14. Jaundice Flashcards Preview

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Flashcards in 14. Jaundice Deck (13)
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1
Q

What 3 steps can bilirubin metabolism be summarised into?

A

Production of unconjugated bilirubin
Conjugation of bilirubin
Excretion of bilirubin

2
Q

What is prehepatic jaundice?

A

Jaundice caused by excessive production of bilirubin

3
Q

What is hepatic jaundice?

A

Jaundice due to pathology in the liver

4
Q

What is posthepatic jaundice?

A

Jaundice caused by problems with biliary flow

5
Q

What is obstructive jaundice?

A

Jaundice caused by lack of bile flow into the gut, resulting in pale faeces and dark urine

6
Q

What is cholestatic jaundice?

A

Jaundice caused by bilirubin not flowing out the common bile duct, can be due to gallstones, ileus or common bile duct peristalsis due to certain drugs

7
Q

What is unconjugated jaundice?

A

Jaundice caused by accumulation of unconjugated bilirubin due to excessive production of unconjugated bilirubin or decreased capacity to conjugate bilirubin

8
Q

What causes increased production of bilirubin

A

Intravascular haemolysis which can be congenital- G6PD, PKD, sickle cell and thalassemia or acquired- artificial haeart valves, DIC, malaria

Extravascular haemolysis: congenital- hereditary spherocytosis and acquired- autoimmune haemolysis

9
Q

What causes decreased conjugation of bilirubin?

A

Decreased hepatocyte uptake due to contrast agents and portosystemic shunts to bypass a cirrhotic liver

Congential enzymatic problems like Gilbert’s

10
Q

What causes decreased excretion of bilirubin?

A

INVITED MD
Infection- hepatitis, ascending cholangitis, liver abscess
Neoplastic- mets, HCC, cholangiocarcinoma and pancreatic cancer
Vascular- Bud chiari syndrome
Inflammation- PBC, PSC, autoimmune hepatitis, pancreatitis
Trauma- gallstones, stricture after ERCP
Endo- intraheptic cholestasis of pregnancy
Degenerative- none
Metabolic- Wilson’s, haemachromatosis
Drugs- some drugs affect the ability of hepatocytes to excrete bilirubin- acohol, paracetamol, valproate and rifampicin. Some drugs cause biliary ileus- co amoxiclav, nitrofurantoin, OCP

11
Q

What questions should you ask in the presenting complaint in someone with jaundice?

A

Is it acute/ chronic?

Associated symptoms:
RUQ pain, nausea, vomiting, pruritus (points towards hepatitis)
Fever or diarrhoea (also hepatitis/ abscess)
Steatorrhoea, dark urine (obstructive jaundice)
Weight loss, fever, night sweats (malignancy)
Bronzed skin (haemochromatosis)
Exposure to outdoor water/ sewage (risk factor for leptospirosis)

12
Q

What should you ask in the PMHx in someone with jaundice?

A
Gallstones
Liver disease
Haemophilia
Recent blood transfusion/ surgery
Ulcerative colitis
Diabetes
Emphysema (suggests alpa 1 antitrypsin deficiency)
13
Q

What should you ask about in the social history in someone with jaundice?

A
Excessive alcohol consumption
Intravenous drug use
Unprotected sex/ multiple partners
Foreign travel
Tattoos