Week 7 - Jaundice

Question 1

what is jaundice

Answer 1

• yellow discoloration to the skin & sclera of the eyes

Question 2

what is another word for jaundice

Answer 2

• icterus

Question 3

what causes jaundice

Answer 3

• elevated blood bilirubin ( can be unconjugated or conjugated)

Question 4

what are the 3 types of jaundice

Answer 4

• prehepatic
• hepatic
• posthepatic

Question 5

what is prehepatic jaundice

Answer 5

• jaundice caused by excessive RBC breakdown

Question 6

list 4 common causes of prehepatic jaundice

Answer 6

• hemolytic transfusion rxn
• sickle cell anemia
• autoimmune/acquired hemolysis
• hemolytic disease of the newborn

Question 7

what are the 4 characteristics of prehepatic jaundice

Answer 7

• indirect (free) hyperbilirubinemia (high unconj. bilirubin)
• no excess bilirubin in the urine
• decreased Hct
• normal colored stool

Question 8

why do you get high lvls of uncong. bilirubin in prehepatic jaundice

Answer 8

• the excessive death of RBC causes excessive breakdown Hgb
• when Hgb is broken down, you get the formation of uncong. bilirubin
• this large amt of uncong. bilirubin overwhelms the hepatocytes & they cannot work fast enough to conjugate all the bilirubin

Question 9

why is there no excess bilirubin in the urine during prehepatic jaundice? how will the urine appear?

Answer 9

• uncong. bilirubin is not water soluble = cannot go into the urine
• therefore, not getting any extra bilirubin in the urine
  = amber urine

Question 10

why do we have normal colored stools during prehepatic jaundice

Answer 10

• during prehepatic jaundice, your conjugated bilirubin isn’t being effected = still get bilirubin to the intestine
• bilirubin gives our stool its brown color
  = normal colored stool

Question 11

what is hyperbilirubinemia in the newborn

Answer 11

• by the 2nd or 3rd day of life, 60% of infants become jaundiced due to the natural breakdown fetal hgb and an immature liver that cannot handle all this uncong. bilirubin

Question 12

how long does it take for hyperbilirubinemia to resolve in newborns

Answer 12

~ a week

Question 13

how is hyperbilirubinemia of the newborn treated (3)

Answer 13

• fluids
• using bilitanks that utilize phototherapy
• exchange transfusions

Question 14

when is jaundice of the newborn serious

Answer 14

• if it happens at birth or after 1 week or more

Question 15

what can cause more serious types of newborn jaundice (5)

Answer 15

• breast feeding
• hemolytic disease (Rh+)
• hypoxia
• infection
• albumin binding drugs

Question 16

how can breast feeding cause newborn jaundice

Answer 16

• if the milk contains an Ab that destroys RBC

Question 17

what is hemolytic disease

Answer 17

• when an Rh- mother carries an Rh+ fetus

= mother creates antibodies that attack’s the fetus’ blood cells

Question 18

what is a potential consequence of hyperbilirubinema of the newborn

Answer 18

• kernicterus

= brain damage r/t bilirubin

Question 19

how does kernicterus occur?

Answer 19

• bilirubin is v toxic to the - brain
  normally, bilirubin cannot cross the blood brain barrier
• in newborns, the blood-brain barrier is weak & does not do a good job of keeping bilirubin out

Question 20

what is an exchange transfusion

Answer 20

• removal of blood while that blood is replaced with donor blood
• blood in to replace RBC
• blood out to take out bilirubin

Question 21

what is hepatic jaundiceq

Answer 21

• jaundice that involves problems with the liver, specifically the hepatocytes
  1. impaired uptake of bilirubin by the liver
  2. impaired conjugation of bilirubin

Question 22

what are the 2 most common causes of hepatic jaundice

Answer 22

• hepatitis (inflammation or infection)

