing cholangitis
Neoplasm

30

Extrinsic compression of bile ducts

Neoplasm
Pancreatitis
Lymph nodes
Vascular engorgement