Jaundice Flashcards
Definition
Disease effecting the production of bilirubin
Classification
Pre-hepatic: affecting the production/transport of bilirubin
Hepatic: affecting the excretion, uptake and conjugation of bilirubin
Post-hepatic: affecting the transport of bilirubin
How is bilirubin produced?
Pre-hepatic
-It is formed from the splitting of hemoglobin in RBCs of the spleen
-Haem is then used to produce bilirubin which is released into circulation
Hepatic:
-Bilirubin is conjugated and taken up by hepatocytes
-Excreted into the hepatic system
Post-hepatic;
-taken to SI and broken down
-Recycled into liver using enteric-hepatic system
Causes of pre-hepatic jaundice
haemolysis - release of XS haemoglobin from RBC
Causes of hepatic jaundice
Cholestasis- inflammation of the bile duct
Intra-hepatic duct obstruction
Causes of post-hepatic jaundice
Extra hepatic duct obstruction
Cholethiasis=gall stones
causes of intra-hepatic bile obstruction
Primary biliary cholangitis
Primary sclerosis cholangitis
Secondary sclerosis cholangitis
Tumours of the liver
Symptoms
yellowing of the skin and conjunctivae Pallor of anaemia Pale stools Flapping tremor Ascites Abdominal pain Fatigue
History of a patient with pre-heptic jaundice
- anemia
- chest pain
- Fatigue
history of a patient with hepatic jaundice
- cld : e.g. spider nave, ascites…
- risk of liver disease e.g. drug intake, alcohol intake …
signs of patient with post-hepatic jaundice
- palpable gall bladder
- pale stool relating to cholesistitis
- Abdominal pain
investigation
Liver screen
- alpha-anti tripsin levels
- Ferritin/ transferrin saturation
- Hepatitis B/C serology
- Fasting glucose and lipid profile
Ultrasound
- Allows to differentiate between intra-hepatic and extra-hepatic obstruction
- Allows site of obstruction to be identified
ERCP
MRCP
Endoscopic ultrasound
Percutaneous transhepatic cholangiogram
