Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine I > Approach to Patients with Jaundice and Interpretation of Liver Function Test > Flashcards

Approach to Patients with Jaundice and Interpretation of Liver Function Test Flashcards

1
Q

What are the clinical presentation of Jaundice?

A

Serum bilirubin >3mg/dL
First detected in the sclera, frenulum
Coca-cola/Tea-colored urine -> conjugated hyperbilirubinemia
Greenish shade –> prolonged elevation of bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is pseudojaundice and when do you see it?

A

yellowish discoloration of the skin but not the sclerae (other factors aside from hyperbilirubinemia)

Carotenoderma -> spares sclera
Intake of Quinacrine/Phenol exposure
Addison’s disease
Anorexia nervosa
Spray tanning products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the diagnostic considerations in jaundice?

A

Unconjugated hyperbilirubinemia = >80% B1
Conjugated hyperbilirubinemia = >50% B2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

WHat are the different causes of jaundice?

A

Isolated disorder of bilirubin metabolism
Liver diseases
Obstrution of bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

WHat are the 2 isolated hyperbilirubinemia cases?

A

Indirect Hyperbilirubinemia => DRugs, Inheritend conditions (Crigler Najar, Gilbert’s syndrome), ineffective EPOiesis, INC bilirubin production, hemolytic disorders

Direct Hyperbilirubinemia => Dubin Johnson & Rotor syndrom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

WHat are the different hemolytic disorders that can cause isolated indirect hyperbilirubinemia?

A

Familial: SPherocytosis, Sickle cell anemia, Thalassemia, G6PD def

Acquired: Microangiopathic hemolytic anemia, Paroxysmal nocturnal hemoglobinuria, Spur cell anemia, immune hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the different deficiencies due to ineffective erythropoiesis?

A

Cobalamin deficiency, Folate deficiency, Severe iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHat are the 2 causes of INC bilirubin production? Other causes?

A

Intravascular & Extravascular hemolysis

Other causes: Massive transfusion, resorption of hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

WHat are the diff conditions brought about by Intravascular & Extravascular hemolysis?

A

Intravascular hemolysis = Microangiopathic hemolytic anemia, Paroxysmal nocturnal hemoglobinuria

Extravascular hemolysis = Intrinsic RBC defect (G6PDD, Sickle cell dis, Membrane defects) & Extrinsic RBC defects (AIHA, Hypersplenism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the diff drugs that can cause isolated indirect hyperbilirubinemia?

A

Rifampin
Probenecid
Ribavirin
Proteas inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 3 conditions caused by decreased hepatic conjugation? WHat are its causes?

A

Crigler Najjar Type 1 = complete absence of UDPGT
Crigler Najjar Type 2 = Partial absence of UDPGT
Gilbert’s syndrome = reduced UDPGT activity-induced stress/fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

WHat are the causes of decreased clearance of bilirubin?

A

Intrahepatic = defects in transport conjugation, Intrahepatic cholestasis

Posthepatic = Extrahepatic cholestasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the diff conditions that cause defects in transport conjugation

A

Genetic diseases = Gilbert syndrome, Crigler Najar synd
HF= Congestive hepatopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the different conditions that causes intrahepatic cholestasis?

A

Hepatitis, Cirrhosis, Intrahepatic mass lesions, Primary biliary cirrhosis, Infiltative diseases, Cholestasis of pregnancy, Total parenteral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the diff conditions that causes extrahepatic cholestasis?

A

Choledochololithiasis, Cholangitis, Malignancy/Neoplasms, Biliary strictures, Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What conditions cause isolated direct hyperbilirubinemia? What are the cause of these?

A

Dubin-Johnson syndrome = defect in MRP2 gene
ROto Manahan syndrome = defect in OATP1B1 & OATP1B3 gene, absence of black pigments in liver biopsy (diff)

17
Q

WHat is affected in px with extrahepatic biliary obstruction?

