Jaundice

Question 1

When is jaundice detectable clinically?

Answer 1

serum bilirubin >50umol/L

Question 2

What are the 3 categories of Jaundice?

Answer 2

1) haemolytic jaundice
2) congenital hyperbilirubinaemias
3) Cholestatic Jaundice

Question 3

what is the bilirubin metabolism pathway?

Answer 3

1) Haemaglobin broken down to haem
2) Haem coverted to biliverdin
3) Biliverdin to bilirubin
4) Albumin binds to bilirubin and transports it to the liver.(unconj bili is insoluble unless bound to albumin)
5) unconjugated - Bilirubin is conjugated in the liver. now it is soluble. it is excreted into the gut.
6) In the gut it is converted to urobilinogen (excreted via urine) or stercobilinogen (excreted via faeces)

Question 4

What are the pre-hepatic causes of cholestatic jaundice?

Answer 4

Haemolysis:

• sickle cell
• malaria
• thalassaemia

Question 5

What are the intra-hepatic causes of jaundice?

Answer 5

Hepatitis caused by:

• virus
• drugs
• alcohol

Other

• cirrhosis
• autoimmune cholangitis
• pregnancy
• recurrent idiopathic choelstasis

Question 6

What are the post-hepatic causes of jaundice

Answer 6

• common bile duct stone
• carcinoma (BD , head of pancreas, ampulla)
• biliary stricture
• sclerosing cholangitis
• pancreatic pseudocyst

Question 7

What are the features of jaundice?

Answer 7

• yellow skin / sclera
• pale stool
• dark urine