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GI, liver, kidney > Jaundice > Flashcards

Jaundice Flashcards

1
Q

When is clinical jaundice often visible?

A

> 35 micomols/L
Normal - 3-20

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2
Q

What drugs can cause pre hepatic jaundice?

A

Methyldopa, sulfasalazine (5 ASA)

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3
Q

What haemolytic anaemias can cause pre hepatic jaundice?

A

Sickle cell
THalassaemia
Herediatary spherocytosis
Glucose-6-phosphate dehydrogenase deficiency
Haemolytic uraemic syndrome

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4
Q

What are haemolytic uraemic syndrome?

A

Group of blood disroders characterised by low red blood cells, acute kidney failure, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness

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4
Q

What are haemolytic uraemic syndrome? Initial symptoms?

A

Group of blood disroders characterised by low red blood cells, acute kidney failure, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness

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5
Q

What causes Gilbert syndrome?

A

Autosomal recessive condition causing defective bilirubin conjugation due to deficiency of UDP glucuronyl transferase

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6
Q

Gilbert vs Criggler najjar syndrome cause

A

Gilbert - mutation in promoter seuquence for UDP - enzyme functional but fewer
Criggler najjar - mutation in coding for enzyme itself - all UDPs non functional or minimal activity

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7
Q

Which is dangerous, criggler najjar or gilbert

A

CN - can cause neonatal death due to unconjugated hype bilirubinemia
Gilbert does not need treatment

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8
Q

Which is dangerous, criggler najjar or gilbert

A

CN - can cause neonatal death due to unconjugated hype bilirubinemia
Gilbert does not need treatment

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9
Q

Do malaria and severe rhabdomyolysis cause pre, hepatic or post jaundice?

A

Pre hepatic

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10
Q

What drugs cause intra hepatic jaundice

A

Isoniazid, rifmapicin
Pyrazinamide (antibiotic)
Paraceetemol overdose

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11
Q

Autoimmune disorders causing intrahepatic jaundice

A

Primary biliary chooangitis, autoimmune hep

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12
Q

Other causes of hepatic jaundice

A

Alcohol
NAFLD
Viral hepatitis A-4, CMV, EBV
Leptospirosis - blood infection from animals
Liver malignancy
Wilsons disease

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13
Q

Drugs causing post hepatic jaundice

A

Co-amoxiclav, flucloxacillin, COCP, HRT, corticosteroids

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14
Q

WHat structural issues can cause post hepatic jaundice?

A

Gallstones
Surgical strcitures
Biliary atresia
Malignancy = cholangiocarcinoma, extrahepatic malignancy

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15
Q

What type of jaundice does primary sclerosing cholangitis cause?

A

Post hepatic

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16
Q

How can pregnancy cause jaundice?

A

Cholestasis - post heoatc

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17
Q

What jaundice do both parasitic infections and pancreatitis cause?

A

Post hepatic

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18
Q

Blood tests in jaundice

A

ALT
AST
Bilirubin
GGT
ALP
albumin
Clotting
FBC incl reticulocyte count and blood smear - haemolysis
LDH

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19
Q

Hwo screen for heamolysis in jaundce

A

Blood smear in FBC
LDH is increased

20
Q

How does stool and urine appear in pre hepatic jaundice?

A

Normal

21
Q

Which jaundice types do urine appear dark and stool pale?

A

Hepatic and post hepatic

22
Q

Which type of jaundice is ALP normal in?

A

Pre
Hepatic and post = raised

22
Q

Which type of jaundice is ALP normal in?

A

Pre
Hepatic and post = raised

23
Q

Which type of jaundice is unconjugated bilirubin normal in?

A

Post hepatic

24
Q

What test for in hepatitis serology

A

ANA
AMA
ASMA
Immunoglobulins

24
Q

What test for in hepatitis serology

A

ANA
AMA
ASMA
Immunoglobulins
Viral serology hep A,B,C,E and CMV
Monospot test for EBV
Alpha fetoprotein
Caerolplasmin
Alpha 1 antirypsin

25
Q

What can cause raised IgM?

A

Autoimmune disease, OBC, chronic infection

26
Q

Which immunoglobulin is raised in acute hepatitis?

A

IgG

27
Q

How test for CMV

A

Monospot

28
Q

What condition is ANA and AMA raised in?

A

Primary biliary cholangitis

29
Q

What is ASMA raised in?

A

Autoimmune hepatitis

30
Q

What does alpha fetoprotein test for?

A

hepatocellular carcinoma

31
Q

How do you test for Wilsons disease?

A

Caeruloplasmin

32
Q

What urinary result is suggestive of obstructive jaundice?

A

Increased urinary bilirubina
Decreased urobilinogen

33
Q

What urine result is suggestive of hepatocellular failure or increased RBC breakdown?

A

Increased urinary bilirubin AND urinobiligen

34
Q

Imaging investigations jaundice

A

Abdo US
CT abdo
MRCP
Liver biopsy, laporotmy

34
Q

Imaging investigations jaundice

A

Abdo US
CT abdo
MRCP
Liver biopsy, laporotmy

35
Q

What is bilirubin

A

Breakdown product of haem molecules in red blood cells and other proteins eg myoglobin

36
Q

What happens to bilirubin in th eliver?

A

Itws conjugated - excreted in bile

37
Q

When does birlirubin become soluble?

A

When its conjugated

38
Q

What happens to haem moleculaes in the spleen and liver?

A

Degraded by biliverdin within macrophages to unconjugated bilirubin, bound to plasma albumin and transported to liver

39
Q

What happens to bilirubin after the liver?

A

Through liver and cystic ducts in bule, stored in gallbladder or duodenym
Bilirubin is excreted in stool as sterconibilonegne

40
Q

What happens to conjugated bilirubin that is not excreted?

A

Rest metabolised by gut flora into urobilinogen - reabsorbed and excreted by kdinedys

41
Q

Clinical features of jaundice

A

Fetor hepaticus - sweet breath
Asterixis/hepatic flap
Constructional apraxia
Hypoglycaemia
Bleed and bruising
Hepatomegaly
Ascites

42
Q

Grading for encephalopathy

A

0 - no change
1 - decreased awareness and attention, euphoria or anxiety
2 - lethargy, apathy, minimal disorientation, subtle personality change, innaprropriate behaviour
3 - somnolence -> stupor
Responseive - verbal stimuli, confusion, gross disorientation

43
Q

Complications of liver failure

A

Cerebral oedema
Hypotension
Hypoglycaenua
Hepatorenal syndrome
Sepsis
Seizures
ARDS

44
Q

What serum bilirubin suggests acute liver failure

A

> 300

45
Q

DAMN drugs

A

Diuretics
ACEis/ARBs
Metformin
NSAIDs

GI, liver, kidney (50 decks)

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