Jaundice

Question 1

How are red blood cells converted to Unconjugated bilirubin @ Spleen

Answer 1

RBC -> HAEM and Globin
HAEM -> BILIVERDIN and Fe
BILIVERDIN -> UNCONJ. BILIRUBIN

Question 2

How is Biliverdin converted to Unconj. Bilirubin

Answer 2

Biliverdin reductase

Question 3

What is a RBC broken down into

Answer 3

Haem and Globin

Question 4

What is haem broken down into

Answer 4

Biliverdin and Iron

Question 5

Biliverdin reductase converts what to what

Answer 5

Biliverdin to unconj.Bilirubin

Question 6

How does Unconj. Bilirubin travel to the liver

Answer 6

UCB binds to Albumin

Question 7

Where is UCB converted to Con Biliribuin

Answer 7

Liver

Question 8

How is UCB converted to Con B at the liver

Answer 8

UGT and Glucorinic Acid

Question 9

Which enzyme is used to convert UCB to Con Bilirubin w/ the addition of Glucorininc acid

Answer 9

UGT

-UDP Glucoronyl Transferase

Question 10

What does Con Bilirubin become at the colon

Answer 10

Urobilinogen by Colonic Flora

Question 11

How does Con Bilirubin travel to Colon to become Urobilinogen

Answer 11

Via CBD

Question 12

What are the two products of Urobilinogen at the colon

Answer 12

Stercobilin (Brown shit)

Urobilin (Yellow Piss)

Question 13

What is jaundice also known as

Answer 13

Icterus

Question 14

Why does jaundice present as yellowed skin and eyes

Answer 14

Accumulation of UCB and Con bilirubin

Question 15

What are the three types of causes for jaundice

Answer 15

Pre hepatic (Haemolytic anaemia)
Hepatic (Parenchymal disease)
Post Hepatic (Billiary obstruction)

Question 16

Pre hepatic jaundice is due to raised…….

Answer 16

UCB due to RBC Breakdown (Haemolytic)

Question 17

Intrahepatic jaundice is due to raised……

Answer 17

UCB and Con Bilirubin

Question 18

Post hepatic Jaundice is due to raised…..

Answer 18

Con Bilirubin due to Biliary obstruction

Question 19

What are some anaemias responsible for Prehepatic jaundice

Answer 19

Haemolytic

• SCD and Malaria
• G6PDH deficiency
• Autoimmune
• Thalassemia

Question 20

What are some parenchymal diseases responsible for Intrahepatic Jaundice

Answer 20

HCC
ALD/NAFLD
Hepatitis 
Rifampicin
Gilbert syndrome

Question 21

What is Gilbert Syndrome

Answer 21

Aut Recessive mutation of the UGT1A1 gene

-Defective UGT = Less Con Bilirubin

Question 22

In Gilbert syndrome less Con Bilirubin is produced why

Answer 22

Mutated UGT1A1 gene = Defective UGT

Question 23

What is the most common sign of Post hepatic Jaundice

Answer 23

Pale stool

Dark Urine

Question 24

What are some Biliary tree pathologies responsible for Post hepatic Jaundice

Answer 24

Choleodocolithiasis (Stone in CBD)
Pancreatic cancer
Cholangiocarcinoma
Ampicillin
PBC and PSC
Mirizzi Syndrome

Question 25

What is Mirizzi syndrome

Answer 25

Gallstones in Gallbladder neck compressing the CBD

Question 26

Why is there dark urine and pale stools in post hepatic/obstructive jaundice

Answer 26

Increased Con Bilirubin in blood / less in Intestine - Sterocobilin (Pale) - Urobilin (Dark)

Question 27

What is the typical presentation of a patient with Gilbert syndrome

Answer 27

Young male with painless, sudden jaundice

Question 28

What is the Courvoisier sign in Jaundice

Answer 28

Painless jaundice w/ Palpable Gallbladder | -Most likely Pancreatic Cancer/Cholangiocarcinoma

Question 29

What is the Charcot's triad

Answer 29

Fever RUQ pain Jaundice

Question 30

Bilary colic presents with what symptom found in the Charcot's triad

Answer 30

RUQ pain

Question 31

What triad is present in a patient with Ascending cholangitis

Answer 31

Charcot (Fever RUQ Jaundice)

Question 32

How can you differentiate a patient with cholecystitis and Ascending Cholangitis

Answer 32

Cholecystitis has no jaundice

Question 33

What is the Reynold Pentad

Answer 33

Ascending Cholangitis - Fever - RUQ Pain - Jaundice - Confusion - Hypotension

Question 34

What is the Murphy sign

Answer 34

Tender RUQ | "breathe while pressing RUQ" Pain = Cholecystitis

Question 35

How can Jaundice be investogated

Answer 35

Blood and LFT Urine Bilirubin/Urobilinogen USS

Question 36

Urine bilirubin is raised in what instance

Answer 36

Post hepatic Jaundice

Question 37

Urobilinogen is raised and lowered in what instances

Answer 37

``` Raised = Haemolysis Low = Intra and Post Hepatic ```