What is Jaundice?
- Yellow discolouration of skin and sclera
- Due to hyperbilirubinamia
- bilirubin > 50umol/L
Why is bilirubin conjugated in liver?
- to make it water soluble to be excreted into GI tract via bile
Bilirubin is the breakdown product of?
Haem
What form of bilirubin is found in faeces?
- urobilinogen
- stercobilin
How many percent of urobilinogen is reabsorbed into bloodstream and excreted in kidneys?
- 10%
What types of jaundice are there? Briefly describe each of them
- Prehepatic jaundice
- Excessive rbc breakdown - overwhelm’s liver ability to conjugate bilirubin
- High unconjugated bilirubin
- Hepatocellular jaundice
- dysfunction of hepatic cells
- mixed conjugated and unconjugated bilirubin
- Posthepatic jaundice
- Obstruction of biliary drainage
What are the causes of prehepatic jaundice?
- Haemolytic anaemia
- Gilbert’s syndrome
- Criggler-Najjar syndrome
What causes hepatocellular jaundice?
- Alcoholic liver disease
- Viral hepatitis
- Iatrogenic, e.g. medication
- Hereditary haemochromatosis
- Autoimmune hepatitis
- Primary biliary cirrhosis or primary sclerosing cholangitis
- Hepatocellular carcinoma
What causes post hepatic jaundice?
- gallstones
- cholangiocarcinoma
- strictures
- drug-induced cholestasis
- pancreatic cancer
- lymphoma
What does each of the following show
Dark-coloured urine
Bright coloured urine
- conjugated/mixed bilirubin
- unconjugated bilirubin
What Ix would you order for jaundice pt?
- LFT
- Bilirubin
- Albumin
- AST & ALT
- ALP
- Gamma GT
- Coagulation studies
- FBC & U&Es
*
When would you perform a liver screen?
- no initial cause for liver dysfunction
What liver screening would you perform for acute liver injury?
- Virus serology
- Hepatitis A,B,C,E, CMV and EBV
- Non infective markers
- Paracetemol level
- Caeruloplasmin
- ANA
- IgG
What liver screening would you perform for chronic liver injury?
- Viral serology
- Hep B&C
- Non-infective markers
- Caeruloplasmin
Ferritin and transferrin saturation
Tissue Transglutaminase antibody
Alpha-1 antitrypsin
Autoantibodies*
What imaging would you order for jaundice?
- USS abdo (first line)
- MRCP - to observe biliary tree
- liver biopsy
How would you Mx jaundice?
- treat underlying cause
- Identify and manage complications ie
- coagulopathy
- hepatic encephalopathy
- hypoglycaemia
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Bowel Presentations23
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Volvulus17
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Upper GI Cancer51
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Lower GI cancer28
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Anorectal Abcess8
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Surgical Care33
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Post Op Cx30
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Jaundice17
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Melaena8
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Hiatus Hernia13
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Anastomotic Leak11
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Other hernias18
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Incisional hernia8
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Hiatus hernia13
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Bowel Obstruction26
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Angiodysplasia11
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Colonic Ischaemia17
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Post op ileus6
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Bowel Adhesions6
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Wound dehiscence8
