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ANKI GI > [38] Jaundice > Flashcards

[38] Jaundice Flashcards

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1
Q

What is the normal range of bilirubin?

A

3-17uM

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2
Q

At what bilirubin level is jaundice visible?

A

50uM

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3
Q

How is bilirubin produced?

A

Unconjugated bilirubin (uBR) is produced from the breakdown of haemoglobin by splenic macrophages

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4
Q

What happens to uBR produced by splenic macrophages?

A

It is converted to conjugated bilirubin (cBR) by BR-UDP-glucuronyl transferase in the liver

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5
Q

What happens to cBR after it has been produced in the liver?

A

It is secreted in the bile, then converted into urobilinogen

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6
Q

What colour is urobilinogen?

A

Colourless

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7
Q

What happens to urobilinogen in the GIT?

A

Some is reabsorbed

The urobilinogen that remains in the GIT is converted to stercobilin and excreted

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8
Q

What colour is stercobilin?

A

Brown

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9
Q

What happens to the urobilinogen that is reabsorbed into the liver?

A

It is returned to the liver and re-excreted into bile or urine

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10
Q

What causes pre-hepatic jaundice?

A

Excess bilirubin production

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11
Q

What can cause excess bilirubin production?

A

Haemolytic anaemia

Ineffective erythropoiesis

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12
Q

Give an example of something that can cause ineffective erythropoiesis

A

Thalassaemia

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13
Q

What are the categories of hepatic jaundice?

A

Unconjugated

Conjugated

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14
Q

What causes unconjugated hepatic jaundice?

A

Decreased bilirubin uptake

Decreased bilirubin conjugation

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15
Q

What can cause decreased bilirubin uptake?

A

Drugs

CCF

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16
Q

Give 2 examples of drugs that can cause decreased bilirubin uptake

A

Contrast

Rifampicin

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17
Q

What can cause decreased bilirubin conjugation?

A

Hypothyroidism
Gilbert’s
Crigler-Najjar

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18
Q

What causes neonatal jaundice?

A

Increased production and decreased conjugation of bilirubin

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19
Q

What causes conjugated hepatic jaundice?

A

Hepatocellular dysfunction

Decreased hepatic bilirubin excretion

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20
Q

What are the categories of causes of hepatocellular dysfunction leading to conjugated hepatic jaundice?

A 
Congenital 
Infection
Toxin
Autoimmune
Neoplasia
Vascular
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21
Q

What are the congenital causes of hepatocellular dysfunction?

A

Heriditary haemochromotosis
Wilson’s
Alpha 1 anti-trypsin deficiency

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22
Q

What are the infectious causes of hepatocellular dysfunction?

A

Hepatitis A/B/C
CMV
EBV

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23
Q

What are the toxic causes of hepatocellular dysfunction?

Study These Flashcards
A

Alcohol

Drugs

24
Q

What are the autoimmune causes of hepatocellular dysfunction?

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A

Autoimmune hepatitis

25
What are the neoplastic causes of hepatocellular dysfunction?
Hepatocellular carcinoma | Mets
26
What are the vascular causes of hepatocellular dysfunction?
Budd-Chiari
27
What are the causes of decreased hepatic bilirubin excretion?
Dubin-Johnson | Rotor's
28
What causes post-hepatic jaundice?
Obstruction
29
What can cause obstruction leading to post-hepatic jaundice?
``` Stones Pancreatic cancer Drugs PBC PSC Biliary atresia Choledochal cyst (wtf is this????) Cholangiocarcinoma ```
30
What are the mechanisms of drug-induced jaundice?
Haemolysis Hepatitis Cholestasis
31
What drug causes jaundice through haemolysis?
Antimalarials, e.g. dapasone
32
What drugs cause jaundice through causing hepatitis?
``` Paracetamol (in overdose) Rifampicin, isoniazis, pyramizide (idk how you spell it, its the TB one) Valproate Statins Halothene MOAIs ```
33
What drugs cause jaundice through causing cholestasis?
``` Fluclox Co-amox OCP Sulphonylureas Chlopromazine Prochloperazine ```
34
What is Gilbert's syndrome?
Partial UDP-GT deficiency
35
What is the inheritance pattern of Gilbert's syndrome?
Autosomal dominant
36
What % of the population have Gilbert's syndrome?
2%
37
When does jaundice occur in Gilbert's syndrome?
During intercurrent illness
38
How is a diagnosis of Gilbert's syndrome confirmed?
Increased unconjugated bilirubin on fasting | Normal LFTs
39
What is Crigler-Najjar syndrome?
Rare condition with total UDP-GT deficiency
40
What is the inheritance pattern of Crigler-Najjar syndrome?
Autosomal recessive
41
What does Crigler-Najjar syndrome result in?
Severe neonatal jaundice | Kernicterus
42
How is Crigler-Najjar syndrome managed?
Liver transplant
43
What is found on urine testing in pre-hepatic jaundice?
No bilirubin | Increased urobilinogen
44
When is increased Hb seen in urine testing in pre-hepatic jaundice?
If intravascular haemolysis
45
What will be found on LFTs in pre-hepatic jaundice?
Increased uBR Increased AST Increased LDH
46
What other tests should be done in pre-hepatic jaundice?
FBC and film Coombs test Hb electrophoresis
47
What is found on urine testing in hepatic jaundice?
Increased BR | Increased urobilinogen
48
What is found on LFTs in hepatic jaundice?
``` Increased cBR Increased AST and increased ALT Increased ALP Decreased albumin Increased prothrombin time ```
49
What does a AST:ALT ratio of >2 indicate is the cause of hepatic jaundice?
Alcohol
50
What does a AST:ALT ratio of <1 indicate is the cause of hepatic jaundice?
Viral
51
What does increased GGT indicate is the cause of hepatic jaundice?
Alcohol or obstruction
52
What other tests should be done in hepatic jaundice?
FBC Anti-SMA, LKM, SLA, and ANA Alpha1-AT, ferritin, and caeruloplasmin Liver biopsy
53
What may be found on FBC in hepatic jaundice?
Anaemia
54
What is found on urine testing in post-hepatic jaundice?
Greatly increased bilirubin | No urobilinogen
55
What is found on LFTs in post-hepatic jaundice?
Greatly increased cBR Increased AST and increased ALT Greatly increased ALP Increased GGT
56
What other investigations should be done in post-hepatic jaundice?
Abdominal US ERCP and MRCP Anti-AMA, ANCA, and ANA
57
What may be found on abdominal US in post-hepatic jaundice?
Ducts >6mm

ANKI GI (43 decks)

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