jaundice

Question 1

what is Gilbert’s syndrome

Answer 1

isolated mild unconjugated hyperbilirubinaemia

Question 2

how to tell if there’s an obstruction in the bile ducts

Answer 2

USS
further CT and ERCP
MRI, MRCP

Question 3

Diagnostic pathway

Answer 3

History
examination
investigations - blood tests, imaging and biopsy

Question 4

jaundice history

Answer 4

pruritus, WL, pain, fevers, lethargy
due to other illness, alcohol, viral hep (IVDU, travel, blood transfusion, tattoos, sexual history), drug history and family history

Question 5

signs of CLD

Answer 5

spider naevi
palmar erythema
leuconycia
dupytren's contracture 
caput medusae
ascites
gynaecomastia 
pallor

Question 6

LFTs

Answer 6

ALT INFLAMMATION
AST
ALP CHOLESTATIC
GGT
Albumin MET FUNC
bilirubin 
INR

Question 7

Abnormal LFTs

Answer 7

NAFLD
Alcohol/drugs/hep/biliary disease
AI - hep, PBC, PSC
Haemochromatosis
Wilson disease

Question 8

other investigations

Answer 8

viral serology
AI screen
immunoglobulins
ferritin 
a-1 trypsin 
copper
caeruloplasmin 
others

Question 9

fibroscan - liver disease

Answer 9

transient elastography
measure of liver stiffness
correlates with fibrosis

Question 10

liver biopsy

Answer 10

confirm/establish diagnosis
staging
assess treatment/disease progress