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Year 3 Conditions > Jaundice > Flashcards

Jaundice Flashcards

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1
Q

What are RBCs broken down into and each of their fates

A

Hb into unconjugated bilirubin that binds to albumin in blood
Iron stored in transferrin proteins

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2
Q

What is other name for conjugated bili

A

Glucuronate

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3
Q

What is conjugated bili converted to

A

Urobilinogen
Stercobilinogen
(colourless)

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4
Q

What are stercobilinogen and urobilinogen converted to

A

oxidised to stercobilin and urobilin

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5
Q

What does high conjugated bili in blood indicate about cause of jaundice

A

Obstructive

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6
Q

What does high unconjugated bili in blood indicate about cause of jaundice

A

Pre-hepatic and hepatic

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7
Q

Confusion over post hepatic and hepatic definitions

A

Post hepatic can include bilie canaliculi or it can be hepatic- confusion over PSC

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8
Q

What is cholestatic jaundice

A

Jaundice from obstruction of common bile duct

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9
Q

2 causes of cholestatic bile duct

A

Gallstones

Ileus of commmon bile duct- drug induced

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10
Q

Two categories of increased production of bili

A

Intra and extravacular in spleen

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11
Q

How can urine be dark in pre hepatic jaundice

A

Haemoglobin can be broken down an alternative route into haemosiderin which is very dark

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12
Q

How to confirm if jaundice pre hepatic

A

Blood film see schistocytes or spherocytes

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13
Q

Congenital causes of intravascular heamolysis

A

SCD
Thalassaemia
PK deficiency
G6PDH deficiency

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14
Q

Acquired causes of intravascular haemolysis

A

DIC
Blood group mismatch
Malaria
Artificial heart valves

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15
Q

Where does extravascular haemolysis occur

A

Spleen- macrophages nibble at blood cells causing spherocytes

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16
Q

How does intravascular haemolysis appear on blood film

A

Schistocytes

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17
Q

Examination finding of extravascular haemolysis

A

Splenomegaly

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18
Q

Congenital cause of extravascular haemolysis

A

Hereditary spherocytosis

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19
Q

Acquired cause of extravascular spherocytosis

A

AI haemolysis

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20
Q

What drugs can induce cholestasis of common bile duct

A

Co-amoxiclav, the pill, nitrofuarontin

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21
Q

What do fever and diarrorhoea indicatea bout jaundice cause

A

abcess or infection

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22
Q

What does steatorrhoea indicate about jaundice

A

Cholestatic

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23
Q

What do signs of diabetes indicate about jaundice

A

Haemochromatosis

Pancreatic insufficiency

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24
Q

Patient presents with liver problems and also polyuria and polydipsia

A

Haemochromatosis

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25
What does emphysema suggest about jaundice
Anti-trypsin
26
What drug can cause extravascular haemolysis
Methyldopa
27
What drug can cause intravascular aemolysis
Aspirin | Sulphonamides
28
Must asks in relation to jaundice
``` Sexual Travel All drugs Transfusions Tattoos ```
29
What happens to pulse pressure in dehydration
Narrow
30
What are signs of stable chronic liver disease
``` Spider naevi Clubbing Bruising Palmar erythema Gynaecomastia ```
31
What does RUQ tenderness indicate about jaundice
Gall bladder inflammations | Acute hepatitis
32
What to look for in FBC jaundice and further investigation if necessary
Anaemia suggesting haemolysis so do blood film
33
What to look for in levels of bilirubin
Elevated unconjugated bilirubin suggesting prehepatic | Elevated conjugated suggesting post hepatic
34
What does elevated AST and ALT suggest and further investigation
Viral serology | Autoantibodies screen- ASMA, AMA, ANA,ANCA
35
What does elevated GGT and ALP suggest and further investigation
Biliary tree problem so US biliary tree
36
First line investigations for jaundice
``` FBC LFTs Van der begh Urinalysis for bilirubin Serum amylase ```
37
Jaundice with high reticulocytes
Pre hepatic haemolysis
38
Microcytic anaemia with jaundice
Thalassaemia
39
When will you see ALT and AST in thousands
Ischaemic hepatitis Paracetemol OD Viral
40
Why cant use ALP exclusively
Produced in many other cells such as placenta and bones- use GGT as exclusive to biliary tree
41
How can bilirubin in urine appear
Brown
42
How is jaundice specific to pregnancy
Acute fatty liver HELLP syndrome Intrahepatic cholestasis
43
Secind line investigations for jaundice
Haemolysis screen Viral screen Autoimmune screen Congential screen
44
What would be tested in haemolysis screen for jaundice
Coombs- autoimmune haemolysis Blood film for spherocytes, reticulocytes and schistocytes Haptoglobins LDH
45
What would be tested for viral screen for jaundice
Hep A-C CMV HIV EBV
46
What would be tested for in autoimmune screen for jaundice
ANA- AIH ASMA- AIH AMA- PBC ANCA- PSC
47
What would be tested for in congenital screen for jaundice
Haemochromatosis- high ferritin, high transferrin sats Wilsons- high copper- low caeruplasmin Antitrypsin- low antitrypsin
48
What can be picked up by US of liver
``` Cancer Cirrhosis Cholangiocarcinoma Choledochal cyst Gallstone Vascular causes ```
49
If US isnt clear what do you use
MRCP CT Endoscopic US
50
What would consider if biliary outflow a problem but bile duct not dilated
Drugs PSC PBC
51
How long does it take albumin to drop and what are 3 causes
Nephrotic syndrome Reduced diet Liver synthesis problems
52
What is tested for in Hep B serology
Surface and core antigen anitbody Surface antigen Just surface suggests vaccine
53
Prognosis options for Hep B infection
Full recovery- self limiting however can persist in blood and if immunosuppressed can cause infection Chronic hep b Carrier status- asymptomatic carrier Fulminant Hep B- 0.5% get this but 80% mortality
54
Acute phase management of Hep B
Contact tracing partners and vaccinating them Safe sex Avoid toothbrush and razor shaving Minimise alcohol
55
Investigation findings for gilberts
Bilirubin lower than 100micros | Low conjugated bili
56
Management of gallstones
Ultrasound to prove gallstone but if unsure do MRCP | Most pass themselves but if are jaundiced do ERCP
57
What must be excluded in gallstones
Cholestytitis | Ascending cholangitis
58
How is cholecystitis differentiated from gallstones
Constant pain and fever
59
Treatment of cholecystitis
Abx Analgesia IV fluids Cholecystectomy after a few weeks when recovered
60
Management of ascending cholangitis
Blood cultures Close monitoring Abx broad spectrum ERCP to drain duct of pus
61
Pathophysiology of PBC
T cell destruction of biliary tree which results in speapage of contents
62
Imaging to confirm PBC and PSC
MRCP | If strongly suspected would do first before US
63
FBC finding of someone with cancer
Anaemia
64
First line imaging for pancreatic cancer
CT
65
Procedure to remove pancreatic cancer
Whipple
66
Jaundice with lethargy and tiredness
Haemolysis
67
What is risk of HIV infection in needlestick injury
0.3
68
Risk of Hep C infection in needlestick infection
3
69
Risk of Hep B infection after needlestick infection
30
70
How to differentiate between chronic and acute Hep B
Chronic will be IgG positve whereas acute IgM
71
Most common tumours causing obstructive jaundice
Pancreatic Lymph nodes at porta hepatis Cholangiocarcinoma much rarer
72
What is nutritional consequence of obstructice jaundice
Vit ADEK deficiency

Year 3 Conditions (33 decks)

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