Clinical Conundrum

Question 0

where do RBC’s get broken down?

Answer 0

spleen, liver, bone marrow

Question 1

when RBC’s are broken down, the heme is acted upon by _____ which converts it to ___

Answer 1

heme oxygenase, Fe CO and Biliverdin

Question 2

bilirubin is created by the enzyme _____

Answer 2

biliverdin reductase

Question 3

how does bilirubin get transported through the blood?

Answer 3

by linking on to albumin

Question 4

in the liver, the enzyme ___ conjugates bilirubin making it ___

Answer 4

UDP glucuronosyl-transferase (UGT), hydrophilic

Question 5

enterohepatic circulation

Answer 5

the secretion and reuptake of bile

Question 6

unconjugated bilirubin is called:

Answer 6

indirect bilirubin

Question 7

conjugated bilirubin is called:

Answer 7

direct bilirubin

Question 8

someone with O blood type has anti ____ antibodies

Answer 8

A and B

Question 9

someone with an A blood type has anti ___ antibodies

Answer 9

B

Question 10

a thick meconium is associated with ___

Answer 10

cystic fibrosis

Question 11

in physiologic jaundice, what kind of bilirubin builds up in the baby?

Answer 11

unconjugated

Question 12

why does breast-feeding cause jaundice?

Answer 12

1. it has beta-glucoronidase, an inhibitor of glucoronidase 2. it increases the reuptake of unconjugated bilirubin

Question 13

other causes of jaundice in infants:

Answer 13

ABO incompatibility hypothyroidism-UGT needs thyroid hormone

Question 14

Crigler-Najjar syndrome type I

Answer 14

have no UGT

Question 15

Crigler-Najjar syndrome type II

Answer 15

have reduced amount of UGT

Question 16

Gilbert’s syndrome

Answer 16

reduced activity of UGT

Question 17

Dubin-Johnson

Answer 17

impaired canalicular export of conjugated bilirubin

Question 18

Rotor syndrome

Answer 18

impaired canalicular export of conjugated bilirubin

Question 19

what’s the problem with jaundice? (also disease name)

Answer 19

neurological defects (Kernicterus)

Question 20

if they have normal colored urine, the bilirubin is _____

Answer 20

unconjugated

Question 21

what is the main purpose of phototherapy?

Answer 21

convert the bilirubin to hydrophilic bilirubin so that the baby can pee it out

Question 22

scleral icterus

Answer 22

yellowing of the sclera due to jaundice

Question 23

at what level of bilirubin do people tend to look jaundiced?

Answer 23

2 or 3

Question 24

a high alkaline phosphatase level is associated with ___

Answer 24

a biliary problem

Question 25

prothrombin time is a measure of ____

Answer 25

clotting, and therefore function of the liver (liver makes clotting factors)

Question 26

if conjugated is > 1/3 of total, we have a _____

Answer 26

conjugated hyperbilirubinemia

Question 27

endoscopic retrograde cholangiopancreatography (ERCP)

Answer 27

put a catheter into the mouth and put in contrast to look back up to the biliary tree

Question 28

HIDA

Answer 28

tag the bilirubin

Question 29

Kasai procedure

Answer 29

carve out the biliary tree and connect a piece of the small intestine to it