Pathophysiology Flashcards

1
Q

Jaundice?

A

Jaundice is due to excessive accumulation of bilirubin in tissues.

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2
Q

Metabolism of bilirubin - production of unconjugated bilirubin?

A

RBCs are broken down by macrophages in the spleen; haemoglobin-> iron and unconjugated bilirubin (travels to liver bound to albumin).

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3
Q

Metabolism of bilirubin - conjugation of bilirubin?

A

Liver hepatocytes uptake unconjugated and add it to glucoronate.

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4
Q

Metabolism of bilirubin - excretion?

A

Conjugated bilirubin is secreted into the bile canaliculi, flows with bile to duodenum.

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5
Q

Prehepatic jaundice?

A

too much production of bilirubin.

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6
Q

Hepatic jaundice?

A

problems affecting hepatocytes or bile canaliculi.

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7
Q

Post-hepatic jaundice?

A

problem with biliary flow

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8
Q

Obstructive jaundice?

A

lack of bile flow into the gut, manifests as pale faeces and dark urine.

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9
Q

Cholestatic jaundice?

A

bilirubin not flowing out via the common bile duct

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10
Q

Unconjugated jaundice?

A

can be excess production of unconjugated bilirubin or decreased capacity to conjugate it.

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11
Q

Conjugated jaundice?

A

posthepatic jaundice is always conjugated.

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12
Q

Increased production of bilirubin?

A

Intravascular haemolysis; might find black urine and schistocytes on the blood film.

Congenital causes; G6PDH deficiency, pyruvate kinase deficiency, sickle cell disease.

Acquired causes; artificial heart valves, blood group mismatch, disseminated intravascular coagulopathy, malaria.

Extravascular haemolysis; may find splenomegaly and spherocytes on a blood film.

Congenital causes; hereditary spherocytosis.

Acquired causes; autoimmune haemolysis.

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13
Q

Decreased conjugation of bilirubin?

A

Reduced hepatocyte uptake; cholecystographic contrast agents, portosystemic shunts to bypass a cirrhotic liver.

Congenital enzymatic problems; Gilberts syndrome.

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14
Q

Decreased excretion of bilirubin?

A

(pale faeces, dark urine)

Acquired causes; INVITED MD

Infection; hepatitis, ascending cholangitis, liver abscess, tapeworm infection.

Neoplasia; hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, liver metastases.

Vascular; Budd-Chiari syndrome (thrombosis in a hepatic vein).

Inflammation; primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, pancreatitis.

Trauma; gallstones, stricture.

Endocrine; intrahepatic cholestasis of pregnancy.

Degenerative – none.

Metabolic; Wilson’s disease, haemochromatosis.

Drugs; alcohol, paracetamol, sodium valproate, rifampicin.

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