65. Jaundice Flashcards Preview

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Flashcards in 65. Jaundice Deck (22):
1

jaundice ?

abnormal yellowing of skin and / or sclera due to bilirubin deposition

2

mechanism of jaundice

hyperbilirubinemia 2ry to increased production or decreased disposition ( impaired hepatic uptake, conjugation, excretion )

3

bilirubin levels
total:
direct:
indirect:
jaundice:

total: 0.1-1 mg/dL
direct: 0-0.3 mg/dL
indirect: 0.2-0.7 mg/ dL
jaundice: more than 2.5 mg /dL

4

jaundice types according to bilirubin

1. uncojugated ( indirect) hyperbilirubinemia
2. cojugated ( direct) hyperbilirubinermia
3. mixed ( direct and inderect) hyperbilirubinemia

5

causes of uncojugated ( indirect) hyperbilirubinemia

1. hemolytic
2. physiology
3. Cringler Najjar
4. Gilbert syndrome

6

causes of cojufated ( direct) hyperbilirubinemia

1. Biliary tract obstruction ( gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke)
2. Biliary tract disease ( 1ry sclerosing cholangitis, 1ry biliary cirrhosis)
3. excretion defect ( Dubin - Johnson syndrome, Rotor syndrome)

7

causes of mixed ( direct and indirect ) hyperbilirubinemia

1. Hepatitis
2. Cirrhosis

8

• Is the hyperbilirubinemia of an intrahepatic process (such as hepatitis or cirrhosis) conjugated, unconjugated, or mixed?

This is mixed (direct and indirect) hyperbilirubinemia

9

• Lab results show high direct and indirect bilirubin levels. Is this process conjugated, unconjugated, or mixed?

This is mixed (direct and indirect) hyperbilirubinemia

10

• Is the hyperbilirubinemia of biliary tract obstruction conjugated, unconjugated, or mixed?

This is conjugated (direct) hyperbilirubinemia

11

• Labs show high direct bilirubin and normal indirect bilirubin levels. What types of biliary disease process might cause this?

Obstructive processes such as primary sclerosing cholangitis or biliary cirrhosis (this is a conjugated [direct] hyperbilirubinemia)

12

• A 5-day-old infant has persistent hyperbilirubinemia despite phototherapy. Is it likely conjugated, unconjugated, or mixed?

This is unconjugated (indirect) hyperbilirubinemia, likely due to hemolysis

13

• Labs show high indirect bilirubin levels. Does this represent a conjugated, unconjugated, or mixed hyperbilirubinemia?

Unconjugated (indirect) hyperbilirubinemia

14

• A patient with Dubin-Johnson syndrome comes in to your office. What type of hyperbilirubinemia does she have?

Conjugated (direct) (Dubin-Johnson is a defect of bile excretion)

15

• A patient presents with Crigler-Najjar syndrome. What sort of hyperbilirubinemia does she have?

Unconjugated (indirect) (Crigler-Najjar is a defect of conjugation)

16

• Name some causes of an unconjugated (indirect) hyperbilirubinemia.

Hemolysis, physiologic (newborns), Crigler-Najjar syndrome, Gilbert syndrome

17

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to biliary tract obstruction.

Gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver flukes

18

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to biliary tract disease but are not obstructive.

Primary sclerosing cholangitis, primary biliary cirrhosis

19

• Name some causes of a conjugated (direct) hyperbilirubinemia that are due to bile excretion defects.

Dubin-Johnson syndrome, Rotor syndrome

20

• A newborn has persistent hyperbilirubinemia despite phototherapy. What type of bilirubinemia supports a diagnosis of Dubin-Johnson syndrome?

Conjugated hyperbilirubinemia (Dubin-Johnson is a defect of hepatic excretion of bile)

21

• What physiologic process is defective in patients with Dubin-Johnson syndrome?

Excretion of bilirubin from hepatocytes

22

• A patient has defective excretion of direct bilirubin. Gross pathology shows a black liver. Diagnosis?

Dubin-Johnson syndrome, which has the characteristic black liver on gross pathology

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