Flashcards in Jaundice Deck (48)
where is haemoglobin broken down?
What breaks down haemoglobin in the spleen?
What is haem broken down into?
What is biliverden converted to?
How is bilirubin carried to the liver?
What conjugates bilirubin in the liver?
In the small intestine what do bacteria convert bile to?
How does the liver get rid of conjugated bilirubin?
urobilinogen is _____ to form urobilin which gives faeces its brown colour
Some urobilinogen is reabsorbed and then re-excreted by the kidney. This does what to urine?
causes it to be yellow
Prehepatic jaundice is caused by?
the haemolysis of RBCs
Examples of conditions causing pre-hepatic jaundice?
haemolytic anemias, new born jaundice
Jaundice from pre-hepatic causes is usually...?
Blood tests would show what levels of conjugated and unconjugated bilirubin in pre-hepatic jaundice?
normal conjugated, raised unconjugated (saturated enzyme)
clinical features that may present with pre-hepatic jaundice?
anemia, splenomegaly, gall stones
Potential causes of hepatic jaundice?
hepatitis, hepatotoxicity, cirrhosis, congenital disorders
What two possibilities are the cause of hepatic jaundice (pathophysiological processes)?
1. disruption in the ability to uptake or conjugate bilirubin 2. oedema of the hepatocytes causing intrahepatic obstruction of the bile ducts
Causes of disruption in ability to conjugate bilirubin in hepatic jaundice
reduced UDP enzyme: leads to increased unconjugated bilirubin but otherwise normal LFTs (Gilbert syndrome)
Intrahepatic obstructive jaundice would potentially cause what blood abnormalities?
raised unconjugated and conjugated bilirubin - highest being conjugated as it is an obstructive issue
LFTs in hepatic jaundice may show?
very raised AST and raised ALT, slightly raised GGT and ALP
A low albumin in hepatic jaundice indicates?
ongoing chronic condition
What is the process behind extrahepatic jaundice?
obstruction of bile drainage through the biliary system
Main causes of extrahepatic jaundice?
gallstones, cancer of the head of the pancreas
Hepatic jaundice may cause what changes to stools and urine?
Depending on obstruction may have paler stools and darker urine. depends on level and is not a diagnostic indicator
Extrahepatic jaundice causes what changes to stools and urine? why?
pale stools and dark orange urine. Conjugated bilirubin isnt getting into the gut to be oxidised but may be excreted by the kidneys
Blood results concerning bilirubin in extrahepatic jaundice?
normal unconjugated and increased conjugated as there is normal liver function, just issues in excretion.
LFTs in extrahepatic jaundice?
slightly raised AST, ALT, ALP and GGT - more from back pressure through the biliary system than liver issues
A history involving country of origin might point to what causes of jaundice?
Hep B and Hep C
A history involving duration of illness might point to what causes of jaundice?
1. prolonged, weight loss - malignancy 2. short, prodromal - hepatitis