L8*-Jaundice Flashcards
(16 cards)
What is Jaundice in general ?
-yellow discolouration of the skin, eye and other tissues.
-Due to a build up of bilirubin in tissue fluids and bloodstream.
How do you know when liver disease is present ?
-look for the serological patterns by performing liver functions tests
-increased AST/ALT
-increased AP/gGT
What would happen to serum albumin levels when liver disease is present ?
They would decrease bc in liver disease the functional hepatic cells(hepatocytes) 👇se. and Albumin is made in hepatocytes.
How do you diagnose and stage liver disease ?
Bilirubin levels
Liver enzymes (AST/ALT)
Hepatobiliary enzymes ( gGT, Alk Phos)
Albumin
Total protein
-Autoantibodies(by giving antibodies against the person) / Antibody titre
Haematology
Viral markers - elevated white cell counts bc of a problem in the liver
-Metabolic indicators - dyslipidaemia, Type II diabetes, insulin resistance so yeh liver disease.
-Tumour markers - tumour specific molecule called alpha beta protein is found originally in foetus, and as we grow the levels drop in the blood indicating liver cancer
-MRI scan or CT imaging - non invasive tests
-Fibro scan - bounce ultrasound off the liver - how fast it bounces back gives u an index of how scar the liver is.
-prothrombin time - liver makes the clotting factors, you can measure how quickly the blood clots which is called a prothrombin test.
Explain the metabolism of Bilirubin
-Bilirubin is a waste product from Haem catabolism (break down of RBCs).
-from red blood cells, myoglobin, cytochromes, peroxidases.
-need a lot of bile for excretion of substances and for digestion and we loose some through feal route so bile salts are recycled.
Name 3 types of Jaundice. Jaundice can be due to the liver or not.
- PreHepatic - Nothing to do with the liver
- IntraHepatic - liver plays role
- ExtraHepatic - after the liver, its liver related but its downstream.
Explain the 1st type of Jaundice.
- Pre-Hepatic - nothing to do with the liver, before the liver. Unconjugated bilirubin can damage the liver however the initial cause is not related to the liver.
Haem metabolism - macrophages are eating the red cells.
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increased Bilirubin (unconjugated bc not conjugated from the liver as it is not involved)
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Normal AST/ALT, Normal ALP/gGT
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Haemolysis-destruction of RBCs-something to do with the RBCs / Gilberts syndrome
Name the 1st example of prehepatic Jaundice, why is the haemolysis linked to jaundice ? also name liver symptoms in anaemias.
-sickle cell disease - genetic, variant forms of Hb present (Malaria)
-Haemolytic anaemia - red cell destruction
-PNS> Paroxysmal nocturnal haemaglobulinurea - genetic, fragile RBCs
- liver symptoms in anaemia
-Gallstones, increased bilirubin, dark urine
-Hepatomegaly, splenomegaly
-AST/ALT elevated
-Thrombosis
-Iron overload (transfusional)
-Hepatic thrombosis
-Coagulation deficit
-Altered MRI signal (Iron overload, gallstones etc)
Name the 2st example of prehepatic Jaundice, why is the Gilbert’s syndrome linked to jaundice ?
-genetic condition present in the liver
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-Mutation in Bilirubin UDP-glucuronyl transferase 1 gene
-So ELEVATED UNCONJUGATED bilirubin in blood bc the enzyme can’t conjugate it fast enough.
Would see increased fasting bilirubin/also possibly with other concurrent illness/surgery
Need to exclude haemolysis and other liver diseases
Name the 3rd example for prehepatic jaundice. and explain it.
Neonatal Jaundice
Pretty common (up to 90% of babies, more if premature)
-Delays in clearance of bilirubin from red cell breakdown
-Treated by phototherapy
-Only a concern if it persists and accompanied by pale stool/dark urine
Explain the 2nd type of Jaundice.
Intrahepatic Jaundice - due to a liver injury
Heam metabolism
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Both increased unconjugated and conjugated bilirubin in the macrophages
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Elevated AST/ALT (20x higher due to the liver)
Mild increase ALP/gGT
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Liver Disease
(Viral Hepatitis, Toxic causes)
—Jaundice due to liver injury:
-Cholestasis or interruption of bile flow as a result of damage to the liver.
-Intrahepatic mechanisms – Cancer
-Destruction of bile ductules (autoimmunity/drugs).
-Cholestasis (secondary to systemic injury, pregnancy, drug toxicity)
Name the 1st example of intrahepatic Jaundice, why is viral hepatitis linked to jaundice ?
-Viruses selectively infect hepatocytes (A-E)
-Very strong immune response causes severe hepatitis.
-The immune system then kills the infected hepatocytes.
not jaundice all the time in here
What is the treatment for sickle cell intrahepatic cholestasis ?
-Aggressive manual exchange RBC transfusion
-to reduce HbS (<30%)
-fresh plasma and Vit K(to correct INR)
Why do liver disease causes signs of deteriorating mental function ?
Liver usually clears ammonia(build up ammonia causes astrocytes in the brain to swell) from the blood. In liver disease these proteins starts to accumulate and affect brain function like personality changes, confusion, forgetfulness, disorientation, slurred speech, coma.
Explain the 3rd type of Jaundice
Post Hepatic Jaundice - due to a place downstream of the liver, maybe an obstruction to the exit of conjugated bilirubin > gallstones in the gallbladder.
Haem metabolism
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Unconjugated bilirubin
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Increased Bilirubin
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Modest increase in AST/ALT (5x)
Raised ALP/gGT(>3x)
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Obstructed bile flow (cancer, gallstones)
Obstruction of bile ducts :
Gallstones - caused by imbalance in chemical constituents of bile and leads to backflow of bile. If gallstones migrate to bile ducts, can cause obstruction, jaundice and cholangitis.
Disease of the ducts(cancer, gallstones, inflammation).
Compression of ducts (lymph nodes, pancreatic cancer, squeezing)
Explain the cancer of Pancreas
Growth obstructs the bottom of the common bile duct.
painless jaundice often with weight loss.
