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Flashcards in FN: Jaundice Deck (18):
1

Hb metabolism

1. Hb converted to unconjugate Bilirubin by splenic macrophages
2. uBR is conjugated by bilirubin UDP glucoronyl transferase in the liver
3. cBR is then secreted in bile and converted to urobilinogen (colourless)

2

Urobilinogen metabolism

1. Some urobilinogen is reabsorbed, returned to liver and excreted into bile
2. Some reabsorbed urobilinogen is excreted into the urine
3. The urobilinogen that remaines in the GIT is concerted to stercobilin (brown) and excreted

3

Pre-Hepatic causes if Jaundice

Excess BR production
􏰀 - Haemolytic anaemia
􏰀- Ineffective erythropoiesis
􏰁 e.g. thalassaemia

4

Hepatic causes of Jaundice unconjugated

1. ↓ BR Uptake
􏰀 Drugs: contrast, RMP 􏰀 CCF
2. ↓ BR Conjugation
􏰀 Hypothyroidism
􏰀 Gilbert’s (AD)
􏰀 Crigler-Najjar (AR)
3. Neonatal jaundice is both ↑ production + ↓ conjug.

5

Hepatic causes of Jaundice conjugated

Hepatocellular Dysfunction
􏰀 1. Congen: HH, Wilson’s, α1ATD
2. 􏰀 Infection: Hep A/B/C, CMV, EBV
3. 􏰀 Toxin: EtOH, drugs
4. 􏰀 AI: AIH
5. 􏰀 Neoplasia: HCC, mets
6. 􏰀 Vasc: Budd-Chiari

↓ Hepatic BR Excretion
􏰀 - Dubin-Johnson
􏰀 - Rotor’s

6

Post-Hepatic causes of Jaundice

Obstruction
􏰀 Stones
􏰀

7

Drug-induced Haundice and mechanism of causing jaundice

1. Antimalarials (e.g. dapsone)

2. Hepatitis caused by
- paracetamol OD
- RMP, INH, PZA
- Valproate
- Statins
- Halothane
- MAOIs

3. Cholestatsis
- Fluclox (may be weeks after Treatment)
- Co-amoxiclav
- OCP
- Sulfonylureas
- chlopromazine, prochlorperazine

8

Gilberts syndrome

􏰀 Auto dom partial UDP-GT deficiency
􏰀 2% of the population
􏰀 Jaundice occurs during intercurrent illness 􏰀

Dx: ↑ uBR on fasting, normal LFTs

9

Crigler-Najjar

- Rare auto rec total UDP-GT deficiency
- Severe neonatal jaundice and kernicterus
- Rx: liver Tx

10

Pre-hepatic Jaundice urine results

- No BR (acholuric)
- increased urobilinogen
- increased Hb if intravascular haemolysis

11

Pre-hepatic Jaundice LFTs show

- increased uBR
- Increased AST
- Increased LDH

12

Pre-hepatic jaundice other investigations

- FBC and film
- Coombs test
- Hb electrophoresis

13

Hepatic Jaundice Urine shows

Increased BR
- increased urobilinogen

14

Hepatic Jaundice LFTs shows

􏰀 ↑ cBR (usually)
􏰀 ↑AST:↑ALT
􏰁 >2=EtOH
􏰁 <1=Viral
􏰀 ↑ GGT (EtOH, obstruction)
􏰀 ↑ALP
􏰀 Function: ↓ albumin, ↑ PT

15

Hepatic Jaundice Other investigations

􏰀 - FBC: anaemia
- 􏰀 Anti- SMA, LKM, SLA, ANA
􏰀 - α1AT, ferritin, caeruloplasmin
- 􏰀 Liver biopsy

16

Post-Hepatic Jaundice Urine results

very high Bilirubin
No urobilinogen

17

Post-Hepatic Jaundice LFTs show

􏰀 ↑↑cBR
􏰀 ↑AST,↑ALT 􏰀 ↑↑ALP
􏰀 ↑GGT

18

Post-Hepatic Jaundice other investigations

􏰀 Abdo US: ducts >6mm
􏰀 ERCP, MRCP
􏰀 Anti- AMA, ANCA, ANA

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