OnlineMedEd: Gastroenterology - "Jaundice"

Question 1

Go through the order of yellowing in jaundice.

Answer 1

• First: sublingual mucosa
• Second: ears
• Third: sclera
• Fourth: skin

Question 2

Haptoglobin binds to _______________.

Answer 2

hemoglobin

Question 3

The rate-limiting step of conjugation is ______________.

Answer 3

2,3-UDP glucuronyltransferase

Question 4

Review the three categories of jaundice and some causes of each.

Answer 4

•Prehepatic (unconjugated bilirubinemia):

• Hemolysis (G6PD deficiency, hereditary spherocytosis)
• Resorption of a hematoma

•Intrahepatic (unconjugated or conjugated bilirubinemia):

• Gilbert’s (unconjugated)
• Crigler-Najjar (unconjugated)
• Rotor’s (conjugated)
• Dubin-Johnson (conjugated) –black liver!!
• Hepatitis (mixed)

•Posthepatic (conjugated bilirubinemia):

• Gallstones (which will be painful)
• Cancer (which will be painless)
• Strictures (which will be painless)
• Biliary atresia (in an infant)

Question 5

How can you use the history to figure out if the jaundice is conjugated or unconjugated?

Answer 5

•”Is your urine dark?”

- Dark urine means conjugated bilirubinemia.