Jaundice Flashcards
3 main causes of liver disease in the UK?
Alcohol
Viral hepatitis
NASH
When is jaundice usually detectable? (what level of bilirubin?)
Bilirubin >60umol/l
What signs might you see on examination of a jaundiced patient?
Palmar erythema Clubbing Leuconychia Telangiectasia Gynaecomastia Dupuytren's contracture Loss of muscle bulk Oedema/ascites Encephalopathy Liver bruits Abdominal masses: liver, splenomegaly, gall-bladder
What are the pre-hepatic causes of jaundice?
Unconjugated hyperbilirubinaemia
Increased urobilinogen
Gilbert’s syndrome
Haemolysis (e.g. sickle cell, spherocytosis, thalassemia major).
What are the hepatic causes of jaundice?
Viral hepatitis- B and C Alcoholic cirrhosis/hepatitis Primary biliary cirrhosis Drug induced jaundice Autoimmune hepatitis Non-alcoholic hepatitis Cryptogenic
What are the post-hepatic causes or jaundice?
(OBSTRUCTIVE)
Stones
Strictures
What blood tests would you do to investigate hepatic jaundice?
HBsAg Anti-HCV Ferritin Caeruloplasmin (for Wilson's disease) alpha-1-antitrypsin Autoantibodies/Igs (smooth muscle antibody for autoimmune hepatitis)
How do we define acute liver failure?
Development of encephalopathy and coagulopathy within 12 weeks of onset of jaundice, in the absence of pre-existing liver disease.
What are common causes of acute liver failure?
Paracetamol
Acute viral hepatitis (A, B, E)
Idiosyncratic drug reactions (isoniazid, phenytoin, sulphonamides, PTU)
What is the only successful treatment for acute liver failure?
Transplantation
What is Gilbert’s syndrome?
A congenital hyperbilirubinemia, in which there is reduced activity of glucuronyltransferase, the enzyme that usually conjugates bilirubin in the liver.