A

DEC hepatic excretion -> Intraductal obstruction or Extraductal compression

18
Q

WHat are the diff diseases acquired in DEC hepatic excretion?

A

Familial: Dubin Johnson & Rotor syndorme
Acquired: Hepatits, Cirrhosis, Drug-induced

19
Q

What are the diff drugs that can induce DEC hepatic excretion?

A

Androgens
Oral contraceptives
CHlorpromazine
Erythromycin Estolate

20
Q

In evaluation of jaundice, what should be taken note in hx taking?

A

Chronology of jaundice (duration, episodic vs constant)
Presence of assoc symptoms
Hx of hematologic, liver, biliary pancreatic, cardiac dis or HIV
Meds hx
Alcohol & drug hx
Sexual hx
Travel hx

21
Q

In hx & PE how would u differentiate Intrahepatic & Extrahepatic causes of cholestasis?

A

Intrahepatic
- exposure to hepatits, drug ingestion, alcohol abuse, fam hx of cholestasis, stigmata f chronic liv disease

Extrahepatic
- presence or absence of: abdominal pain, rigors, severe weight loss, palpable gallbladder or pancreas
- prior biliary surgery

22
Q

What are the diff stigmata of chronic liver dis?

A

Spider nevi
palmar erythema
gynecomastia
caput medusae
Dupuytren’s contracture
alcoholic cirrhosis
parotid gland enlargement
testicular atrophy

23
Q

What is indicated if there is an elevation of ALT & AST?

A

Hepatocellular damage

24
Q

What is indicated if there is elevated GGTP level & albumin, PT INR?

A

Albumin, PTR INC = liver synthetic function
Elevated GGTP = biliary obstruction & hepatocellular damage, pancreatic disorders, MI, renal disease & DM

25
Q

What are the the 2 transminases that are important in determining hepatocellular function ?

A

Alanine aminotransferase = more specific for liver injury

Aspartate Aminotransferase = liver, heart, skeletal muscle, kidneys, brain, pancrease, etc.

26
Q

What are the diff enzymes used to determine cholestatic damage?

A

ALP = bile ducts, BONE, PLACENTA, INTESTINES
GGT = bile ducts, kidney, pancrease, intestines, PROSTATE

27
Q

What are non-hepatic causes of ALP elevation?

A

Bone dis
Chornic renal failure
lymphoma
malignancies
CHF
infection/inflammation

28
Q

What are the diff hepatobiliary causes of ALP & GGTP elevation & Elevated conjugated bilirubin?

A

Cholestasis, Bile duct obstruction, Primary biliary cirrhosis, Primary sclerosing cholangitis, Drug-induced, Sarcoidosis, Amyloidosis, Lymphoma, CF, Hepatic metastasis

29
Q

What is considered if albumin is LOW?

A

Malnutrition
Acute inflammation
Cirrhosis
NEPROTIC SYNDROME
Protein wasting enteropathies

30
Q

What are the 2 lab tests used to determine cholestatic pattern?

A

Fractionated levels of bilirubin
Elevation of ALP or GGT

31
Q

What should you do if ascites are present?

A

Ask for ultrasound w/ hepatic vein doppler

32
Q

What are additional lab tests done to determine cholestatic pattern?

A

If B1 is elevated
If mostly B2 seen
Biliary tract obstruction

33
Q

In px w/ jaundice, what condition can be considered if the px has abdominal pain with or after eating?

A

Choledocholithiasis

34
Q

In px w/ jaundice, what condition can be considered if the px has lightening of stool/darkening of urine ?

A

Post-hepatic obstruction

35
Q

What condition may be present with positive Murphy’s sign, RUQ pain, Elevated wbc ct, Biliary colic >6hrs

A

Cholecystitis

36
Q

What clinical signs are present in diagnosing Cholangitis?

A

INC transmainases, INC ALP
Charcot’s triad: fever, jaundice, RUQ pain
Reynold’s pentad: Charcot triad + DEC BP, sensorial changes, manifesation of severe cholangitis

Medicine I (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions