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Clinical Alimentary System > 3.1. Liver + Biliary Tree Disease - Jaundice > Flashcards

3.1. Liver + Biliary Tree Disease - Jaundice Flashcards

1
Q

What are the 3 types of Jaundice?

A
  1. Pre-Hepatic (Haemolytic)
  2. Hepatic (Conjugative)
  3. Post-Hepatic (Cholestatic)
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2
Q

What is Pre-Hepatic (Haemolytic) Jaundice?

A

Pre-Hepatic = Jaundice caused by a problem in the blood, before it reaches the Liver

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3
Q

What is the cause of Pre-Hepatic (Haemolytic) Jaundice?

A

Haemolysis - The causes of Haemolytic Jaundice are that of Haemolytic Anaemia

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4
Q

What is Hepatic (Conjugative) Jaundice?

A

Hepatic = Jaundice caused by a problem within the Liver

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5
Q

What are the causes of Hepatic (Conjugative) Jaundice?

A
  1. An Uptake Problem
  2. A Conjugation Problem
  3. An Excretion Problem
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6
Q

What happens in an Uptake problem, causing Hepatic Jaundice?

A

The Hepatocytes cannot absorb the Bilirubin

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7
Q

What can cause a Conjugation problem, causing Hepatic Jaundice?

A
  1. Hepatitis
  2. Cirrhosis
  3. Drugs (Toxification)
  4. Pregnancy
  5. Recurrent Idiopathic Cholestasis
  6. Congenital Disorders:
    a) Gilbert’s Syndrome
    b) Crigler-Hajjar Syndrome
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8
Q

What can cause a Excretion problem, causing Hepatic Jaundice?

A
  1. Benign Recurrent Intrahepatic Cholestasis Syndromes

2. Progressive Familial Intrahepatic Cholestasis Syndromes

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9
Q

What is Post-Hepatic (Cholestatic) Jaundice?

A

Post-Hepatic = Jaundice caused by a problem in the Biliary Tree, after the Bile has left the Liver

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10
Q

What are the causes of Post-Hepatic (Cholestatic) Jaundice?

A
  1. Extrahepatic Cholestasis

2. Intrahepatic Cholestasis

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11
Q

What causes Extrahepatic Cholestasis, causing Post-Hepatic Jaundice?

A

A large obstruction of Bile Flow, at any point in the Biliary Tract distal to the Bile Canaliculi

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12
Q

What can cause Extrahepatic Cholestasis, causing Post-Hepatic Jaundice?

A
  1. Common Duct Stones
  2. Biliary Tract Carcinoma
  3. Biliary Stricture
  4. Sclerosing Cholangitis
  5. Pancreatic Carcinoma
  6. Pancreatic Pseudocysts
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13
Q

What causes Intrahepatic Cholestasis, causing Post-Hepatic Jaundice?

A

Failure of Bile Secretion into the Biliary Tree

The same as what causes Excretion Problems in Hepatic (Conjugative) Jaundice

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14
Q

What is the Pathology of Jaundice?

A

Due to the Aetiology there is an increase in the Concentration of Unconjugated Bilirubin in the Blood

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15
Q

What is Bilirubin?

A

A Break-Down Product of Old / Damaged Erythrocytes

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16
Q

What are the Clinical Features of all Jaundice?

A
  1. Hepatomegaly
  2. Splenomegaly
  3. Dark Urine
  4. Yellow Pallor
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17
Q

What is Hepatomegaly?

A

Enlargement of the Liver

18
Q

Why might Hepatomegaly occur in Jaundice?

A

Due to the potential altered functional ability of the Liver - Due to the Aetiology

19
Q

What is Splenomegaly?

A

Enlargement of the Spleen

20
Q

Why might Splenomegaly occur in Jaundice?

A

This indicates Portal Hypertension - common in patients with Chronic Liver Disease who also present with Jaundice

21
Q

Why does the Urine appear Darker in colour?

A

Due to the Increase in Unconjugated Bilirubin in the Blood, more is excreted at the Kidneys, changing the Urine colour

22
Q

Why does the Skin/Sclera appear Yellow in colour?

A

Due to the excess presence of Bilirubin in these areas

23
Q

What are some Clinical Features of Pre-Hepatic Jaundice?

A
  1. Anaemia

2. Acholuric Jaundice

24
Q

Why might Anaemia be present in a patient with Pre-Hepatic Jaundice?

A

As the Aetiology of Pre-Hepatic Jaundice is the same as the of Haemolytic Anaemia

25
Q

What is Acholuric Jaundice?

A

Jaundice without Bilirubinaemia

26
Q

Why might Acholuric Jaundice be present in a patient with Pre-Hepatic Jaundice?

A

As the Erythrocytes are being broken down, and there is not a back up of Bilirubin anywhere

27
Q

What are some Clinical Features of Hepatic Jaundice?

A
  1. Stigmata of Chronic Liver Disease
  2. Ascites
  3. Asterixis (Liver Tremor)
28
Q

What is Stigmata of Chronic Liver Disease?

A

Signs of Chronic Liver Disease, including:

  1. Spider Naevi
  2. Gynaecomastia
29
Q

Why might Ascites occur?

A

Due to the decomposition of the Liver

30
Q

Why might Asterixis (Liver Tremor) occur?

A

Due to the inability of the Liver to process Ammonia / Urea, and its effect on the Brain

31
Q

What is a major risk factor for Liver Disease?

A

Intra-Venous Drug Abusers (IVDA’s)

32
Q

What are some Clinical Features of Post-Hepatic Jaundice?

A
  1. A Palpable Gallbladder
  2. Abdominal Pain
  3. Cholestasis Signs
33
Q

What is a Palpable Gallbladder also known as?

A

Courvoisier’s Sign - This could also be due to Hepatomegaly / Pancreatic Carcinoma

34
Q

Why might there be Abdominal Pain in Post-Hepatic Jaundice?

A

Due to the increased pressure within the Liver

35
Q

What are Cholestasis Signs?

A
  1. Pruritus (Itching)
  2. Pale Stools
  3. Dark Coloured Urine
36
Q

What investigations are required for Jaundice?

A
  1. An Abdominal Ultrasound
  2. A Liver Screen
  3. A CT / MRI Scan
  4. An ERCP / MRCP
37
Q

What is the purpose of the Abdominal Ultrasound?

A

To look for the Site and Cause of a Blockage

38
Q

What is looked for in a “LIver Screen”?

A
  1. Hepatitis B and Hepatitis C Serology
  2. An Autoantibody profile, in the form of Immunoglobulins
  3. Alpha-1-Antitrypsin
  4. Fasting Glucose and Lipid Profile
  5. Ferritin and Transferritin Saturations
  6. Caeruloplasmin and Copper
39
Q

What is the purpose of a CT / MRI scan?

A

To identify the cause of the Jaundice

40
Q

What is the purpose of the MRCP / ERCP?

A

To view what could be causing the blockage - if Post-Hepatic

41
Q

What does MRCP and ERCP stand for?

A

MRCP - Magnetic Resonance Cholangio-Pancreatography

ERCP - Endoscopic Retrograde Cholangio-Pancreatography

42
Q

What is the treatment of Jaundice?

A

Treat the Underlying Cause

Clinical Alimentary System (64 decks)

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