PRACTICAL: MEDICINE JAUNDICE

Question 1

BILIRUBIN HANDLING

Answer 1

Question 2

Hepatic Cell: BILIRUBIN METABOLISM

Answer 2

Question 3

Transporter which transports UNCONJUGATED BILIRUBIN-ALBUMIN into Hepatocyte

Answer 3

LIGANDIN

Question 4

Transporter which transports CONJUGATED BILIRUBIN into BILE DUCT

Answer 4

MRP2/CMOAT

Question 5

Enzyme causing CONJUGATION of BILIRUBIN

Answer 5

UGT1A1

Question 6

Difference BETWEEN JAUNDICE & ICTERUS

Answer 6

Elevation of Serum BILIRUBIN > 3mg/dl: Jaundice

ICTERUS: Clinical sign of Jaundice; Yellowish discolouration of Sclera

Question 7

Serum BILIRUBIN that causes DISCOLOURATION of MUCOUS MEMBRANE

Answer 7

Serum BILIRUBIN > 4-5mg/dl

Question 8

NORMAL Serum BILIRUBIN

Answer 8

0.2-1.2 mg/dl

Question 9

Sites to look for JAUNDICE

Answer 9

1. Sclera
2. Sublingual mucosa
3. Oral cavity
4. Palms & Soles
5. Skin

Question 10

PSEUDO-JAUNDICE
Yellowish discolouration without JAUNDICE

Answer 10

1. Carotenemia
2. HypO-Thyroidism
3. Quinacrine poisoning
4. Phenols & Nitric acid exposure
5. Addison’s disease
6. Anorexia / Bullemia Nervosa

Question 11

Why Scleral ICTERUS is an MISNOMER?

Answer 11

Bilirubin has HIGH AFFINITY for ELASTIN
⬇️
Abundant in CONJUNCTIVA, SUPERFICIAL & FIBROVASCULAR EPISCLERA

BUT ⛔ IN SCLERA PROPER.

WHEN examining ➡️ ICTERUS of the Bulbar Conjunctiva is SEEN against WHITE BACKGROUND Provided by SCLERA

Question 12

1st SIGN of HYPER-BILIRUBINEMIA

Answer 12

Conjunctival Icterus

Question 13

MUDDY SCLERA/CONJUNCTIVA

Answer 13

Yellowish discolouration can be NORMALLY seen in EXPOSED PARTS of Sclera/Conjunctiva

Question 14

1st SYMPTOM to Resolve after HEPATITIS

Answer 14

Hepatitis
⬇️
BILIRUBIN
⬇️
Jaundice

Question 15

Total Bilirubin
Components

Answer 15

1. Indirect Bilirubin
2. Direct BILIRUBIN
3. Delta Fraction (Direct BILIRUBIN ➕ Albumin)

Question 16

Which Bilirubin is WATER SOLUBLE?

Answer 16

Direct Bilirubin

Question 17

SINUS BRADYCARDIA is seen in OBSTRUCTIVE JAUNDICE
Why?

Answer 17

Bile acids suppress SA NODE FUNCTION

Question 18

Yellowish discolouration is not seen, even though HYPERBILIRUBINEMIA in

Answer 18

1. Paralyzed Areas
2. Edematous areas

Question 19

DELTA FRACTION is prominent in

Answer 19

1. Viral Hepatitis (High BILIRUBIN)
2. Prolonged Severe CHOLESTASIS
3. RENAL FAILURE (Albumin NOT Excreted)

Question 20

CORVOISIER’S Law

Answer 20

PALPABLE NON-TENDER GALL BLADDER
➕
PAINLESS JAUNDICE
⬇️
MALIGNANCY

Question 21

Normal Gall stone produces

Answer 21

Acute Pain

Question 22

Jaundice will be ➕ in BILIARY TRACT Stones

Answer 22

1. Stone in CBD
2. MIRIZZI Syndrome

Question 23

GRADING of JAUNDICE

Answer 23

Question 24

Medical JAUNDICE

Answer 24

Prehepatic JAUNDICE
Or
Hemolytic Jaundice

Question 25

Surgical JAUNDICE

Answer 25

Posthepatic
(OR)
OBSTRUCTIVE JAUNDICE

Question 26

Differences BETWEEN Prehepatic, Hepatic and OBSTRUCTIVE JAUNDICE

Answer 26

Question 27

Inherited UnConjugated Hyperbilirubinemia
🧠⚡Can Grow ⚡

Answer 27

Crigle Najjar Syndrome
Gilbert Syndrome

Question 28

Inherited Conjugated Hyperbilirubinemia
🧠⚡DR ⚡

Answer 28

Dubin Johnson Syndrome
Rotor Syndrome

Question 29

Conjugated Hyperbilirubinemia

Answer 29

Question 30

Intra-Hepatic Cholestasis

Answer 30

Obstructive ➡️ Space occupying lesion of LIVER

Non-Obstructive ➡️
1. 1deg BILIARY CIRRHOSIS
2. Progressive Familial Intrahepatic CHOLESTASIS
3. Intra-Hepatic cholelithiasis of Pregnancy
4. Drugs: OCP