Jaundice

Question 1

How can you tell whether a jaundice is prehepatic Vs Hepatic or post hepatic?

Answer 1

PREhepatic is:
NORMAL urine 
NORMAL stools 
NO itching 
NORMAL liver tests

Question 2

What’s gleeson’s 6 step approach to hepatic/post-hepatic jaundice Ix?

Answer 2

1. imaging - rule out large duct obstruction
2. Severely injury - high transaminases, ill pt, coagulopathy, encephalopathy - all need actioning ASAP
3. ?Drug cause - stop drug
4. Another “obvious” cause - Alochol, viral hep (contact Hx, prodrome), pregnancy, HF, Ca, Occupation
5. FAST TRACK - non-invasive screen
6. Liver biopsy - specialist decision

Question 3

What drugs cause jaundice?

Answer 3

Possible drugs that will cause a biochemical profile similar to that seen in pre-hepatic jaundice, i.e. an unconjugated hyperbilirubinaemia include:
rifampicin

Possible drug-related causes of intra-hepatic jaundice include:
ethanol: cirrhosis
paracetamol, halothane, methyldopa, barbiturates

Possible drug-related causes of post-hepatic jaundice include:
isoniazid
chlorpromazine

Question 4

What causes Ascities

Answer 4

Chronic Liver disease
    -Portal vein HTN
Portal vein thrombosis
Neoplasia
Pnacreatitis
Cardiac causes

Question 5

What test do you do for ascities?

Answer 5

-Bloods: FBC, U&E, LFTs, Tumour markers
-Imaging: USS, CT
-Diagnostic Paracentesis:
Albumin levels (decreased = transudate, increased=exudate)
microscopy + cytology

Question 6

How do you manage Ascittes?

Answer 6

• Fluid + salt restriction
• Dieretics - Spironolactone +/- Furosemide W/ Weight & U&E monitoring
• Large Volume paracenetsis
• TIPSS

Question 7

What is a TIPSS?

Answer 7

• Transjugular intrahepatic portosystemic shunt
• Tx of ascities + bleeding varices
• Complication = encephalopathy due to blood bypassing the liver & not getting processed