S6. jaundice Flashcards
what is jaundice
clinical manifestation of having inc levels of bilirubin in blood
>yellow sclera and skin
what is stercobilin
pigmented part of faeces> makes it brown
what’s pre hepatic causes of jaundice
- too much haem
unconjugated bilirubin (not water soluble)
e.g. sickle cell/ spherocytosis/ damage to RBC
what’s hepatic causes of jaundice
liver function declined
dec hepatocyte function
> reduced conjugating ability of liver
> mix of conjugated and unconjugated bilirubin as some liver is healthy some isn’t.
what’s post hepatic causes of jaundice
obstruction! (most common cause of jaundice)
- conjugated bilirubin (water soluble) > more go to kidney (urobilinogen)>more excrete by kidney > dark looking urine
key clinical feature to distinguish post hepatic jaundice
dark urine
pale stool
causes of reduced albumin
- reduced liver function (chronic)
- renal cause
what is seen if damage to liver
ALT (Liver specific)
AST (also found in cardiac, skeletal muscle and RBC)
if damaged, these are released so see high levels in the blood
compare ALT and AST and when each rises?
ALT= rise more in acute phase of liver damage AST= more in chronic conditions e.g. alcoholic hepatitis
*likely to see inc in both but one go up more
where is ALP found (alkaline phosphotase)
in cells lining bile duct
- damage / obstruction to bile duct levels inc
cholestasis meaning
bile duct obstruction
what can cause ALP to inc?
how to determine between these?
- damage/ obstruction of bile duct
- malignancy of bone
- growing children (high bone turnover)
- gamma GT confirms if its bone related or bile duct
which type of bilirubin can cross the blood brain barrier?
unconjugated bilirubin can cross BBB
why do we do LFTs in healthy patients
to determine a baseline
>could do this before starting medication that could potentially damage liver