- cirrhosis

Question 23

how does hepatitis & cirrhosis cause hepatic jaundice

Answer 23

• there is hepatocyte dysunfction r/t inflammation

= impaired conjugation & edema that interferes with bile secretion (intrahepatic cholestasis)

Question 24

what is hepatic jaundice characterized by (4)

Answer 24

• uncong and cong hyperbilirubinemia
• dark urine
• N or pale stool
• elevated liver-specific enzymes in blood

Question 25

why do we get both uncong and cong hyperbilirubinemia in hepatic jaundice

Answer 25

- the increased uncong would be due to impaired conjugation | - increased cong due to edema, which would block bile secretion (intrahepatic cholestasis)

Question 26

why do we get dark urine in hepatic jaundice

Answer 26

- due to the increased cong bilirubin (water soluble)

Question 27

why can we have either N or pale stool in hepatic jaundice

Answer 27

- pale if edema causes blockage of bile secretion | - N if no swelling

Question 28

why do we have increased liver-specific enzymes in the blood during hepatic jaundice

Answer 28

- liver damage & inflammation = hepatocytes lyse or become permeable = release of enzymes

Question 29

what genetic (inherited) disease can cause hepatic jaundice

Answer 29

- Gilbert's disease

Question 30

what is Gilbert's disease

Answer 30

- a genetic disease that results in diminished activity in the enzyme responsible for conjugating bilirubin - considered mostly harmless

Question 31

what does Gilbert's disease cause and how does this contribute to hepatic jaundice

Answer 31

= slowed conjugation = slight elevation in unconjugated bilirubin

Question 32

what is posthepatic jaundice

Answer 32

- jaundice that occurs when bile flow is obstructed at any point between the liver & duodenom

Question 33

describe how bile is excreted from the liver

Answer 33

- bile gets conjugated and leaves the liver via the bile duct - it then goes to the gall bladder where it is stored - then, bile is excreted from the gall bladder into the small intestine

Question 34

what is bilirubin converted into in the intestine

Answer 34

- urobilinogen | - stercobilin

Question 35

what is the fnxn stercobilin

Answer 35

- gives stool its color

Question 36

what are 3 common causes of post hepatic jaundice

Answer 36

- bile duct strictures - gall stones - tumors

Question 37

what is post hepatic jaundice characterized by (10)

Answer 37

- elevated conj bilirubin - elevated or normal unconj bilirubin - elevated blood cholestrol - dark urine - pale feces - decreased urobilinogen & stercobilin - steatorrhea - accumulation of bile salts in the blood & depositing in the skin - vitamin K defic - elevated liver enzymes ( may or may not happen)

Question 38

why do we get elevated conjugated & unconj bilirubin in post hepatic jaundice

Answer 38

- conj = due to backflow, can't get rid of conj bilirubin in the - unconj = ???

Question 39

what is the function of urobilinogen

Answer 39

- some reabsorbed back into portal circulation & returned liver - small amt released in urine

Question 40

why do we get dark colored urine in post hepatic jaundice

Answer 40

- increased conjugated bilirubin | - since the bilirubin cannot leave the bile duct, it is excreted thru the kidneys instead (???)

Question 41

why do we get pale colored feces in post hepatic jaundice

Answer 41

- due to decreased stercobilin

Question 42

why do we get steatorrhea in post hepatic jaundice

Answer 42

- bile is responsible for emulsifying fat which allows fat to be absorbed - if fat cannot be emsulified, we wont absorb it & it is lost in the feces

Question 43

what does the depositing of bile salts in the skin during post hepatic jaundice cause

Answer 43

- puritis

Question 44

why do we get vitamin K deficiency during post hepatic jaundice

Answer 44

- it is a fat soluble vitamin | - therefore, no bile = cannot emsulfy & absorb

Question 45

what are types of fat soluble vitamins

Answer 45

A, D, E, K

Question 46

what does vitamin K deficiency cause

Answer 46

= decreased clotting factor production | = abnormal bleeding