Jaundice Flashcards
What are the congenital causes of intravascular haemorrhage?
Glucose-6-phosphate dehydrogenase deficiency
Pyruvate kinase deficiency
Sickle cell disease
Thalassemia
What are the acquired causes of intravascular haemorrhage?
Artificial heart valves
Blood mismatch
Disseminated intravascular haemorrhage
Malaria
Medications
What is extravascular haemolysis and why might it occur?
Extravascular haemolysis is when there is increased haemolysis in the spleen
This may be due to hereditary spherocytosis or autoimmune haemolysis
Why might be the cause of decreased conjugation be?
Reduced hepatocyte uptake - Cholecystographic contrast agents, portosystemic shunts to bypass a cirrhotic liver
Congenital enzymatic problems - Gilbert’s syndrome, Crigler-Najjar syndrome
What does steatorrhoea, dark urine pruritis suggest in the context of jaundice?
Obstruction to biliary flow
What does bronzed skin and signs of diabetes mellitus suggest in the context of jaundice?
Haemochromatosis
How can medications cause haemolysis?
Intravascular haemolysis
Autoimmune, extravascular haemolysis
Hepatitis
Cholestasis
What are reticulocytes?
Why are they important in diagnoses?
Precursor to RBCs
If bone marrow is struggling to keep up with RBC destruction then bone marrow will release these into circulation
Therefore raised reticulocytes suggests high RBC turnover
Jane is a 21-year-old female who attends her GP complaining of ‘yellow eyes’. For the past few days she has been feeling unwell with a cough and fever, but she is most distressed about the unusual colour of her eyes. She has never received blood or coagulation factors, denies any intravenous drug use, and she denies any sexual intercourse in the last 6 months.
Blood tests taken by the GP reveal: Hb 13.7 g/dL RBC 6.1 × 1012 cells/L WCC 13 × 109 cells/L Platelets 180 × 109 cells/L Total bilirubin 60 μM Conjugated bilirubin 2 μM
Markers for viral hepatitis are negative. Liver enzymes and reticulocyte count are within the normal range. A blood fillm is reported as unremarkable. A urine dipstick is normal.
Gilbert’s syndrome
What is Charcot’s triad? What does it suggest?
Febrile rigors, jaundice and right upper quadrant pain
Ascending cholangitis
What is PBC?
What is its pathology?
Primary biliary cirrhosis cholangitis
AI disease of liver characterised by T-cell mediated destruction of the biliary ducts (the autoantibodies are a secondary consequence)
9:1 ratio of females to males
What are the symptoms of PBC? (other than cirrhosis)
80% experience fatigue
70% experience itching
More severe disease leads to jaundice
What is PSC?
What is its pathology?
Primary sclerosing cholangitis
Idiopathic in origin. Although it is thought to be idiopathic in origin, it does not demonstrate a clear response to immunosupressants
Believed to be due to inflammation in the bile ducts, with consequent strictures and hardening of these ducts
What is the association of ulcerative colitis with PSC?
Approx 90% of patients with PSC have UC
but on 5% of patients UC develop PSC
Mr MacDonald is a 72-year-old gentleman referred to the surgical admissions unit by his GP. He is jaundiced and has noticed his trousers becoming looser over the past few months. He initially attributed his jaundice to excessive alcohol consumption, as he drinks 2 pints of Guinness every day before going to bed. He says that he is otherwise well, but on inspection you notice that he is severely cachectic, with the skin around his ribs and abdomen looking too big for him. Lymph nodes are palpable in his left
supraclavicular fossa, and on deep palpation of his abdomen a mass is noted in his epigastrium.
Pancreatic carcinoma
