Jaundice TBL

Question 1

what is jaundice?

Answer 1

clinical sign - visible with eyes
yellow sclera - occurs earlier than anywhere else so best indicator
clinically apparent bilirubin in the skin/eyes
clinically apparent hyperbilirubinaemia
Usually spotted at around 40 mmol of bilirubin
normal range = 17-21 mmol

Question 2

what is liver failure?

Answer 2

abnormalities of bilirubin and prothrombin time

also presents with ascites and encephalopathy

Question 3

what are the liver function tests?

Answer 3

bilirubin, albumin, prothrombin time

main functions of the liver

Question 4

what are the liver damage tests?

Answer 4

Alkaline phosphatase, Alanine amino transferase (ALT), gamma glutamyl transferase (GGT)
All go up in liver damage
(other things like alcohol and drugs can increase GGT)

Question 5

what are cholestatic LFTs?

Answer 5

ALT, bilirubin, albumin, prothrombin time not associated with gall bladder
Cholestatic tests = alkaline phosphatase and GGT as related to biliary system rather than liver tissue

Question 6

What are hepatitic or hepatocellular LFTs?

Answer 6

ALT

enzyme component of hepatocytes so released when hepatocytes die

Question 7

what is the normal range for bilirubin?

when does it become detectable

Answer 7

17-21

>40 usually

Question 8

Hepatic/hepatocellular damage?

Answer 8

increased ALT and AST

normal alk phosphate and GGT (maybe little rise)

Question 9

cholestatic problem?

Answer 9

normal ALT and AST (maybe a little raised)

alk phosphate and GGT raised?

Question 10

liver screening components?

Answer 10

FBC
Us & Es
clotting
LFTs
liver immunology
serum selenium
HBV and HCV alpha 1 antitrypsin ..........

Question 11

Painless jaundice?

Answer 11

pancreatic carcinoma

Question 12

what investigation for suspected pancreatic cancer?

Answer 12

CT abdomen
detects cancer and stages it
(ERCP now more reserved for therapy)

Question 13

investigation for a dilated bile duct?

Answer 13

ERCP (as already know whats there so acts as therapeutic intervention)
(liver biopsy contraindicated in obstructive disease)

Question 14

investigation for non-dilated bile duct?

Answer 14

liver biopsy
(no indication of obstruction so biopsy is safe)

Question 15

19 yr old girl
jaundice
tired
nauseus
not itchy
normal stools
dark urine
no PMH
mother hypothyroid
high ALT, bit high ALk Phos, high ....., high bilirubin

Answer 15

hepatocellular jaundice (as ALT increase more than other 2)
Autoimmune hepatitis (FH of autoimmune disease)
investigate via liver biopsy (if non-dilated bile duct)
treated with prednisolone and azathioprine

Question 16

mixed cholestatic and hepatocellular?

Answer 16

ALT, Alk phos and GGT all raised by same amount

Question 17

unconjugated bilirubin urine?

Answer 17

normal colour

Question 18

conjugated bilirubin problem urine?

Answer 18

dark